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Posts Tagged ‘Joint Damage’

Firstly, it felt so good to start the Ciclosporin this morning and know that I wouldn’t have to take the Methotrexate again; the brand I have is called Neoral and although the capsules smell of hops (ie. yucky) I tolerate them sooo much better than the MTX and usually they have the added benefit of actually treating my symptoms too, whereas MTX was used to stop me from forming anti-bodies to the meds rather than therapeutically.

I was surprised to get an email from my Rheumy in the afternoon with the results of my xrays. The xrays were, in his words, ‘essentially normal’, meaning that there was no major damage evident, which is great news neck-wise. I had a feeling that the neck problem was muscular, since it has improved so much since my GP treated the spasms with Valium and neck exercises. He wants to see if my right hip settles down with the changes in my meds and the steroid injection to the right knee; if it doesn’t do so within the next couple of weeks, then the pain is possibly not due to inflammation and will need investigating further via MRI Scans.  Avascular Necrosis, which is my main worry, doesn’t show up on xrays in the initial stages so an MRI would give us a better idea of what was going on. Hopefully, I’ll see some improvement rather than it get to that stage though.

I was surprised that he had started me on quite a high dose of Ciclosporin (300mg) rather than gradually increasing the dose and I got the chance to check that out with him. He reassured me that it would be better to get to the therapeutic level as quickly as possible, plus I have always tolerated it in the past – well, until it started to effect my Kidney function, but there has been a big break since I last took it so that may help.

I have a good feeling about this combination, could this be the one to turn things around again?

I hope so!

L

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Call it what you want: Crepitus, Joint Cracking, Popping, Grinding, Crunching, Snapping, Clicking… we have all probably experienced it in at least a couple of joints, if not all.  I decided to look into things a bit more and write a post about it after noticing a definite increase in the amount of crepitus I’m experiencing myself at the moment. Unfortunately, I think I’ve ended up with more questions than answers!

Crepitus of a joint can occur in Rheumatoid and Osteo Arthritis and is defined as the sound and sensation experienced when the cartilage around the joint has eroded away, reducing the joint cavity space and causing the surfaces to grind against each other.  Most of the time it causes no pain and isn’t a sign of anything serious (but a release of gas build-up in the synovial fluid), but when it is accompanied by pain does it become a reason for concern?

In Rheumatoid Arthritis crepitus can arise when ‘inflammatory tissue invades the cartilage and bone surface and causes cartilage and bone tissue destruction’, in which case, crepitus can be considered a clinical sign of joint surface destruction. And this is what we all want to avoid. So does an increase in joint sounds signify that things need to be controlled better, or, by this point, is the damage already done?

You would think that if it was a significant symptom, it would be evaluated alongside other symptoms in clinical practice, but I know it’s not something that I have ever really discussed with my Rheumatologist, since other symptoms always seem more relevent. However, my worry is that sometimes we ignore what is right before us, the most obvious things, and I wouldn’t like this to be one of those times. If crepitus really is a signifier of joint damage and it is getting worse, then obviously I need to do something about it.

I only found minimal information on the subject in my internet research today but I’ll post links to the most useful information that I have found at the bottom of the page. Any further information anyone has would be greatly appreciated.

A couple of final things though. There were two suggestions that kept cropping up as ways to reduce crepitus (in addition to disease control) and they were:

  1. Increase your intake of Omega-3 through oily fish and supplements.
  2. Gentle, low impact exercises to help keep joints mobile – in particular swimming.

So, it looks like I’ll have to put up with the snap, crackle and popping for now.

L

Links:

Patient Guide To Joint Cracking  (Johns Hopkins Orthopaedic Dept)

Joint Popping (Washington Orthopaedics)

Joint Cracking and Popping; Understanding the Noises Associated With Articular Release. (An Osteopathy-based article but still interesting)

Painful Cracking in Joints During Exercise  (Live Strong)

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