| The first and most important activity a doctor | | | | stretching and strengthening play a role.o |
| must do when the patient comes in is to make | | | | Modification of lifestyle: sometimes habits need to |
| an accurate diagnosis. This is done with a careful | | | | change and routines need to be altered. |
| history, physical exam, laboratory tests, and | | | | Medicines:o Analgesics: These help reduce pain. |
| imaging procedures. | | | | They don't block inflammation. Analgesics may be |
| In the history, we ask questions such as:o How | | | | habit-forming or addictive. They offer the |
| long have you had the symptoms?o What joints | | | | potential for side effects as well. Examples: |
| are involved?o Is it symmetrical? One side like the | | | | Tylenol, Ultram, Darvocet, Percodan.o |
| othero Is there a family history?o Are there | | | | Anti-inflammatory medicines: These block |
| other symptoms? | | | | inflammation and help with pain. There is the |
| On physical exam, we examine a patient from | | | | potential for side-effects including the liver, |
| the top of the head to the bottoms of the feet! | | | | kidneys, and cardiovascular systems. Examples: |
| We look at the skin, eyes, ears, nose, throat, | | | | Naprosyn, Motrin, Celebrex.o Disease-modifying |
| internal organs, and finally the joints | | | | drugs: these drugs slow down the progression of |
| The goals of treatment are straightforward. They | | | | arthritis. They are used in conjunction with |
| are:o Relieve pain/inflammationo Enhance quality | | | | analgesics and anti-inflammatory medicines. |
| of lifeo Slow disease progressiono Control | | | | Wxamples: hydroxychloroquine (Plaquenil), |
| co-morbidity (associated diseases such as high | | | | methotrexate, azathioprine (Imuran).o Biologic |
| blood pressure, diabetes, etc.)o Minimize risks of | | | | therapies: these are lasers that target the |
| therapy | | | | immune abnormalities found in many forms of |
| We first start with non-medicine treatment:o | | | | arthritis. Examples: Enbrel, Humira, Remicade. |
| Social support: make sure the patient's family and | | | | Specifically for arthritis related pain we also use |
| friends understand the problemo Education: make | | | | medicines such as GABA stimulators such as |
| sure the patient understands all the things they | | | | gabapentin (neurontin) and pregabalin (Lyrica). |
| must do themselves to get bettero Weight-loss: | | | | Lidoderm patches also help as do topical agents |
| many patients with low back pain, knee pain, and | | | | such as Myorx. |
| hip pain are overweight. All the medicines in the | | | | Sometimes injections of different types will be |
| world aren't going to help until weight is | | | | needed. These injections may be combinations of |
| corrected.o Assistive devices: splints, braces, | | | | local anesthetics and glucocorticoid or they may |
| walkers, canes, etc. all may help.o Thermal | | | | consist of materials such as Botox. We have used |
| modalities: ice or moist heat depending on the | | | | the latter quite successfully in patients with neck |
| situationo Exercise: non impact as well as | | | | and low back problems. |