The first and most important activity a doctor must do when the patient comes in is to make an accurate diagnosis. This is done with a careful history, physical exam, laboratory tests, and imaging procedures. In the history, we ask questions such as:
How long have you had the symptoms?
What joints are involved?
Is it symmetrical? One side like the other
Is there a family history?
Are there other symptoms?
On physical exam, we examine a patient from the top of the head to the bottoms of the feet! We look at the skin, eyes, ears, nose, throat, internal organs, and finally the joints The goals of treatment are straightforward. They are:
Relieve pain/inflammation
Enhance quality of life
Slow disease progression
Control co-morbidity (associated diseases such as high blood pressure, diabetes, etc.)
Minimize risks of therapy
We first start with non-medicine treatment:
Social support: make sure the patients family and friends understand the problem
Education: make sure the patient understands all the things they must do themselves to get better
Weight-loss: many patients with low back pain, knee pain, and hip pain are overweight. All the medicines in the world arent going to help until weight is corrected.
Assistive devices: splints, braces, walkers, canes, etc. all may help.
Thermal modalities: ice or moist heat depending on the situation
Exercise: non impact as well as stretching and strengthening play a role.
Modification of lifestyle: sometimes habits need to change and routines need to be altered.
Medicines:
Analgesics: These help reduce pain. They dont block inflammation. Analgesics may be habit-forming or addictive. They offer the potential for side effects as well. Examples: Tylenol, Ultram, Darvocet, Percodan.
Anti-inflammatory medicines: These block inflammation and help with pain. There is the potential for side-effects including the liver, kidneys, and cardiovascular systems. Examples: Naprosyn, Motrin, Celebrex.
Disease-modifying drugs: these drugs slow down the progression of arthritis. They are used in conjunction with analgesics and anti-inflammatory medicines. Wxamples: hydroxychloroquine (Plaquenil), methotrexate, azathioprine (Imuran).
Biologic therapies: these are lasers that target the immune abnormalities found in many forms of arthritis. Examples: Enbrel, Humira, Remicade.
Specifically for arthritis related pain we also use medicines such as GABA stimulators such as gabapentin (neurontin) and pregabalin (Lyrica). Lidoderm patches also help as do topical agents such as Myorx. Sometimes injections of different types will be needed. These injections may be combinations of local anesthetics and glucocorticoid or they may consist of materials such as Botox. We have used the latter quite successfully in patients with neck and low back problems. |
