Polyarthritis/ R.A/ Psoriatic/ Gout/Reactive Arthritis

POLYARTHRITIS/ PSORIATIC ARTHRITIS/ REACTIVE ARTHRITIS/ ANKYLOSING SPONDYLITIS/ ENTEROPATHIC ARTHRITIS

Polyarthritis- is a progressive joint disorder that causing pain, discomfort and movement restriction of joints in various parts of the body. When five or more joints are affected by arthritis the condition is termed as Polyarthritis. Severe medical conditions such as cancer, still’s disease, chikungunya or parvovirus affected patient can develop polyarthritis condition.

The doctor checks the affected joints for pain, tenderness, swelling and record the medical history and conducts various blood tests and X-rays or an ultrasound of the joints. Conventional medical treatment for polyarthritis involves reducing symptoms and inflammations through non-steroidal anti-inflammatory drugs, corticosteroids, Hydroxychloroquine, Methotrexate, Leflunamide, other Disease-modifying anti-rheumatic drugs, anti-TNF drugs and over-the-counter medications.

Rheumatoid Arthritis - Click Here To Read More...

Psoriatic arthritis- is a chronic arthritis condition developed in patients having a skin disorder called as psoriasis. Psoriasis is the formations of red patches on skin top with silvery scales. Psoriatic arthritis caused pain, stiffness and swelling of the joints, fingers and toes, foot pain and lower back pain. The condition is developed when body's immune system is altered causing inflammation in the joints and overproduction of skin cells. Both genetic and environmental factors play a role in the development of psoriatic arthritis. Viral or bacterial infection may trigger psoriatic arthritis in people with an inherited tendency.

During the physical exam, the doctor examines the joints for swelling or tenderness, pitting, flaking and other abnormalities on fingertips and soles of the feet. Conventional treatment methods aim on controlling inflammation and to prevent joint disability. These include medications (Immunosuppressants) to reduce the symptoms of psoriatic arthritis, Steroid injections and joint replacement surgery for severe damage by psoriatic arthritis.

Reactive arthritis- is a condition that is triggered by an infection in any part of the body causing joint pain and swelling. The condition mostly affects the intestines, genitals or urinary tract, knees and the joints of the ankles and feet with pain and stiffness in the knees, ankles and feet, eye inflammation, urinary problems, skin problems and low back pain.

Ankylosing Spondylitis (AS)- is a chronic (long-term) type of inflammatory arthritis that causes stiffness and pain in the back. Spondylitis refers to inflammation of the spine and ankylosing refers to the fusion of two bones into one. Chronic inflammation in the spine leads to it becoming stiff and inflexible. It could cause restricted breathing in later stages.

Enteropathic Arthritis (EA)- may develop in those patients who suffer from Inflammatory Bowel Disease (IBD) like Ulcerative Colitis or Crohn’s disease. It may usually affect the lower limb joints and the spine but any joint can become involved. It may also lead to debilitating and severe body aches similar to fibromyalgia. The specific symptoms of EA vary and not all people who have an inflammatory bowel disease will get EA. It is part of seronegative spondyloarthropathies that include psoriatic arthritis, ankylosing spondylitis and reactive arthritis.

Conventional Treatments- The doctor investigates the symptoms in the spine and affected joints and tailors a treatment plan accordingly. Conventional treatment method aims to manage the symptoms and treat any infection present in the body. Medications include antibiotic, nonsteroidal anti-inflammatory drugs which may include steroids. A physical therapist provides instructions and training with targeted exercises for the joints and muscles to increase the joint's support and flexibility and to reduce stiffness.

ALTERNATIVE TREATMENT METHODS AT BETH YEHUWDAH ARTHRITIS/SPINE CENTRE & DAYSTAR CLINIC

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Low Dose Steroid Infilteration/ Neural & Soft Tissue Infilteration Therapy (NESTIT)

We offer alternative treatment techniques to treat various severe conditions caused by the inflammation of the lining if the joints. These treatments are not meant to replace (however it may reduce dependence on) DMARDS (Disease Modifying Anti Rheumatoid drugs) given to patients with Polyarthritis. Alternative treatment techniques includes:

Steroid tablets and injections of the group Corticosteroids, (which are very different from Anabolic steroids misused by some athletes) have been repeatedly proven medically for the last 70 years in the successful treatment of inflammatory conditions due to its potent anti-inflammatory effect. Though corticosteroids are very effective in reducing inflammation, they carry numerous potential side effects, which are undesirable. To circumvent this problem, and in order to utilize the potent anti-inflammatory effects of steroid injections, at the same time taking appropriate measures to considerably lower its side-effects, Dr Tejaz Koshy John in 2010 while working as an Orthopaedician in his private clinic in Guyana, South America developed NESTIT. NESTIT stands for (Juxta) Neural and Soft Tissue Infilteration Therapy. It consists of injecting small amounts of diluted anti inflammatory steroid solution indirectly near (juxta) nerve CCPs- (chronic constricting points) in the lower back/ hip/ neck/ shoulder regions, in order to reduce juxtaneural and perineural inflammation, as well as in certain soft tissue sites including but not limited to trigger points (painful muscle “knots”)/ myofascial syndrome and/or enthesitis (inflammation of soft tissue-bone junctions) and/or sites of nerve inflammation (neuritis/ radiculitis) and/or bursitis (inflammation of fluid filled cushions called bursa) and/or additional sites causing pain referrals (referred pain) to distant sites; in order to obtain a reduction in inflammation and pain in the concerned joint/ region/ limb. It is preferably given for those patients who have Rheumatoid Arthritis, Inflammatory Arthritis, Synovitis, Inflammatory Low Back Pain, Spondyloarthropathy & Nerve and Nerve root irritation. It is not a substitute for DMARDS (Disease modifying anti rheumatoid drugs), however when given with low dose DMARDS, in Dr Tejaz John’s clinical experience it may result in significant reduction of local inflammation, pain and improvement of joint function in most cases, also indirectly reducing side effects of high dose DMARDS.

NESTIT involves 

1. Administeration of low dose local steroid via infilterative type of injection technique rather than giving oral steroids (as cumulative daily dosage of oral steroids over a 6 week period could exceed the dose of local steroid injection by almost 5 to 10 times) or conventional single injection into joints directly.
2. Reduce the dosage of Steroid given via injection and the use of a sliding scale according to patient’s body weight and height to regulate dosage. A 40 kg woman of 4 feet 9 inches should not receive the same dosage as a 100 kg male of 6 feet height.
3. Dilute the low dose steroid injection upto 80% with sterile water and local anesthetic.
4. Administer relatively insoluble low dose steroid via multiple infilterations locally in inflamed tissues in very small amounts indirectly near (juxta) nerve CCPs- (chronic constricting points) in the lower back/ hip/ neck/ shoulder regions as per requirement, in order to reduce juxtaneural and perineural inflammation, as well as in certain soft tissue sites including but not limited to trigger points (painful muscle “knots”)/ myofascial syndrome and/or enthesitis (inflammation of soft tissue-bone junctions) and/or sites of nerve inflammation (neuritis/ radiculitis) and/or bursitis (inflammation of fluid filled cushions called bursa) and/or additional sites causing pain referrals (referred pain) to distant sites; in order to obtain a reduction in inflammation and pain in the concerned joint/ region/ limb.
5. Identification of high risk patients and risk stratification to reduce possibility of side effects, for eg. Patients suffering from serious heart & liver conditions tuberculosis, infections, significant osteoporosis, immuno-compromised patients, menstrual irregularities, already having Cushing’s syndrome, ongoing significant hair loss etc.
6. Regular monitoring of body weight and physical appearance for early detection of Cushingoid features, if it occurs (rarely), to delay/ avoid further injections.
7. Control of High Blood Pressure and Diabetes prior to giving injections.
8. Doing skin sensitivity tests to rule out allergic reactions to the drugs.
9. Explaining possibilities of common & rare side effects to the patient and taking precautions regarding other common side effects wherever possible.
10. Opting for/ Shifting to regenerative treatments like Platelet Rich Plasma and Dextrose Prolotherapy wherever there is secondary degenerative disease / soft tissue damage, once the severe inflammation subsides.

In Dr Tejaz John’s clinical experience, the patient benefits of Low Dose Steroid Infilteration/ Neural & Soft Tissue Infilteration Therapy (NESTIT) treatment are:

• Minimally invasive treatment method
• Almost painless injection technique using very thin needles under local anesthesia
• Avoid if not delay Surgery.
• Significantly reduces the symptoms associated with Inflammation in cases of Polyarthritis/Psoriatic Arthritis/ Reactive Arthritis/ Ankylosing Spondylitis/ Enteropathic Arthritis.
• Reduced risk of adverse events compared to oral steroid tablets which are taken daily, due lower dosage (very low steroid dosage compared to cumulative oral steroids over 6 week period).
• Reduced risk of side effects/ adverse effects due to prior risk stratification and identification of high risk patients vs. low risk patients by doing precautionary steps and tests prior to giving injection.
• Reduced incidence of post-injection pain due to highly diluted steroid solution.
• Reduces pain and discomfort in most patients.
• More effective treatment method in the above inflammatory conditions.
• Faster recovery.
• NESTIT treatment usually results in significant, effective, progressive improvement of pain, function and reduction of stiffness if given in series.
  
  At Beth Yehudah Arthritis Centre, Pullad and Daystar Clinic, Alappuzha we tailor customized treatment plan to treat patients suffering from Polyarthritis/Psoriatic Arthritis/ Reactive Arthritis/ Ankylosing Spondylitis/ Enteropathic Arthritis. To know more about treatment plans and treatment costs, book an appointment now.