I Have Arthritis In My Ankle. What Can I Do?

Ankle arthritis is one of the most common problems seen in a
rheumatology office. While it is a relatively small joint
complex, it is subjected to a great deal of stress because of
the weight-bearing required with standing and walking.

Throw in the need to make forward and backward movements as
well as side to side movements, it becomes clear that the stress
placed on the bones, ligaments and tendons is tremendous. And
that doesn't even account for the twisting and [pivoting motions
that are often required during a typical day.

Because of this responsibility and location, ankles are
probably injured more than any other joint complex.

Many different kinds of arthritis can affect the ankle. The
most common are osteoarthritis. Osteoarthritis is a wear and
tear type of arthritis. The cartilage that cushions the joint
begins to wear away prematurely as a result of trauma and
localized inflammation. This type of osteoarthritis that occurs
following injury is referred to as post-traumatic
osteoarthritis. A common scenario is someone who sprains their
ankle as an adolescent or young adult and then develops ankle
arthritis years later.

Rheumatoid arthritis comprises about 15 per cent of ankle
arthritis. Rheumatoid arthritis is a chronic systemic autoimmune
disease that affects virtually all joints. The chronic
inflammation leads to progressive deterioration of cartilage,
bone, and ligaments.

Other types of arthritis that can attack the ankle include
psoriatic arthritis, Reiter's disease, gout, pseudogout,
sarcoidosis, juvenile arthritis, and ankylosing spondylitis.

Treatment of ankle arthritis first consists of making the
correct diagnosis. That takes a careful history and physical
examination. Laboratory testing and imaging studies such as
x-ray, ultrasound, and magnetic resonance imaging are useful.

Treatment for mild discomfort is straightforward. Limit
activities that cause pain. That means high impact sports like
running, soccer, and basketball. If excess weight is an issue,
then weight loss is mandatory. Over-the-counter
anti-inflammatory medicines can also provide symptomatic relief.

Various ankle braces can be a lifesaver. These come in
different varieties and shapes. They can fasten using laces or
Velcro. Braces may be soft or may contain a hard synthetic
shell. It is best to consult with your rheumatologist or
orthopedist before purchasing a brace.

Orthotics are shoe inserts that tilt the ankle and relieve pain
by altering the direction of stress forces. These should be
custom-made for optimal results.

Rocker bottom shoes reduce pain with walking because they limit
the amount of motion the joint has to go through. People who
have had ankle fusion surgery 9where the joijt is fused
together) often find rocker bottom shoes helpful.

When ankle pain is severe due to inflammation and/or fluid
accumulation, then aspirating the joint with a needle and
injecting a long-acting glucocorticoid ("steroid") may be very
useful. Following a procedure like this, it is a good idea for
the patient to have their ankle braced for at least three days
to rest the joint.

Physical therapy is also an excellent adjunctive therapeutic
approach. The therapist can help the patient with different
modalities that can reduce edema (soft tissue swelling0 as well
as inflammation and also teach a patient exercises to strengthen
and stabilize the ankle so that future ankle sprains and strains
are less likely.

Patients who have severe ankle arthritis due to osteoarthritis
may benefit from viscosupplementation. This is a procedure where
a lubricant is injected into the joint. Viscosupplements have
been used successfully in many joints including the knee, hip,
and shoulder, as well as the ankle.

Surgery is an option for patients who have failed more
conservative measures. Arthroscopy, which is a procedure where a
small telescope is inserted into the ankle joint through a tiny
incision. Small instruments are used to remove loose pieces of
cartilage. This procedure can also be incorporated with
simultaneous cartilage transplant where healthy cartilage is
inserted in place of damaged cartilage at the time of the
procedure. Cartilage transplant procedures are very time
intensive and require limited weight bearing for several weeks
to months afterward.

Joint realignment is a procedure where a wedge of bone is
removed from one side of the ankle so that stress forces are
transferred to the healthy part of the ankle. While this is a
temporary fix, it is useful for some patients.

Ankle fusion is a surgical procedure where the tibia (leg bone)
is screwed to the talus (upper ankle bone). This restores
alignment and reduces pain. Unfortunately, the patient loses
about half of the plantar and dorsiflexion (toe down and toe up)
movement in the ankle. The ability to walk without pain is
restored to the ankle; however, there is more stress placed on
other weight-bearing joints such as the knee, which can lead to
the development of osteoarthritis in these joints.

Ankle replacement is an increasingly popular option. In the
past, ankle replacements weren't that effective but
technological advances have improved their success. Good
candidates for ankle replacement are those who are older than 55
years of age, in good medial condition, have their weight in the
normal range, and who don't engage in high impact activities
either at work or during their leisure time.

About The Author: Nathan Wei, MD FACP FACR is a rheumatologist
and Director of the Arthritis and Osteoporosis Center of
Maryland. He is a Clinical Assistant Professor of Medicine at
the University of Maryland School of Medicine. For more info:
http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html

What Kinds Of Physical Therapy Work For Arthritis?

Patients with arthritis in our practice are often referred to
physical therapists during the course of their management. One
question I often hear from patients when I suggest physical
therapy is, "But, why can't I do exercises at home?"

So the big misconception here is that physical therapy is just
a bunch of glorified exercise instruction. Nothing could be
further from the truth. Physical therapy plays an extremely
important role in the management of the patient with arthritis.

Before we go into the treatment modalities that physical
therapists use, let's start with exercises since they are an
integral part of treatment.

Exercises consist of stretching, strengthening, and range of
motion. In addition, as patients get older they need different
types of training such as with balance and gait. Finally, the
physical therapist in conjunction with the occupational
therapist may look into activities of daily living and suggest
some modifications that may be helpful.

But where physical therapy plays a major role is in using
different modalities to relieve pain and speed the healing
process.

Diathermy is a treatment method which delivers deep heat. It is
useful for chronic pain conditions such as deep muscle injury or
arthritis.

Precautions in regard to skin and subcutaneous tissue depth
should be attended to. For example, a person who is skinny will
require much less diathermy than an obese person. Also patients
with damage to sensory nerves probably should not receive
diathermy.

Iontophoresis (IP) is a procedure where an electric current
pushes ionically charged chemicals (ie., glucocorticoids or
steroids) through the skin to reach deeper tissues. IP can be
used for calcific tendonitis and inflammatory conditions such as
arthritis. Contraindications to use of iontophoresis include
allergy to the chemical being applied, open wounds, or
neurologic deficits that impair a person's ability to feel.

Iontophoresis also should not be used near metallic implants,
wires, or staples.

Ultrasound (US) is a type of treatment in which high-frequency
sound waves are used to "heat up" superficial soft tissues and
to help with tissue healing. Ultrasound can be used for tendon
injuries or for short-term pain relief related to muscle strain
or spasm. Contraindications of ultrasound include the use of US
directly over recently surgically manipulated nerves such as a
recent laminectomy, directly over malignant tumors, and over
joint replacements and permanent pacemakers. US should also not
be used in areas of thrombophlebitis (blood clots), near the
eyes, over the uterus, ovaries, and testicles. US also should
not be used in areas of acute inflammation, over the epiphyseal
plates of growing children, and over breast implants of any
type.

Phonophoresis (P) is the use of ultrasound to transport
therapeutic medications to subcutaneous tissues. P can be used
for inflammatory conditions such as tendonitis, arthritis, and
bursitis. The same cautions and contraindications exist as for
US.

Electrical stimulation (ES) is the process of using electrical
current to deliver a therapeutic effect by generating an action
potential in nerve tissue. This action potential leads to two
potential results. The first is a change in sensory input, ie. a
reduction in the ability to perceive pain. The second is a
muscle contraction. Low grade muscle contractions can often
relieve the severe muscle spasms that occur in association with
arthritis. ES can be used for chronic pain related to arthritis,
bursitis, or tendonitis. It is also useful for muscle spasm as
well as neuropathic or radicular pain (pain from pinched nerves
in the spine).

It has the same contraindications as US.

Low-level laser therapy- also known as cold laser- acts through
the absorption of photon radiation. This leads to changes in
cellular oxidative metabolism. Evidence indicates that levels of
inflammatory and pain mediators such as prostaglandin E2 can be
reduced with this modality. Cold laser can be used for minor
musculoskeletal pain, osteoarthritis, chronic neck and low back
conditions, and fibromyalgia.

It should be used with caution in patients with malignant
tumors or in those being treated with anticoagulants,
corticosteroids, or immunosuppressive drugs and should not be
used over the thyroid gland or over reproductive organs.

Patients and those providing the cold laser treatment should
use safety goggles to limit eye exposure to laser light.

These are only a very small portion of the many therapeutic
modalities a physical therapist has in their arsenal. In the
care of patients with arthritis, physical therapists are an
indispensable member of the team.

About The Author: Nathan Wei, MD FACP FACR is a rheumatologist
and Director of the Arthritis and Osteoporosis Center of
Maryland. He is a Clinical Assistant Professor of Medicine at
the University of Maryland School of Medicine. For more info:
http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html

Doctor. Do Rubs Work For Arthritis?

Treatments for arthritis pain vary in terms of type,
effectiveness, and mode of administration. Types of therapies
include oral analgesics, topical analgesics, oral non-steroidal
anti-inflammatory drugs (NSAIDS), topical NSAIDS, oral
narcotics, and parenteral (meaning intramuscular or intravenous)
narcotics.

As a general rule, for mild to moderate pain, narcotics should
not be used. What this means is that the non-narcotic analgesics
or NSAIDS are the drugs of choice.

The next decision to be made is, "Do I use an oral drug or will
a topical agent, a rub, work just as well?"

So how does a patient choose?

One significant measure is efficacy. Does the agent really
work?

The perception among many patients as well as physicians is
that topical agents may not be as effective as oral drugs.

A recent study looked at this issue of effectiveness and
patient preference in regards to oral versus topical NSAIDS.

Their conclusion? "In older patients with knee osteoarthritis,
treatment with either oral or topical non-steroidal
anti-inflammatory drugs (NSAIDs) had an equal effect on knee
pain after one year," according to the results of this
randomized controlled trial reported in the British Medical
Journal.

The study was conducted among patients from 26 general
practices in the United Kingdom.

Patients eligible for study participation were over the age of
50 and had a history of knee pain on most days of the month for
at least 3 months. All participants had been treated for knee
pain in the 3 years before study enrollment. Patients with a
history of peptic ulcer, significant indigestion, or kidney
problems were excluded from study participation.

There were 2 treatment groups. In 1 group, patients were
randomized to receive a recommendation for either topical or
oral ibuprofen, at a dose determined by the patient. In the
other intervention group, patient volunteers were left to decide
for themselves whether they used topical or oral ibuprofen.

The volunteers were observed for 24 months. The primary outcome
measure was the WOMAC Osteoarthritis Index questionnaire, which
was used to assess knee pain and stiffness at 1 year. The WOMAC
(Western Ontario McMaster) scale is typically used in arthritis
studies to assess quality of life issues.

282 patients were included in the randomized trial and 303
patients participated in the patient preference study. The
average age of the volunteers was 64 years, and baseline
characteristics were similar regardless of study treatment. The
mean global score on the WOMAC at baseline was 40 of a possible
100.

224 subjects in the preference study opted for topical
treatment, whereas 79 chose oral ibuprofen. Patients with more
severe or widespread pain generally selected oral therapy.

There was a modest change in WOMAC scores at 1 year, regardless
of study therapy. WOMAC pain scores at 24 months slightly
favored oral therapy, but this difference was not considered
significant.

More patients in the topical ibuprofen group experienced
significant pain at 3 months, which prompted 11% of the
volunteers receiving topical treatment to change to oral
ibuprofen.

Quality-of-life scores were similar between the oral and
topical ibuprofen groups.

There were no differences in the rate of major side effects in
the topical and oral ibuprofen groups. However, oral ibuprofen
was associated with side effects involving the respiratory tract
in 17% of participants compared to only 7% of subjects receiving
topical ibuprofen. In addition, signs of kidney malfunction
occurred more frequently in the oral ibuprofen treated patients.

Rates of changing treatment because of adverse effects were 1%
and 16% in the topical and oral ibuprofen groups, respectively.

The conclusions were:

Patients with knee pain consider topical NSAIDs effective for
mild pain but reserve oral NSAIDs for more severe or persistent
pain. Patients generally believe that topical NSAIDs do not have
adverse effects, but they will tolerate mild adverse effects
associated with oral NSAIDs.

The current study suggests that topical NSAIDs are similarly
effective to oral NSAIDs for knee pain for 1 year, and oral
NSAIDs are associated with a higher rate of adverse effects.

Dr. Martin Underwood, who was the spokesperson for the research
group conducting the study stated, "If topical NSAIDs are as
effective as oral NSAIDs for reducing knee pain but produce
fewer adverse effects, then topical treatment might be
preferred."

In our practice, we have found that topical agents are
generally useful for patients with mild to moderate localized
pain. However, if a patient has generalized pain, it makes no
sense for them to slather a goo all over themselves.

A big bugaboo though with oral NSAIDS are the potential side
effects, particularly in older patients.

One area not explored in the study was the use of pain patches.
Lidoderm, which is a patch containing lidocaine, has been found
to be helpful for some patients with arthritis, although an FDA
approval has not yet been secured for this indication.

Newer NSAID patches containing diclofenac will also be
available soon and these look very promising for local
arthritis-related pain.

As far as topical agents that don't contain NSAID, my favorite
is Myorx which contains Omega-3 fatty acids. This helps provide
anti-inflammatory effect without the potential problems
associated with NSAIDS. For more information about Myorx, you
can visit http://www.aocm.org or call the Arthritis and
Osteoporosis Center of Maryland at (301) 694-5800.

About The Author: Nathan Wei, MD FACP FACR is a rheumatologist
and Director of the Arthritis and Osteoporosis Center of
Maryland. He is a Clinical Assistant Professor of Medicine at
the University of Maryland School of Medicine. For more info:
http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html

How The Law Of Attraction Has Helped Me With Arthritis

I had been diagnosed with Arthritis about 5 years ago. I was
only 52 at the time and I was thinking how debilitating this
decease can be. I was wondering how I could get around in about
10 more years? Would I have to be a burden for my family? The
doctor prescribed the usual medication for persons who are
suffering from Arthritis. Some of the medication I have heard
caused a few people to die. When I talked to my doctor about
this he told me that he never had a patient who had died from
certain medications. Well I was hurting and so I started to take
medication for Arthritis for about 2 weeks when I came down with
a severe bronchitis. I stopped taking the medication
immediately. Then I heard about the Law of Attraction and I was
watching the "Secret". I also have bought some books on the same
subject. I started meditation and affirmations, I left a very
restrictive religion and I was changing the way I was thinking.
I felt appreciation for each and every day that I lived. I was
in pains everyday but I tried not to focus on my pain or even
talk about it. I tried to ignore it which was really hard.

I used to love to do yard work and I had beautiful flower beds
that had been neglected since I came down with this painful
condition. Every year I was thinking maybe next year I can go
back outside and do what I used to do. In my mind I was trying
to rearrange my flower beds and I was even drawing pictures of
how I wanted them to look. My family supported me in these
efforts as they too used the Law of Attraction for their own
goals.

Well I did not take any of the prescribed medications and I did
make my doctor mad. I took my vitamins and tried to enjoy a
healthy diet rich in fruits and vegetables, I did my meditations
and affirmations and I focused on a happy and exciting future. I
felt every day how it feels to have a wonderful live, I was
determined not to let anybody make me feel bad. I never talked
to others much about my health condition.

Healing is a process it does not always come overnight. But I
am here to tell you that I have been able this year to arrange
and work in my flower beds exactly the way I wanted to for the
first time again. Lately I have noticed quiet a difference in
the way I feel and in the way I can manage my pains. I am
amazed, it's true I am still having arthritis but it has become
so much better! There has been a big improvement! I will
continue to live in harmony with the knowledge about the Law of
Attraction and how it really works.

I am telling you this story to let you know that there is hope
even if you are experiencing health problems. What you think and
how you feel can make all the difference. The knowledge about
the Law of Attraction is the key to take the first steps to
posses a better health!

Read more about the Law of Attraction and how other people have
been able to get well despite severe health problems. Take
heart! You are not powerless and you do not always have to
depend on expensive medicines to improve your health. Apply the
power of the Law of Attraction in your life and become well!

About The Author: Please visit
Http://www.LifeResourceCenter.net for more information

I Have Rheumatoid Arthritis And Have Heard About Golimumab. What Is It?

Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune
disease for which there is no current cure. However, the advent
of biologic therapy has made it possible to induce remission in
the majority of patients.

However, in order to effect remission, research suggests that a
critical therapeutic window may exist within the first two years
of disease onset when the rate of x-ray progression of the
disease- which correlates directly with potential disability-
can be slowed. X-ray changes occur within two years of disease
onset in 50-70 percent of RA patients.

Many experts have suggested control of disease progression
should start early to limit joint damage in RA. RA is associated
with substantial disability and economic losses.

Most studies have shown that a combination of methotrexate and
TNF-inhibitors work effectively to slow x-ray progression and
improve daily functioning. TNF-inhibors include drugs such as
etanercept (Enbrel), infliximab (Remicade), and adalimumab
(Humira). A second generation of biologics has become available
for use in patients who fail first line treatment. These include
drugs such as abatacept (Orencia) and rituximab (Rituxan).

Newer biologic drugs are currently under study. One such drug
is golimumab. Golimumab (Centocor, Schering-Plough) is a
fully-human TNF-inhibitor monoclonal antibody that targets and
neutralizes both the soluble and the membrane-bound form of
TNF-alpha. Golimumab is being investigated for administration by
subcutaneous (SC) injection and intravenous (IV) infusion.

In RA clinical trials in the U.S., patient responses to
treatment are measured using the American College of
Rheumatology (ACR) response of 20% (ACR 20), 40% (ACR 50), and
70% (ACR 70). In other words, if a patient has a 20 percent
response to treatment, they have an ACR 20 response. If they
have a 50 percent response to treatment they have reached ACR
50… and so on. The greater the number of patients reaching a
higher ACR level the more effective the treatment.

The greater the number of patients responding at a given ACR
level, the better the drug.

For instance, a drug that gives an ACR 70 response of 40
percent is much better than a drug that gives an ACR 70 response
of 20 percent.

According to new findings presented from a double-blind,
placebo-controlled, dose-ranging Phase 2 study, nearly 75
percent of patients with moderately to severely active
rheumatoid arthritis (RA) receiving golimumab (CNTO 148) and
methotrexate experienced at least 20 percent improvement in
arthritis symptoms (ACR 20) at one year.

Investigators also reported that more than one-third of
patients treated with golimumab and methotrexate achieved
remission at one year.

In this preliminary study of the effects of golimumab in RA,
172 adults with active RA for at least three months' duration
despite methotrexate therapy were randomized to one of five
treatment groups: placebo every two weeks or golimumab 50 or 100
mg every two weeks or every four weeks.

All patients received stable doses of methotrexate of at least
10 mg/week. At week 16, 62 percent, 31 percent and 12 percent of
all patients receiving golimumab (combined golimumab treatment
groups) plus methotrexate experienced ACR 20, ACR 50 and ACR 70
improvements, respectively, compared with 37 percent, 6 percent
and zero percent of patients receiving placebo plus
methotrexate, respectively.

At week 52 of the study, ACR 20, ACR 50 and ACR 70 scores
improved to 74 percent, 45 percent and 22 percent respectively,
among patients receiving golimumab plus methotrexate (combined
golimumab treatment groups). Moreover, patients receiving 50 mg
every two weeks and 100 mg every two weeks maintained efficacy
through week 52, even after converting to every four weeks
administration at week 20.

Patients receiving golimumab plus methotrexate also achieved
remission, as assessed by the abbreviated disease activity scale
(DAS 28), which measures tender and swollen joints, inflammation
and overall disease activity including measurement of
erythrocyte sedimentation rate (ESR). A DAS 28 of less than 2.6
indicates remission.

After 16 weeks of treatment, 27 percent of patients in the
golimumab (combined golimumab treatment groups) plus
methotrexate group achieved remission as assessed by DAS28 (DAS
< 2.6) compared with six percent of patients receiving placebo
plus methotrexate. Similar remission rates were reported at week
52, with 34 percent of patients receiving golimumab plus
methotrexate achieving remission at that time point. All of
these results were statistically significant.

Golimumab was generally well tolerated in the study through
week 52. Serious adverse events (AEs) reported were eight
percent for the combined golimumab groups compared with six
percent for the placebo group. No deaths, cases of tuberculosis
or other opportunistic infections were reported through 52
weeks, and serious infections were uncommon. The most common
clinically relevant serious AEs through week 52 were pneumonia
(three patients), lung cancer (one patient), cardiac tamponade
(one patient), and cardiac failure (one patient). One patient
died from coronary artery disease approximately four months
after completing 52 weeks of the study.

While these adverse events appear serious (and they are), they
are not worse than what is usually seen in clinical trials
involving RA. RA is not a benign disease and patients will
develop medical problems that are not necessarily related to the
medication being studied. However, all adverse events have to be
reported.

The results from this early (phase 2) study shows promise.
Through the development of new drugs and through the further
investigation of mechanisms of disease, a cure for RA will be
found, hopefully, in the now too distant future.

About The Author: Nathan Wei, MD FACP FACR is a rheumatologist
and Director of the Arthritis and Osteoporosis Center of
Maryland. He is a Clinical Assistant Professor of Medicine at
the University of Maryland School of Medicine. For more info:
http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html

What Is Degenerative Arthritis?

Everyday people are diagnosed with one of 100 different types of arthritis. Some people even have more than one type of arthritis at the same time. This family of illnesses includes degenerative arthritis, rheumatoid arthritis and psoriatic arthritis. Learning the difference between the diseases can help a patient get the right treatment plan.

Causes And Symptoms Of Degenerative Arthritis

Many of the diseases in this family of illnesses can have very similar symptoms. Degenerative arthritis is also known as osteoarthritis, and is one of the most common arthritis's diagnosed everyday. Symptoms of degenerative arthritis include, joint pain and swelling and range of motion within the joint becoming limited.

Degenerative arthritis is caused when the cartilage around the joints disintegrates. This then causes the chain reaction of bone spurs to develop, making the joints extremely painful. Degenerative arthritis becomes more common as people age, and is one of the most common forms of arthritis diagnosed.

As this is a common disease as we age, if a younger person is diagnosed with degenerative arthritis, or has this disease in their shoulder or ankle additional tests to determine if the patient has another disease called hemochromatosis should be run. This disease is caused by too much iron in the blood, and can cause severe damage to organs and joints. There is treatment for this condition that should be started immediately.

Treatment For Degenerative Arthritis

One of the best things a patient with degenerative arthritis can do for themselves to assist with this disease is to maintain a proper weight. Additional weight puts stress on the joints; and makes degenerative arthritis even more painful. Finding an exercise routine that works for the patient is an important treatment plan. Low impact exercise is determined to be the best; by again, keeping impact off the joints. Walking, swimming and even Tai Chi are all good choices for this form of arthritis.

There are medications that can be given in the treatment of this arthritis. These can vary from patient to patients and may include steroids to treat swelling, acetametaphine is also sometimes recommended too. A patient needs to speak with a doctor to discover which types of medication will be recommended.

Degenerative arthritis is a painful disease that affects millions of people. Keeping track of symptoms can help a patient discover if this is the arthritis that they have. Talk to your doctor about any joint pain to begin treatment and help prevent further destruction of the joint cartilage.

John Hilaire offers expert advice and great tips regarding all aspects concerning arthritis herbal remedy,natural remedies for arthritis. Get the information you are seeking by visiting http://www.naturalremediesforarthritis.org