start DMARDs. sulfasalazine can be started at first. depending upon response other drugs can be added
RA is low positive. What is important is patter of joint involvement and diurnal variation - like morning stiffness >1hr.
Rheumatoid Artritis.Start DMARD.
if c/f suggestive of RA then start DMARD
Medical management is important. Physiotherapy may include- Therapeutic wax therapy Hydrotherapy Therapeutic ultrasound Calcium supliments
Start with methotrexate 7.5 weekly with folic acid daily... may add sulfasalazine or hydroxychloroquine with nsaid and steroids initially
Do ANA, treat with disease modifying agents Anti inflammatory drugs
Physiotherapy treatment includes - Hydrotherapy Ultrasound ( localised jnt pain) Rest pauses between the activities General mobility
Need Clinical evaluation with Rheumatologist.
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45yr/F pain in left knee joint since 3 months, difficulty in walking NO H/O trauma.no local rise of temp,no swellings.knee ROM near normal and painfull,on Analgesics and chondroprotectives..please suggest treatment optionsDr. Sannith Kumar Korutla3 Likes29 Answers
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CUSHING'S SYNDROME. Cushing's syndrome is a hormonal disorder caused by prolonged exposure of the body's tissues to the high levels of hormone cortisol.It is also known as HYPERCORTISOLISM.It commonly affects adults aged 20-50. Too much cortisol in the body,regardless of the cause is called CUSHING'S SYNDROME. Pituitary gland tumour which produces excess ACTH leading to hypercortisolism is called CUSHING'S DISEASE. Hypercortisolism due to excess ACTH produced by a tumour elsewhere in the body is called ECTOPIC CUSHING'S SYNDROME. Cushing's syndrome caused by taking excess steroid medications is called EXOGENOUS CUSHING'S SYNDROME. SIGNS AND SYMPTOMS. Patients with Cushing's syndrome have upper body obesity and slender arms and legs. Most people with Cushing's syndrome have Round ,red, full face like a moon. moon facies Truncal obesity,supraclavicular fat pads,buffalo hump,weight gain. SKIN CHANGES. Atrophy, Purple striae. Easy bruising. Hirsutism. Acne, Pigmentation MUSCLE AND BONE CHANGES. Proximal muscle wasting and weakness Bone pain or tenderness. Rib and spine fractures caused by thinning of bones. Osteopenia or osteoporosis. PSYCHOLOGICAL PROBLEMS. Depression Cognitive function. Emotional lability. Diabetes or impaired glucose tolerance. Thirst,polydipsia,polyuria. Hypertension. Nephrolithiasis. Gonadal dysfunction,reduced libido,erection problems. Irregular periods. Growth restriction in a child. Destruction of anterior pituitary may cause hypothyroidism and amenorrhoea. Patients with ACTH producing tumours may develop headache,visual problems and galactorrhea. WHAT CAUSES CUSHING'S SYNDROME. Tasks of cortisol. *Helps maintain blood pressure and cardiovascular function. *Reduces the immune system's inflammatory response. *Balancing the effects of insulin *Regulates the metabolism of carbohydrates,proteins and fats. 1) Most common cause of cushing's syndrome is exogenous intake of steroids.like Prednisone for asthma,rheumatoid arthritis,lupus.Glucocorticoids taken to suppress immune system after transplantation to keep the body from rejecting the new tissue or organ. 2)Next common cause is PITUITARY ADENOMAS. 3) ECTOPIC ACTH SYNDROME. Benign or malignant tumours that arise outside the pituitary can produce ACTH.They are lung tumours especially all cell lung cancer,carcinoid tumours,thymomas,pancreatic islet cell tumours and medullary carcinomas of the Thyroid. 4) ADRENAL TUMOURS. Adrenal adenomas or adrenocortical cancers can cause Cushing's syndrome. DIAGNOSIS. The three most common tests used to diagnose Cushing's syndrome are. 1)24 HOUR URINARY FREE CORTISOL LEVELS. >>>50 - 100 if /day suggests Cushing's syndrome. 2) MEASURE MID NIGHT PLASMA CORTISOL AND LATE NIGHT SALIVARY CORTISOL. Cortisol production is normally suppressed at night ,but in Cushing's syndrome,this suppression doesn't occur . Cortisol levels of >>50 nmol/L , Cushing's syndrome is suspected. 3)LOW DOSE DEXAMETHASONE SUPPRESSION TEST.. (LDDST ).Here patient is given a low dose of dexamethasone ,by mouth every 6 hours for 2 days.Steroids signal the pituitary to release less of ACTH.So the normal response after taking dexamethasone is a drop in blood and urine cortisol levels.If cortisol levels do not drop,cushings syndrome is suspected. TESTS TO FIND THE CAUSE OF CUSHING'S SYNDROME. Once Cushing's syndrome is diagnosed,certain tests are done to locate the exact abnormality that leads to excess cortisol production. 1)CRH STIMULATION TEST. Injection of CRH causes a rise in ACTH and cortisol levels in patients with pituitary adenomas.But this response is not seen in adrenal tumours or ectopic ACTH producing tumours. 2)HIGH DOSE DEXAMETHASONE SUPPRESSION TEST (HDDST.) High doses of dexamethasone suppresses cortisol levels in people with pituitary adenomas but not ectopic ACTH producing tumours. 3)CT AND MRI. TREATMENT. Treatment depends on the exact cause of excess cortisol. PITUITARY ADENOMAS. Trans sphenoidal adenomectomy is most widely used surgery. For patients not suitable for surgery,radiation to the pituitary gland is given over a 6 week period. Cortisol inhibiting drugs like ketoconazole,mitotane,aminoglutethimide and methadone are also used. ECTOPIC ACTH SYNDROME Ectopic ACTH producing tumours or cancerous tissue is treated by surgery //radiation //chemotherapy //immunotherapy. ADRENAL GLAND TUMOURS. Surgery is the mainstay of treatment for benign and cancerous tumours off the adrenal glands. Primary pigmented micronodular adrenal disease and inherited Carney complex -primary tumours of the heart which cause Cushing's syndrome are treated by surgical removal of adrenal glands. POINTS TO REMEMBER. CUSHING'S SYNDROME IS A DISORDER CAUSED BY PROLONGED EXPOSURE OF THE BODY'S TISSUES TO HIGH LEVELS OF THE HORMONE CORTISOL. TYPICAL SYMPTOMS ARE UPPER BODY OBESITY,ROUND FACE,SKIN THAT BRUISES EASILY AND HEALS POORLY,WEAKENED BONES,ACNE AND MENSTRUAL IRREGULARITIES IN FEMALE,DECREASED FERTILITY IN MEN. IIATROGENIC CUSHING'S SYNDROME IS CAUSED BY EXPOSURE TO GLUCOCORTICOIDS. HYPERCORTISOLISM IS ALSO CAUSED BY PITUITARY TUMOURS OR LUNG TUMOURS. SEVERAL TESTS ARE DONE TO DIAGNOSE CUSHING'S SYNDROME AND IDENTIFY THE CAUSATIVE PATHOLOGY. TREATMENT DEPENDS ON THE CAUSE.THEY ARE SURGERY,RADIATION,CHEMOTHERAPY OR CORTISOL INHIBITING DRUGS.Dr. Suvarchala Pratap23 Likes23 Answers
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27 years old male presented with pain, swelling, difficulty in walking & fever . d/d & m/t please.Dr. Naresh Bidkar2 Likes21 Answers
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10 Amazing Health Benefits Of Molokhia stylecraze.com Oct 23, 2017 11:51 AM ￼ Are high blood pressure levels making your life a mess? Do you think your cholesterol levels are sapping the energy and vitality from your life? What if there is one single ingredient that can help you combat these issues, in addition to numerous other common problems? We are talking about molokhia leaves here! This little known vegetable is widely used for its many known health benefits. Want to know what they are? Go ahead with your read! Health Benefits Of Molokhia – Top 10: 1. Lowers Blood Pressure: Molokhia leaves have been found to reduce the risk of hypertension, by effectively helping reduce blood pressure. Molokhia leaves are rich in potassium, and since potassium is a known vasodilator, it helps relax the arteries. This property of potassium helps improve oxygenation and reduces cardiovascular strain (1). 2. Improves Circulation: Molokhia leaves are rich in iron, which not only increases RBC production, but also leads to improved blood circulation. Iron is needed for the blood to carry oxygen and a deficiency in iron usually results in anemia. An iron-rich diet ensures that blood circulation is at the optimal level, which in turn helps you stay energetic (2). 3. Aids Digestion: Molokhia leaves are rich in dietary fiber, and this makes them especially good for your digestive health. Dietary fiber is a bulking agent which helps relieve irritable conditions like bloating and constipation (3). 4. Lowers Cholesterol: Molokhia leaves have been proven to reduce blood pressure, and they are especially rich in dietary fiber. This makes them one of the best agents for cholesterol reduction. Dietary fiber has been found to help reduce bad (LDL) cholesterol, which directly reduces the risk of you contracting arterial diseases like stroke, heart attack or even atherosclerosis (4).‘ 5. Relieves Insomnia: Molokhia is rich in many essential minerals, most notably magnesium. Magnesium has been proved to help eliminate sleep disorders like insomnia and even snoring disorders like apnea. Magnesium triggers the release of hormones that relax the body and calm the nerves. An increase in magnesium intake has been directly linked with regular and better sleep cycles (5). 6. Boosts Immunity: Molokhia leaves are rich in vitamins A, C and E. It is especially effective for the immune system. Vitamin C is one of the most effective antioxidants that not only eliminates free radicals, but also helps instigate WBC production (6). WBCs usually attack pathogens and infections first. Vitamins A and E are antioxidant vitamins that prevent free radical damage. The consumption of Molokhia leaves helps boost immunity. 7. Anti-Carcinogenic: Along with other essential minerals and nutrients, molokhia is rich in antioxidantvitamins A, C and E (7), (8). Antioxidants usually help protect the body from cancer-inducing free radicals and restrict the spread of cancerous cells and tumors. The high antioxidant content of molokhia leaves makes it an ideal anti-carcinogen. 8. Boosts Bone Health: Molokhia is loaded with essential vitamins and minerals that have many health benefits. Some of these have been found to boost bone health and protect one against diseases like osteoporosis and arthritic conditions. Iron, selenium, calcium and magnesium are just some of the essential minerals that molokhia leaves contain (9), (10). 9. Anti-Inflammatory: In traditional medicine, Molokhia leaves have been used extensively as anti-inflammation agents. One of the constituent antioxidants that make up molokhia is Vitamin E, an especially effective anti-inflammatory agent that usually cures and treats most symptoms of inflammation. If you suffer from rheumatoid arthritis, cystitis or other inflammatory conditions, consider adding molokhia leaves to your diet (11). 10. Cellular Growth: Molokhia leaves contain many essential nutrients and minerals that not only aid in the proper functioning of the body, but also help create new cells, skin, ligaments, muscles and organ systems. As molokhia is especially rich in magnesium, it is a great food that boosts cellular growth. Magnesium helps build new organic material and is necessary for proper cell growth (12). So, we hope that all these health benefits of of Molokhia will make you to reevaluate your diet. Tell us about your experiences with molokhia leaves here. Leave a comment below! Recommended Articles:Dr. Tapan Kumar Sau4 Likes15 Answers
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A 69 year old male with no prior medical history presents over the course of several months with new-onset nonspecific joint pain and swelling without evidence of erosions. The joints involved include his wrists, elbows, hands, and knees. Laboratory findings include: High-sensitivity C-reactive protein, 36 mg/L White blood cell count, 13.0 x 103 /µL Hemoglobin, 14 g/dL Hematocrit, 45 g/dL Thyroid stimulating hormone level, 1.13 U/mL Serum creatinine, 0.8 mg/dL Erythrocyte sedimentation rate, 19 Rheumatoid factor was positiveDr. Mukesh Bhalla (Pt)0 Like19 Answers