Arthritis

Shoulder

Shoulders are the work horses of the body. Some of the shoulder disorders that can occur include:

  • Athletic injuries
  • Overuse syndromes
  • Post-traumatic lesions
  • Degenerative lesions
  • Arthritis

Treatments vary by the type of injury and the condition of the patient.

Glenoid Labrum Tear

The glenoid, or socket joint of the shoulder, is surrounded by a fibrocartilaginous supporting structure called the labrum. Injuries to the tissue surrounding the shoulder socket can be caused by acute trauma or repetitive shoulder motions. Examples include falling on an outstretched arm, a direct blow to the shoulder, sudden pull or a violent overhead reach, such as occurs when trying to stop a fall or slide. Throwing athletes and weight lifters can experience tears due to repetitive shoulder motion.

Tears can be located either above (superior) or below (inferior) the middle of the glenoid socket. A SLAP lesion (superior labrum, anterior [front] to posterior [back]) is a tear of the rim above the middle of the socket that may also involve the biceps tendon.

Signs and symptoms of glenoid labrum tears include:

  • Pain, usually with overhead activities
  • Catching, locking, popping or grinding
  • Occasional night pain or pain with daily activities
  • A sense of instability in the shoulder
  • Decreased range of motion
  • Loss of strength

Treatment includes:

  • Rest
  • Cold therapy to reduce pain and inflammation
  • NSAID’s (non steroidal anti inflammatory drugs such as ibuprofen)
  • Rehabilitation program
  • Surgery to re-attach the labrum to the glenoid

Following surgery the shoulder will usually be kept in a sling for 3 or 4 weeks. More sports specific training can be done after 6 weeks, although full fitness may take 3 or 4 months.

Rotator Cuff Tear

Although there are many reasons for shoulder pain, a common problem for people over 40 years of age is a rotator cuff tear.

The rotator cuff is comprised of the muscles and tendons that surround the top of the upper arm bone – the humerus — and hold it in the shoulder joint. A sudden tear may result from a single traumatic event or develop gradually because of repetitive overhead activities. A partial tear may cause pain when the arm is lifted in a certain arc away from the body (painful arc syndrome) and a complete tear may limit the aility to raise the arm.

Signs and symptoms of rotator cuff tears are:

  • Recurrent, constant pain, particularly with overhead activities.
  • Pain at night that prevents you from sleeping on the affected side.
  • Muscle weakness, especially when attempting to lift the arm.
  • Catching and grating or cracking sounds when the arm is moved.
  • Limited motion.
  • Usually occurs in the dominant arm, which is the right shoulder for right-handed people; left shoulder for left-handed people.
  • May be triggered by a specific incident.

Most rotator cuff tears can be treated without surgery. Non-operative rotator cuff treatments may include:

  • Physical therapy
  • Anti-inflammatory pain medications
  • Cortisone injections

The goal of treatment is to reduce inflammation and strengthen the uninjured muscles around the shoulder to compensate for the torn muscles.

In the minority of patients where non-surgical treaments are not effective, surgery may be recommended. Surgery is performed to repair the torn tendons.

Shoulder Fracture

Shoulder blade fractures represent 1 percent of all broken bones. High energy blunt trauma, such as a motorcycle or car crash or falling from a significant height can fracture the shoulder blade.

Signs and symptoms for shoulder fractures include:

  • Extreme pain when you move the arm
  • Swelling around the back of the shoulder
  • Skin abrasions
  • Redness and bruising around the area
  • Bones may appear out of position

Both diagnosis and severity of a shoulder fracture can be confirmed by X-rays.

Nonsurgical treatment with a simple sling works for most fractures of the scapula or shoulder blade. The immobilization device holds your shoulder in place while the bone heals.

If you have a fracture where the bone has moved out of place significantly, or where a fracture in the neck of the scapula results in severe deformity of the bone, you may need further evaluation. In some cases, you may need surgery in which the doctor uses plates and screws to hold the bone together.

Fibromyalgia

Fibromyalgia is a disorder that causes muscle pain and fatigue.

Scientists estimate that fibromyalgia affects 5 million North Americans 18 or older. Between 80 and 90 percent of people diagnosed with fibromyalgia are women. However, men and children also can have the disorder. Most people are diagnosed during middle age.

People with certain other diseases may be more likely to have fibromyalgia. These diseases include:

  • Rheumatoid arthritis
  • Systemic lupus erythematosus (commonly called lupus)
  • Ankylosing spondylitis (spinal arthritis)

Women who have a family member with fibromyalgia may be more likely to have fibromyalgia themselves.

The causes of fibromyalgia are unknown. There may be a number of factors involved. Fibromyalgia has been linked to:

  • Stressful or traumatic events, such as car accidents
  • Repetitive injuries
  • Illness
  • Certain diseases

Fibromyalgia can also occur on its own.

Some scientists think that a gene or genes might be involved in fibromyalgia. The genes could make a person react strongly to things that other people would not find painful.

People with fibromyalgia have “tender points” on the body. Tender points are specific places on the body that hurt when pressure is put on them. They occur on the neck, shoulders, back, hips, arms, and legs.

People with fibromyalgia may also have other symptoms, such as:

  • Trouble sleeping
  • Morning stiffness
  • Headaches
  • Painful menstrual periods
  • Tingling or numbness in hands and feet
  • Problems with thinking and memory

Fibromyalgia can be hard to treat. Treatment often requires a team approach. The team may include your doctor, a physical therapist, and possibly other health care providers. A pain or rheumatology clinic can be a good place to get treatment.

There are many things you can do to feel better, including:

  • Taking medicines as prescribed
  • Getting enough sleep
  • Exercising
  • Eating well
  • Making work changes if necessary

Dermatomyositis

Dermatomyositis is one of a group of muscle diseases known as the inflammatory myopathies, which are characterized by chronic muscle inflammation accompanied by muscle weakness.

Dermatomyositis’ cardinal symptom is a skin rash that precedes, accompanies, or follows progressive muscle weakness. The rash looks patchy, with purple or red discolorations, and characteristically develops on the eyelids and on muscles used to extend or straighten joints, including knuckles, elbows, knees, and toes.

Red rashes may also occur on the face, neck, shoulders, upper chest, back, and other locations, and there may be swelling in the affected areas. The rash sometimes occurs without obvious muscle involvement.

Adults with dermatomyositis may experience:

  • Weight loss
  • A low-grade fever
  • Inflamed lungs
  • Sensitivity to light

Children and adults with dermatomyositis may develop calcium deposits, which appear as hard bumps under the skin or in the muscle (called calcinosis). Calcinosis most often occurs 1-3 years after the disease begins. These deposits are seen more often in children with dermatomyositis than in adults.

In some cases of dermatomyositis, distal muscles (muscles located away from the trunk of the body, such as those in the forearms and around the ankles and wrists) may be affected as the disease progresses.

Dermatomyositis may be associated with collagen-vascular or autoimmune diseases, such as lupus.

There is no cure for dermatomyositis, but the symptoms can be treated. Options include:

  • Medication
  • Physical therapy
  • Exercise
  • Heat therapy (including microwave and ultrasound)
  • Orthotics and assistive devices
  • Rest

The standard treatment for dermatomyositis is a corticosteroid drug, given either in pill form or intravenously. Immunosuppressant drugs, such as azathioprine and methotrexate, may reduce inflammation in people who do not respond well to prednisone. Periodic treatment using intravenous immunoglobulin can also improve recovery. Other immunosuppressive agents used to treat the inflammation associated with dermatomyositis include cyclosporine A, cyclophosphamide, and tacrolimus.

Physical therapy is usually recommended to prevent muscle atrophy and to regain muscle strength and range of motion.

Many individuals with dermatomyositis may need a topical ointment, such as topical corticosteroids, for their skin disorder. They should wear a high-protection sunscreen and protective clothing.
Surgery may be required to remove calcium deposits that cause nerve pain and recurrent infections.

Most cases of dermatomyositis respond to therapy. The disease is usually more severe and resistant to therapy in individuals with cardiac or pulmonary problems.

Scleroderma

Scleroderma is a rare and chronic condition that can affect many parts of your body including the skin, joints, blood vessels and internal organs. The word “scleroderma” means hard skin and can include skin changes and various other symptoms. Scleroderma can be either limited, affecting mainly the hands and face, or diffused, affecting the arms, legs and trunk.

The cause of scleroderma is unknown. The immune system may cause excess amounts of a protein called collagen to deposit in the skin and organs and cause thickening and hardening of the skin.

The condition affects women three to five times more often than men. It usually starts between the ages of 30 to 50, but also can affect children and the elderly.

Scleroderma can affect everyone differently. The following are some of the general symptoms associated with the condition.

Skin changes, including:

  • Hardening or thickening of your skin, particularly on your hands, arms and face, and occasionally on your trunk and legs
  • Loss of hair over the affected area
  • Change in skin color
  • Ulcers or sores on your fingers

Swelling or puffiness in your hands or feet, often occurring in the morning.

Sclerodactyly means shortening of the skin of the fingers and toes. This usually occurs after the initial swelling goes away. You may experience:

  • Skin on your fingers and toes becoming hard and shiny
  • Difficulty bending your fingers

Raynaud’s Phenomenon, a condition associated with poor blood flow to fingers and toes. Blood flow decreases because blood vessels in these areas become narrow for a short time in response to cold or emotional stress. Raynaud’s Phenomenon may cause:

  • Your fingers, toes, tips of your ears, nose or tongue to be very sensitive to cold
  • Your fingers to turn bluish or very pale
  • Your fingers to feel tingly, numb or cold

Telangiectasia, which occurs when tiny blood vessels become dilated and show through your skin. Small reddish spots may appear on your fingers, palms, face, lips and tongue. These spots are harmless and can be hidden with cosmetics.

Calcinosis, which occurs when small white calcium lumps form in or under the skin. It is caused by scleroderma and not by too much calcium in your diet. The lumps occasionally break through the skin and leak a chalky, white material. If injured, they may become infected.

Arthritis and muscle weakness, including:

  • Pain, stiffness and swelling
  • General fatigue
  • Muscle weakness, often in your upper arms or thighs

Digestive problems including poor function of your esophagus and bowels. Symptoms may include:

  • Difficulty swallowing
  • Heartburn
  • Bloating
  • Nausea or vomiting
  • Weight loss
  • Diarrhea or constipation

If the heart and lungs are affected, you may experience:

  • Shortness of breath
  • Persistent cough
  • Chest pain

Kidney problems, such as kidney failure and high blood pressure. Symptoms may include:

  • Fatigue
  • Severe headache
  • Shortness of breath
  • Trouble seeing
  • Mental confusion

If you are suffering from any of these symptoms, consult a physician as soon as you can.

There is no direct cure for scleroderma. Because the exact cause is unknown, any treatment is patient-specific and aimed at improving symptoms of the disease. For example, patients who experience Raynaud’s phenomenon may be treated with agents to increase blood flow to the fingers. Fibrosis of the skin has been treated with varying degrees of success with agents such as d-penicillamine, colchicine, PUVA, Relaxin, and cyclosporine. Because scleroderma is an autoimmune disease, one of the major pillars of treatment involves the use of immunosuppressive agents.

Individuals with limited scleroderma have a relatively positive outlook. They will usually die from another disease, not the scleroderma. Those with very widespread skin and organ involvement (systemic) have a negative prognosis. More women have scleroderma, but the disease kills more men. Following diagnosis, two-thirds of patients live at least 11 years. The higher the patient’s age at diagnosis, the more likely they are to die from the disease.

Vasculitis

Vasculitis is a general term for a group of diseases, approximately 20 different disorders, that involve inflammation in the blood vessels. Although these diseases are similar in some ways, they vary depending on which organs are affected. Blood vessels of all sizes may be affected. When blood vessels become inflamed, they can become weakened, stretch and increase in size, causing an aneurysm. At other times, they may become inflamed and narrowed, partially or completely eliminating blood supply to tissues. If other blood vessels are not able to carry blood to that area, the tissue will die.

Symptoms of vasculitis differ depending on the blood vessels involved. However, many patients with vasculitis feel sick and experience fevers, weight loss, fatigue, a rapid pulse, and a range of aches and pains that are difficult to pinpoint. In addition to these symptoms, vasculitis may affect virtually every organ system in the body, including the skin, joints, lungs, kidneys, gastrointestinal tract, blood, sinuses, nose and ears, eyes, brain and nerves.

The causes of most forms of vasculitis are unknown. However, it has been shown that the immune system plays a critical role in the tissue damage caused by vasculitis. Vasculitis also may be related to other diseases of the immune system, such as rheumatoid arthritis, systemic lupus or Sjögren’s syndrome.

Treatment depends upon the type of vasculitis and the organs affected. Such treatment usually includes medications that suppress parts of the immune system. Examples include cyclophosphamide, azathioprine, methotrexate and prednisone. These medications can cause many side effects and should be discussed in detail with your doctor.

Spondyloarthritis

Spondyloarthritis is a group of diseases that cause inflammation of the spine, joints, tendons, ligaments and surrounding areas. These conditions also can affect the eyes, gut, urinary tract, skin and sometimes the heart and lungs. Spondyloarthritis includes:

  • Ankylosing spondylitis
  • Reactive arthritis
  • Psoriatic arthritis
  • Arthritis of inflammatory bowel disease

Spondyloarthritis tends to impact those in their teens and 20s, and young men two to three times more frequently than young women. In some cases, these diseases are genetic and associated with the gene HLA-B27. They can affect every ethnic group, although they are less common in African Americans who have a lower frequency of HLA-B27. Spondyloarthritis may occur in as many as 13 percent of people with HLA-B27.

While there is no course of prevention at this time, treatment can reduce discomfort and delay the development of spinal deformities. Nonsteroidal Anti-inflammatory Drugs (NSAIDS) offer considerable symptom relief. A regular regimen of recreational activities and back exercises will improve comfort levels.

Reactive Arthritis

Reactive arthritis, formerly called Reiter’s Syndrome, typically occurs as a reaction to an infection somewhere else in the body, usually the bowel or urogenital tract. Chlamydia trachomatis is the bacteria most commonly associated with reactive arthritis of the urogenital tract. Eating foods or substances contaminated by bacteria, such as salmonella, shigella, campylobacter and yersinia, can cause intestinal reactive arthritis. In many patients, the infection is not obvious.

General symptoms of reactive arthritis usually begin about one to three weeks after an infection. The initial symptoms include joint pain and swelling, skin rashes, mouth sores, redness of the eyes, fever and weight loss. Symptoms may come and go, and may be so mild that patients do not notice them.

Arthritis of Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a group of disorders, including Crohn’s Disease and Ulcerative Colitis, that cause an inflammation of the intestines. Approximately 7 percent to 20 percent of people with IBD develop arthritis, which typically affects the large joints of the lower extremities. Men and women with IBD are affected by arthritis equally. Symptoms of arthritis usually occur at the same time a person is experiencing symptoms of IBD.

If you are suffering from any of the symptoms listed above, consult a physician as soon as you can.

Sjögrens Syndrome

Sjögren’s syndrome is an autoimmune disease in which the body’s immune system mistakenly attacks its own moisture producing glands. As a result, a person with this condition usually experiences dry eyes and a dry mouth. Sjögren’s syndrome also may cause dryness of the skin or vagina, and rarely may affect other organs, such as the lungs, kidneys, gastrointestinal tract or nervous system.

Many patients are able to treat problems symptomatically. Others are forced to cope with blurred vision, constant eye discomfort, recurrent mouth infections, swollen parotid glands, hoarseness, and difficulty in swallowing and eating. Debilitating fatigue and joint pain can seriously impair quality of life. Some patients can develop renal involvement (autoimmune tubulointerstitial nephritis) leading to proteinuria, urinary concentrating defect and distal renal tubular acidosis.

Affecting as many as four million North Americans, Sjögren’s syndrome is one of the most common of the autoimmune diseases. Nine out of 10 patients are women, and onset is typically in middle age. The cause of Sjögren’s syndrome is unknown, although heredity, infection and hormones may be contributing factors. Sjögren’s syndrome can occur by itself, called primary Sjögren’s syndrome. It also can occur with another rheumatic disease — such as rheumatoid arthritis, systemic lupusscleroderma and polymyositis-dermatomyositis — called secondary Sjögren’s syndrome.

There is neither a known cure for Sjögren’s syndrome nor a specific treatment to permanently restore gland secretion. Instead, treatment for Sjögren’s syndrome focuses on alleviating its symptoms, often with over-the-counter medications. These include non-steroidal anti-inflammatory drugs (NSAIDs), preservative-free artificial tears, artificial salivas, unscented skin lotions, saline nasal sprays and vaginal lubricants. Exercise can help lessen joint pain and build physical stamina.

Sjögren’s can damage vital organs of the body with symptoms that may plateau or worsen, but the disease does not go into remission as with other autoimmune diseases. Some people may experience only the mild symptoms of dry eyes and mouth, while others have symptoms of severe disease.

Patients with Sjögren’s syndrome have a higher rate of non-Hodgkin lymphoma compared to both patients with other autoimmune diseases and healthy people. About 5% of patients with Sjögren’s syndrome will develop some form of lymphoid malignancy. Patients with severe cases are much more likely to develop lymphomas than patients with mild or moderate cases.