PATIENT INFORMATION BOOKLETS

The Musculo-Skeletal system provides, not only strength to support the body and protect the vital organs but also flexibility to permit a wide range of movement at the joints. A normal joint can be compared to a well-oiled machine. It is a neatly integrated cushion system for the body. Inside its fibrous capsule, the synovial membrane exudes a fluid to nourish and lubricate the cartilage. Together, cartilage membrane and fluid absorb shocks and prevent friction.

INFLAMMATION OF THE JOINTS is known as ARTHRITIS. This term is frequently used to indicate any disease involving pain or stiffness of the musculoskeletal system and is generally considered synonymous with rheumatism. The term RHEUMATIC DISEASES is a broader term, referring to a condition in which there are changes in connective tissue including muscle, tendon, bursae, joints and fibrous tissue.

Nonetheless, whichever part of the joint system is affected the symptoms commonly experienced are:

PAIN : Bone pain is continuous, aching and sharp but that arising in the joints is related to posture or to movement and is accompanied by STIFFNESS. Pain in the limb joints is well localized but in the vertebral column degenerative changes cause localized as well as referred pain i.e. by pressure on the nerve roots giving rise to problems like SCIATICA.

IMPAIRED MOVEMENT : Pain and stiffness limit movement. In Rheumatoid arthritis stiffness is noted on first awakening in the morning and may improve as the day progresses. In Osteoarthritis, movement is restricted when the joints are used after a period of immobility.

ASSOCIATED SYMPTOMS : Fever, sweating, skin eruptions etc.

Rheumatism is divided in 2 major groups:

• ARTICULAR RHEUMATISM (ARTHRITIS) mainly affects the various joints.

• NON-ARTICULAR RHEUMATISM mainly affects the various muscles, ligaments, tendons etc.

OSTEOARTHRITIS

Osteoarthritis is a chronic disease which causes deterioration of the joint cartilage and the formation of new bone (bone spurs) at the margin of the joints.

Clinical features

• Joint pain - worse after exercise or at the end of day

• Pain relieved by rest

• Early morning stiffness

• Stiffness after rest

• Bony joint swelling

DEGENERATIVE JOINT DISEASE OF THE NECK

Also known as Arthritis of the neck, Cervical Osteoarthritis, or Cervical Spondylosis.

Description :

• Cervical Spondylosis is a degenerative process that affects the cervical spine.

• Over the time, these changes lead to changes in the vertebra. This can then cause nerve compression or inflammation.

Symptoms :

• Initially the person may not have any symptoms.

• Others will have neck or shoulder pain, headache in the back of their head, or stiffness of the neck. They may have difficulty turning or bending their neck from side-to-side.

• Some will have pain that shoots down a certain part of the arm. They may also notice numbness, weakness, or pain in the arm. One or both sides may be affected. Often it causes the hands to become clumsy.

LUMBAGO OR LOW BACK PAIN

Low back pain is the most prevalent cause of disability in people under age of 45 years.

Warning Signs:

• Pain is worse when one coughs or sneezes.

• Pain or numbness travels down one or both legs.

• Pain awakens one from sleep.

• Difficulty passing urine or in bowel movements.

RHEUMATOID ARTHRITIS

The disease can occur at any age, but it begins most often between the ages of 25 and 55. The disease is more common in older people. Women are affected 2.5 times more often than men.

Clinical features

• Joint pain - worse during exercise

• Pain relieved by movement

• Prolonged early morning stiffness

• Prolonged stiffness after rest

• Marked soft tissue swelling and erythema

• Systemic features often present

Joint involvement in RA usually affects both sides of the body equally -- the arthritis is therefore referred to as symmetrical.

Joint destruction begins 1-2 years after the appearance of the disease. Characteristic deformities result from cartilage destruction, bone erosions, tendon inflammation and rupture.

ANKYLOSING SPONDYLITIS

Ankylosing spondylitis (AS) is a rheumatic disease that causes Arthritis of the spine and sacroiliac joints and can cause inflammation of the eyes, lungs, and heart valves. It varies from intermittent episodes of back pain that occur throughout life to a severe chronic disease that attacks the spine, peripheral joints and other body organs, resulting in severe joint and back stiffness, loss of motion and deformity as life progresses.

INFECTIOUS ARTHRITIS

• Infectious Arthritis is a form of joint inflammation which may be precipitated by various infections.
  Common symptoms of Infectious Arthritis include joint pain, swelling, and fever.

• Factors that increase the risk for contracting Infectious Arthritis include conditions that weaken the immune system, and existing Arthritis or other joint disease.

RHEUMATIC FEVER

Rheumatic fever is an inflammatory disease which can involve the heart, joints, skin, and brain.

Symptoms

• Fever along with abdominal pain.

• Joint pain, migratory Arthritis -- involving primarily knees, elbows, ankles, and wrists & Joint swelling; redness or warm affected parts .

• Skin eruption on the trunk and upper part of arms or legs, skin rash (Erythema Marginatum) & nodules.

• Sydenham's chorea -- emotional instability, muscular weakness and rapid, uncoordinated jerky movements affecting primarily the face, feet and hands

• Epistaxis (nosebleed).

• Cardiac (heart) involvement which may be asymptomatic or may result in shortness of breath, chest pain .

GOUT

Gout is a systemic disease caused by the accumulation of uric acid in the joints, causing inflammation, swelling, and pain. An episode of gout can be triggered by:

• Drinking too much alcohol

• Eating too much of the wrong foods

• Surgery

• Sudden, severe illness

• Crash diets

• Injury to a joint

Acute stage - Symptoms usually last five to ten days

• Sudden attack of joint pain

• Swelling

• Joints feel hot, tender and look dusty red or bruised

Intercritical stage - Symptom-free intervals between gout episodes. Most people have a second attack after six months to two years, while others are symptom-free for five to ten years.

Chronic stage

• Persistently painful joints with large urate deposits in the cartilage, membranes between the bones, tendons and soft tissues

• Skin over the deposits develops sores with release of white pus

• Joint stiffness

• Limited motion of affected joint

NON-ARTICULAR RHEUMATISM

FIBROSITIS: There is inflammation of the white fibrous tissue of the muscular sheaths and fascial layers of the locomotor system causing PAIN and STIFFNESS.

MYALGIA: Muscular pain.

INTERVERTEBRAL DISC SYNDROME: Pads of cartilage and fiber lying in-between the vertebrae act as cushions, absorbing shocks and strains and help accommodate the various movements of the spine. Constant strain can weaken cartilage causing its rupture/herniation.

LOW BACK PAIN SYNDROME (SCIATICA): Pain in the lumbar, lumbosacral or sacroiliac regions of the back, may be accompanied by pain radiating to the legs along the distribution of the sciatic nerve-SCIATICA.

TENDINITIS: Inflammation of the tendons and tendinous attachments. It is frequently associated with calcium deposits.

TENOSYNOVITIS: Inflammation of a tendon and its sheath, the lubricated layer of  tissue in which the tendon is housed and through which it moves. Rheumatic and other types of Arthritis frequently involve tendon sheaths especially of hands, wrist and ankles.

FASCITIS: Inflammation of the sheet/band of fibrous tissue, which lies deep to the skin and also inserts the muscles and various organs.

Diet & Nutrition

AVOID

•  Cold water, cold aerated drinks eg. Fruity, Maaza, Campa Cola, Pepsi etc.

• Fruit juices (Citrus fruits eg. Orange, Mousambhi)

•  Icecreams, Curd (dahi). Buttermilk (Lassi)

•  Fruits: Orange, Mousambhi, Bananas

•  Vegetables: Colocasia, (arbi) Radish, Cauliflower, Carrots, Spinach (saag esp. sarson ka saag)

•  Starchy and fried food: Urad dal, Rajma,Channa,Rice,Kurdhi, Noodles, paranthas, rice, puris (Rice is permissible for those whose staple diet is rice)