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Posts Tagged ‘Rheumatoid Arthritis’

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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I know at times I am, and never more so than when I started to look into things more for writing the Still’s Disease section of this blog.   It seems that I’m not the only one either, as a brief exchange between tweeters proved earlier today, prompting me to write this.

The main issue seems to be a confusion around its relationship to other conditions. Questions that arose were:

  • Is Still’s disease the same as JIA?
  • If you are diagnosed with Still’s Disease as a child, does this diagnosis change to RA in adulthood?
  • Is there a difference between Still’s Disease in adults and children?

I can try and answer, but as always I am using only my own knowledge / resources and obviously, I’m not a doctor.

Still’s Disease seems to be interchangeable with the term Systemic Juvenile Idiopathic Arthritis and it’s true that it was first described in children.  However, it is not simply a juvenile form of RA, the systemic features can often be more apparent than the joint issues. I know this is often the case for me – Mainly, I have fevers that peak at various times of the day, a rash that thankfully comes and goes (I’ve posted a couple of pictures here), enlarged glands, enlarged spleen and liver, tachycardia, the dreaded sore throat and swallowing problems, episodes of Pericarditis and then the funky bloodwork. I’ve also experienced degrees of Liver and Kidney damage in the past, although thankfully it has all been reversible. 

These things usually appear first in each flare-up and then the joint issues follow alongside, often quite acutely, but not everyone is the same.  There have been times when I’ve had to be admitted into hospital purely for the systemic symptoms, without any obvious joint involvement; on the other hand, I had surgery on my right shoulder when I was otherwise well.

So if a child presents with such striking systemic symptoms alongside joint pain and swelling, they are likely to be given a diagnosis of Still’s Disease or Systemic Juvenile Idiopathic Arthritis.  If an adult were to present with these symptoms, they would receive a diagnosis of Adult-Onset Still’s Disease; this is where the term sJIA becomes redundant (Adult-Onset Systemic Juvenile Idiopathic Athritis anyone?) and why I think we should stick to the term Still’s Disease. 

Similarly, a child with Still’s Disease can grow into an adult with Still’s Disease, with the symptoms remaining the same.  Perhaps for some, the systemic symptoms subside and their diagnosis is changed to Rheumatoid Arthritis, but in my own experience the diagnosis has stuck.  My Rheumatologist also makes a distinction between Still’s Disease and Rheumatoid Arthritis and their similar, but separate, treatment. For example, Anakinra is a drug no longer prescribed for RA but has proven to be particularly successful in the treatment of Still’s Disease, and, when recently discussing the success rate of my current treatment Orencia (73% improvement for people with RA), I was reminded that this did not apply to me directly as a Still’s patient. 

Although part of the same family of disease and sharing many symptoms, the two are separate – the best way I can describe it is similar to the difference between Lupus and RA.  Unfortunately (for us at least), Still’s Disease is not widely known like Lupus and even people who recognise terms such as JIA, RA, sJRA and so forth, may not understand the distinction and/or similarities between those and Still’s Disease.  This makes it very hard to try and get information and support as someone who is newly diagnosed, and for the rest of us to try and raise a bit of awareness.

Perhaps we need to stop the interchangeable name and stick to one recognisable term to clarify things and reduce confusion?

L

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I just received this article  in my inbox.

Basically it says that approval has been taken away for the use of Abatacept / Orencia in the UK as a treatment for RA and even goes on to say that:

 ‘patients currently receiving abatacept for treating rheumatoid arthritis should be allowed to continue therapy until they and their clinicians consider it appropriate to stop.’

I was supposed to be starting this next Thursday. I have been waiting since January for funding approval etc and only got it this month, now it could all have been for nothing and I might have to go through the same again to get funding for another drug…

Maybe I’m jumping to conclusions and should wait to see what the hospital says, if anything – there could be a loop hole since my diagnosis is Still’s Disease, not RA.

Still feel a bit disheartened though,

*sigh*

L

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We all know that Corticosteroid Therapy can be very efficient in the treatment of inflammation and disease activity in Still’s Disease and Rheumatoid Arthritis; in fact I’m not sure I know of anything that gets symptoms under control quite as quickly.  But of course, they come with a long list of worrying side effects that makes their use debateable:

List of Side Effects.

In much of the literature I have come across, it seems to be a popular view that steroid treatment is riskier than I have sometimes been led to believe.  One article in particular, from the Journal of Rheumatology suggests that ‘even exposures of less than 5 mg a day may be associated with potentially severe outcomes; as for exposure to long-term treatment or higher doses… well I’ll let you read that for yourself. 

The article doesn’t deny that sometimes drugs like Prednisolone need to be used, especially in ‘the most afflicted’ patients, (and I wonder if Still’s Disease, with its many systemic symptoms and organ involvement, automatically applies here), but what it does suggest is that doctors and patients need to be better informed when weighing the risks and the benefits and that perhaps more research into this is needed.

However, this is only one article and one perspective.  It is more difficult to find information supporting the benefits of steroid treatment but maybe these are just taken as gospel. I did find an article on a website called Arthritistoday from December 2010 that suggests there could be a turnabout in such opinions, citing two current studies.  The main points that are raised here are that:

1)      Corticosteroids are less toxic than many of the DMARD alternatives, which can also have both acute and long-term side effects, including organ damage.

2)      They do modify disease activity and slow down the progress of joint damage.

3)      There is a chance that corticosteroids protect against large B-cell Lymphomas, of which there is an increased risk of in patients with Rheumatoid Arthritis.

The article goes on to conclude that steroids ‘are still some of the most powerful and essential drugs in use today, with side effects that need to be managed’.

So I guess what this means is that we shouldn’t disregard the use of Steroid treatment altogether, but should stay as informed as possible, so as to be in the position to weigh up the risks and benefits, by discussing any concerns with our consultants.  Hopefully, they too will be weighing up the right factors in making their treatment decisions (it is their job after all).  We also need to make sure that they are never the first line in treatment, in order to keep the dosage/usage to a minimum, and to manage any potential side effects as an when they are experienced.

I think I will need to look into this further at some point.

L

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