Innovative Technologies …
The best management for arthritis first identifies what type of arthritis it is and to stage this. In evaluating patients, different imaging tools are used. Conventional x-rays are not always that helpful because they do not show early changes of arthritis damage.
Musculoskeletal ultrasound and MRI provide a more accurate and early diagnosis of arthritis.
Musculoskeletal ultrasound imaging has become an important diagnostic tool to differentiate different types of arthritis and stage the severity of disease. Common types of arthritis, like osteoarthritis, rheumatoid arthritis, gout and pseudogout arthritis, can be diagnosed and staged.
Ultrasound can aid in the ability to more accurately remove fluid from a joint. We know where the tip of the needle needs to be placed and can see the fluid as it is being removed. And to more accurately place medication when it needs to be injected. The use of musculoskeletal ultrasound is also used to examine structures around joints such as tendons, bursa and ligaments. Musculoskeletal ultrasound is very safe and does not involve any x-ray radiation.
MRI technology has become an important tool for the diagnosis and staging of many types of arthritis. This technology offers more sensitivity to visualizing early changes in and around joint structures. The presence of these early changes will often guide and direct different treatments that may help to treat the patient earlier and prevent further damage. (See photos.)
Ultrasound has been used for many years in examining many areas of the body such as the gallbladder or the circulation for blood clots.
Musculoskeletal ultrasound is useful in examining inflammation around joints as well. This has been shown to improve the physician’s skills of examining joints for signs of joint damage that may not be felt by examination or seen on an x-ray.
Ultrasound can also guide in the placement of the needle during aspiration to remove joint fluid much like a GPS . We precisely know where to place the tip of the needle.
The applications of ultrasound in rheumatology are expanding in many areas to examine other structures such as tendons, bursa, and ligaments because it is safe and very accurate.
We can now diagnose many types of arthritis such as Osteoarthritis, Rheumatoid and Gout at a much earlier stage and initiate treatment and provide better care.
Bone mineral density (BMD) testing uses a special machine (DEXA) to measure one’s bone density to determine if a patient is at risk for fracture and osteoporosis. This is a painless test that takes about 15-20 minutes to perform. Images of the spine, hip and forearm are measured. A FRAX calculation is measured which more accurately determines a patient’s risk for fracture.
DECT scanning is now available to help diagnose and stage patients who have moderate and severe gouty arthritis. X-rays will often not image the presence of uric acid in and around joint structures as sensitively as a DECT scan. DECT scanning involves the use of two CAT scans and provides a very accurate assessment of the presence of uric acid in and around joints in a colorful presentation. This information can better quantify the burden of uric acid in and around joints and thus help to guide management.
Osteoporosis is a common disease of bone loss which often occurs in postmenopausal women. One in two women over the age of 50 will have either a hip ,spine or wrist fracture
Men over the age of 60 are also at increased risk.
Some medications thin bone. These include corticosteroids (prednisone), Dilantin, Heparin, PPI (medicines that treat heartburn and indigestion), SSRI (medications treat anxiety and depression), and testosterone lowering medications used to treat prostate cancer (Lupron).
Some intestinal conditions block the absorption of vitamin D and calcium in the small intestine. This includes lactose intolerance, celiac and Crohn’s disease.
Low bone mass and osteoporosis can lead to fractures often of the spine and hip. The impact of having a severe fracture can be life changing for not only the patient but their family. Many times, patients will no longer be able to adequately care for themselves in their home and find themselves moving to an extended care facility.
The treatment for patients with low bone mass and osteoporosis includes taking adequate amounts of calcium and vitamin D.
The following oral medications are alendronate, risedronate and ibandronate. Side effects of these meds may be indigestion and digestion problems. An important alternative are injectable and intravenous medicines.
See the medication site.
Osteoarthritis, as it is often referred to as degenerative arthritis, is the most common of all arthritic conditions. This affects about 1 in 4 adults. The cause of osteoarthritis is not known. What occurs is that the cartilage or ‘shock absorber’ in the joint, which protects the bones, breaks down and leads to pain and stiffness and often significant immobility. The symptoms are related to where the arthritis occurs. For example, the cervical spine in the neck, patients may have a burning and radiating pain to their shoulder and arm. This is often referred to as a pinched nerve.