No need to give Saaz . Leflunomide 20 mg + HCQS 200 mg alone are enough to prevent progression of Rheumatoid arthritis. With S.uric acid- 8.8 - it is advisable to add tab Febuxostat 80 mg O.D till uric acid comes to 6 mg and then reduce the dose to 40 mg . It is important to know that hyperuricaemia is also known to raise S.creatinine. So in this case to prevent progression of CKD - B.P - target should be less than 120 / 80 mm of Hg , S.uric acid should be below 6 mg . U.T.I should be controlled with nitrofurantoin till infection is over and cranberry extract + D - mannose capsules for 2 months
To find out the cause of UTI must be in priority.. Volvo vaginitis ?? Nitrofurantoin. 100 mg.x BD.x15 days followed by 1 tab OD.x15 days. Repeat Iron mi ro & Culture. + SPA. Febuxoztate.80 mg.1 OD.x10 days followed by 40 mg 1 tab.OD.x1 month.
I am agree with @Dr. Parveen Yograj Sir and @Dr. Dineshchandra Sharma Sir, but I think HAEMOGLOBIN is vital roler of the IMMUNOLOGY section. Folic acid and Cyanocobalamine Or vit- B12 are producer of haemoglobin, so it's regular essential with dietary supplements for Rheumatoid Arthritis patients.
Add Febustat 40mgm Once a day
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.HEALTH BENEFITS OF ARNICA YOU have ever tried Homeopathic medicine, you would be aware of the term ‘Arnica’. The fact that it is used as an active ingredient in medicines is itself an indication of the various arnica benefits. In fact, we often come across shampoos, gels, tonics and tinctures bearing the name of arnica. Arnica is basically a perennial herb belonging to the sunflower (Asteraceae) family. It is native to the mountains of Europe and Siberia. Arnica plant grows to a height of 1 to 2 feet and bears yellow-orange flowers resembling daisies. It possesses bright green leaves, the upper leaves are toothed and slightly hairy while the lower leaves have rounded tips. The stalks are round, fleshy, and hairy. The yellow-orange flowers of this herb have medicinal value. Extracts from fresh and dried flower heads are used in Homeopathic preparations for the treatment of several health conditions. The flowers can also be used in their raw form. Today, arnica is extensively cultivated for medicinal purposes in several areas of Europe and North America. It has been used in medicine since the 1500s and is commercially available in the form of topical creams, ointments, pills, tinctures and even injections. Arnica oil is also available, which is used for topical treatments. Direct intake of arnica by mouth is associated with serious side effects but homeopathic medicines use it in a diluted form which is not considered harmful. There are several species of arnica of which Arnica Montana and A. Chamissonis are used in anti-inflammatory preparations. Both species look similar except that A. Chamissonis has somewhat smaller flowers. It can be extremely toxic even in very low doses. Arnica Montana, on the other hand, possesses medicinal properties and is mostly used in herbal products, particularly hair care products. This herb is known by several names such as Mountain Tobacco, Mountain Daisy and even Leopard’s bane and Wolf’s bane. Arnica Benefits For Skin Image: Shutterstock Arnica is an active ingredient in several skin care products. It can improve your skin health and help you get rid of skin problems too. The various benefits of arnica for skin are as follows. 1. Treatment Of Skin Infections And Eczema Arnica can be applied topically to get rid of skin problems. Arnica extracts are used as an ingredient in several lotions meant for the treatment of skin infections, eczema, itchiness and open wounds. They can even be applied on the vagina to treat vaginitis and vaginal irritation. 2. Treatment Of Frost Bites And Chilblains Arnica extracts are used in ointments meant for treating frost bites. Often, frost bites do not appear as open wounds. Application of arnica ointment on frost bitten areas of the body can significantly improve the condition. This herb can also be used in the treatment of chilblains. 3. Skin Nourishment Arnica Montana flowers contain sesquiterpene lactones, flavonoids, carbonic acid, coumarins and volatile oils, all of which are beneficial for your skin. A sesquiterpene lactone, called helenalin, is the main restorative compound in Arnica Montana, which along with flavonoid, helps soothe and renew the skin after exposure to stress. The antibacterial, antiseptic and anti-inflammatory properties of this herb help in preventing inflammatory skin disorders. They also accelerate the healing process by stimulating the formation of granular tissues. Arnica for skin care can effectively heal bruises, sunburns, minor burns and superficial phlebitis. 4. Treatment Of Stretch Marks Topically rubbing arnica extracts reduces the appearance of pregnancy-related stretch marks. All you need to do is gently apply arnica gel on your stomach at least four times a day. [ Read: Olive Oil For Stretch Marks ] Benefits Of Arnica For Hair The anti-inflammatory properties of arnica make it usable in hair care as well. Arnica extracts are often used in conditioners and shampoos. Some of its benefits for hair are as follows. 6. Arnica For Hair Loss Usage of arnica extract rejuvenates your scalp and stimulates the hair follicles, helping to strengthen your hair and preventing it from falling prematurely. Arnica is combined with other ingredients like calendula and jaborandi in homeopathic Arnica Montana shampoos to provide soft and manageable hair. 7. Treatment Of Dandruff Arnica cleanses the excess oil and sebum from the scalp, giving it a natural shine. By removing dirt, debris, and oil from the scalp, it also helps combat dandruff and itchiness. This also helps in preventing tangled and rough hair. 8. Treatment Of Split Ends And Premature Greying Of Hair Arnica is used at a concentration of 1% to 2% in hair care products. Being an antibiotic, it can effectively cure scalp infections. It strengthens each and every hair strand and helps prevent split ends and premature graying of hair. All you need to do is massage arnica hair oil on your scalp from the roots to the tips before going to bed and wash off the next morning. This will nourish your hair and prevent these problems by providing the requisite nutrition to your hair follicles. Health Benefits Of Arnica As stated earlier, arnica is used in the treatment of a wide range of internal and external disorders. Though arnica is not FDA approved like other herbal remedies, it does contain several active ingredients and volatile oils. Proper dosage of arnica will definitely provide the following health benefits: 9. Treatment Of Arthritis The anti-inflammatory properties of arnica are praiseworthy. It has been used in topical preparations for healing joint pains, muscle aches and swelling associated with arthritis. A research conducted in 2002 indicated that the use of arnica gel twice daily for 6 weeks resulted in a significant decrease in pain and stiffness in patients with mild to moderate osteoarthritis of the knee. In the case of osteoarthritis of the hand, arnica gel has proven to be as effective as ibuprofen in lessening pain and improving hand function. The essence of arnica plant is used in the treatment of rheumatoid arthritis. Being an anti-inflammatory agent, it can be used to massage inflamed or painful joints for relief. 10. Treatment Of Muscle Soreness The anti-inflammatory properties of this herb make it useful for the treatment of muscle soreness. It can be applied topically to reduce pain and inflammation caused by muscle sprain and strains. Thus, it is beneficial for athletes who often suffer from muscle soreness. 11. Healing Qualities Arnica has been used in topical preparations for healing bruises, muscle aches, superficial phlebitis, wounds and swelling due to insect bites and fractures. It can be used as a mouthwash or gargle for treating sore throat and infections. However, it should be used and consumed according to the directions of the physician. It helps in the regeneration of tissues and can heal injuries. It is also effective in healing burns. It improves blood circulation by stimulating white blood cell activity, decreasing the amount of healing time and reducing inflammation. 12. Treatment Of Post-Surgery Pain A study conducted in 2007 observed that taking a homeopathic dilution of arnica resulted in a decrease in pain in patients whose tonsils were removed. Similarly, taking a homeopathic dilution of arnica and topical application of arnica ointment reduces post-surgery pain in patients undergoing surgery for carpel tunnel syndrome. 13. Treatment Of Bruises And Black Eyes Arnica is effective in reducing the appearance of bruises. Topical application of arnica extract on bruises and black eyes can significantly improve the condition. Infusions from arnica plant are effective in the treatment of dark nails caused due to injuries from heavy objects. 14. Oral Health The anti-bacterial and anti-microbial properties of arnica make it great for oral health. Arnica mouthwashes are widely available and can treat bacterial infections in the mouth. Washing your mouth with arnica and water regularly can cure conditions like gingivitis and pyorrhoea. It can also reduce wisdom tooth pain. 15. Treatment Of Post Surgery Swelling A study conducted in 2006 has proved that intake of homeopathic dilution of arnica may slightly reduce post-operative swelling in patients undergoing arthroscopy. 16. Treatment Of Stress And Depression In addition to its medicinal uses, arnica is beneficial in alleviating feelings of depression and emotional distress. It is often used in healing sachets to restore emotional balance and a sense of tranquility. Organic and wild grafted arnica flower extract can be massaged to provide warmth which unwinds your taxed and tight muscles and alleviates stress. 17. Other Benefits Arnica has been used in homeopathy for the treatment of an accident or shock as well as illness of the circulatory system. It is also used in the treatment of conditions like a backache, fibromyalgia, influenza, headaches, migraines and hemorrhoids. Nutritional Value Of Arnica Arnica owes its anti-inflammatory properties to a host of active components comprising of antioxidants, tannins, flavonoids, carotenoids and volatile oils like thymol, an active ingredient contained in thyme. The in-depth nutritional profile of arnica can be understood from the table given below. NUTRITION FACTS CALORIES IN ARNICA MONTANA HOMEPATHIC Serving Size: 1 serving Amount Per Serving Calories 0.0 Total Fat 0.0 g Saturated Fat 0.0 g Polyunsaturated Fat 0.0 g Monounsaturated Fat 0.0 g Cholesterol 0.0 mg Sodium 0.0 mg Potassium 0.0 mg Total Carbohydrate 0.0 g Dietary Fiber 0.0 g Sugars 0.0 g Protein 0.0 g Vitamin A 0.0 % Vitamin B-12 0.0 % Vitamin B-6 0.0 % Vitamin C 0.0 % Vitamin D 0.0 % Vitamin E 0.0 % Calcium 0.0 % Copper 0.0 % Folate 0.0 % Iron 0.0 % Magnesium 0.0 % Manganese 0.0 % Niacin 0.0 % Pantothenic Acid 0.0 % Phosphorus 0.0 % Riboflavin 0.0 % Selenium 0.0 % Thiamin 0.0 % *Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs. Precautions This herb which provides amazing benefits for your skin, hair, and health, is also associated with several side effects when used excessively. That is why it is important to exercise caution while using it in any form. 1. Stomach Discomfort Arnica can irritate the digestive system and its lining called mucosa. For this reason, arnica is never taken orally. Even taken in low dosage in homeopathy medicine, it causes irritation in the stomach. This irritation further leads to pain and loss of appetite. But, this problem is temporary and goes away within a day or two. 2. Breast Feeding And Pregnancy Arnica usage should be avoided if you are pregnant or breast feeding. Arnica is considered as unsafe for pregnant or breast feeding women. 3. Vomiting As mentioned before, arnica irritates the stomach when taken orally. This irritation may further cause severe nausea or an urge to vomit. This side effect is common among many individuals consuming arnica. 4. Allergy People sensitive to Compositae or Asteraceae family plants, which includes chrysanthemums, ragweed, marigolds, daisies and related plants, might also be allergic to arnica. People who are hypersensitive to such plants should consult the doctor before using arnica in any form. 5. Nose Bleeding Arnica can also cause nosebleeds, which is not considered as a serious effect by American Cancer Society. A bleeding nose is not a problem in itself. Rather, it indicates that there is an internal bleeding that needs to be treated. It is best to discontinue the use of arnica on encountering such side effect and immediately visit your doctor. 6. Dizziness Dizziness occurs as a side effect when arnica is taken for internal issues. When you experience such side effect, consult your doctor immediately. 7. Interactions With Drugs Arnica may interact with a number of corticosteroids, anesthetic, and anti-inflammatory drugs. It can also cause bleeding when taken with anticoagulants. Specific constituents present in arnica might lower serum lipids in the body. Those taking drugs for lowering cholesterol should take arnica with a caution. 8. Heart Problems American Cancer Society indicates that arnica might cause irregularities in heart rhythm. This is a condition where the heart beats irregularly. It might either slow down or speed up, causing palpitations. So, consult your doctor immediately if you experience severe palpitations. This is one of the dangerous side effects of arnica since it can cause death. It needs an immediate diagnosis. 9. Tremors American Cancer Society reports tremor as one of the most common side effects of taking arnica orally. The person might experience uncontrollable movements of legs and hands. Such side effect requires medical evaluation. Tremors signal that your central nervous system has been affected. 10. Other Side Effects Arnica in undiluted form is considered unsafe. According to a report, it causes faster heart beat, cardiac arrest, stomach pain, diarrhea, vomiting, skin rashes and shortness of breath. Its toxicity might also cause dyspnea and gastroenteritis. It might also cause damage to your heart, increase the blood pressure level, and organ failure. Sometimes, its consumption leads to coma and even death. Tips On Arnica Usage After knowing the amazing arnica benefits, its time to know how to use this wonderful herb. Before consuming arnica, it is important to dilute arnica. Taking arnica in undiluted form can lead to chronic side effects. Avoid application of arnica on broken skin. Homeopathic doses should also be used according to specific instructions. Arnica forms an integral part of homeopathy. It offers various benefits. But, if you play doctor and overlook the recommended dosage, you can experience any of these side effects. So, discuss completely arnica benefits and side effects with your doctor before the consumption to stay safe! So, the next time you use arnica in any of its forms, remembers the goodness you are getting and return!Dr. Tapan Kumar Sau7 Likes9 Answers
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M29yr c/o pain and swelling since 4yrs plz suggest the treatmentDr. Veeresh Angadi6 Likes17 Answers
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50Yr old male pt has rt foot swelling since 10day h/o htn ,bil. Knee pain please give opinions about rt foot swelling following blood investigationDr. Amol Langhi0 Like31 Answers
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THYROID DISORDERS -EVERYTHING YOU SHOULD KNOW - by Dr Sunil kumar Dear friends and Curofians here's an brief information about thyroid disorders. Thyroid gland is a butterfly shaped gland in the front of the neck. It encircles the windpipe or the trachea. It is about 4 cms in height and weighs about 18 gms. This gland is responsible for the secretion of thyroid hormones. Hormones are chemicals produced by special glands like thyroid, adrenals, ovaries etc. They act as messengers and are carried by the blood to the various target organs. Thyroid disorders are conditions that affect the thyroid glands. It plays an important role in regulating numerous metabolic processes throughout the body. The Thyroid gland is located below the adam’s apple wrapped around the trachea. Thyroid disease is a common problem that can cause symptoms because of over- or under-function of the thyroid gland. The thyroid gland is an essential organ for producing thyroid hormones, which maintain our body metabolism. The thyroid gland is located in the front of the neck below the Adam's apple. Thyroid disease can also sometimes lead to enlargement of the thyroid gland in the neck, which can cause symptoms that are directly related to the increase in the size of the organ (such as difficulty swallowing and discomfort in front of the neck). Thyroxine T4 is the primary hormone developed by the Thyroid gland. A small portion of the T4 released from the gland is converted to Triiodothyronine (T3) which is the most active hormone. Hyperthyroidism: Too much thyroid hormone results in a condition known as hyperthyroidism. Affects about 1 percent of women. It's less common in men. Grave’s disease is the most common cause of hyperthyroidism. Symptoms: RestlessnessNervousnessIrritabilityracing heartIncreased sweatingShakingRestlessnessTrouble sleepingThin skinBrittle hairNailsWeight lossMuscle weakness Causes: Toxic adenomas: Nodules develop in the thyroid glands and begin to secrete thyroid hormones upsetting the body's chemical balance.Subacute thyroiditis: Inflammation of the thyroid that causes the gland to leak excess hormones, resulting in temporary hyperthyroidism that lasts a few weeks but may persist for months.Pituitary gland: Malfunctions or cancerous growths in the thyroid gland. Although rare, hyperthyroidism can also develop from these causes. Treatments for hyperthyroidism: destroy the thyroid gland or block it from producing its hormones. Antithyroid drugs: such as methimazole (Tapazole) prevent the thyroid from producing its hormones.Radioactive iodine: a large dose of it damages the thyroid gland. A pill is given by mouth. As thyroid gland takes in iodine, it also pulls in the radioactive iodine, which damages the gland.Surgery: Surgery can be performed to remove your thyroid gland. Hypothyroidism: Inadequate production of hormones by the thyroid gland is termed as hypothyroidism. This is also called Underactive thyroid state. Hypothyroidism can make the body’s development to slow down and reduces metabolism rates. Since the body needs some amount of thyroid for energy production and drop in hormone production leads to lower energy levels. Symptoms: FatigueDry skinIncreased sensitivity to coldMemory problemsConstipationDepressionWeight gainSlow heart rateComa What are the causes of Hypothyroidism? Hypothyroidism can be caused by a number of factors: Hashimoto's thyroiditis: This is the commonest cause. This is an autoimmune disorder (normally body’s defence system fight against external infections. In autoimmune disorder the defence system attacks the healthy cells of the body by mistake). In Hashimoto’s thyroiditis the immune system/defence system produces antibodies that attack the thyroid gland and destroy it.Iodine deficiency in diet: For the production of thyroid hormones iodine is very important. The body does not produce iodine normally, so it needs to be supplemented from outside. Iodine is mainly present in the food we eat. It is mainly present in shellfish, salt-water fish, eggs, dairy products. If a person does not eat iodine rich foods, he may end up with iodine deficiency leading to hypothyroidism. Currently, this causative factor is on the decline due to government initiative of table salt with iodine.Surgery: Surgery to remove thyroid gland (for e.g. thyroid cancer treatment, overactive thyroid etc.)Radiation to the neck (to treat cancer in the neck area): The thyroid gland cells are damaged due to the radiation.Treatment with radioactive iodine: This treatment is used for managing hyperthyroidism/overactive thyroid, where the thyroid gland produces excessive thyroid hormones. One of the treatment modalities is by radioactive iodine. Sometimes this radiotherapy destroys normal functioning cells which lead to hypothyroidism.Certain medicines: Certain medicines used to treat heart conditions, cancer, psychiatric conditions etc. – for e.g. amiodarone, lithium, interleukin-2, interferon-alpha.Pregnancy: Pregnancy (the reason is unclear but it has been noticed that the thyroid may get inflamed after delivery – this is called Postpartum thyroiditis.Damage to the pituitary gland: Pituitary gland is a gland which is present in the brain. It produces a hormone called TSH (Thyroxine-Stimulating hormone).The TSH tells the thyroid gland how much thyroid hormone it should make. If the levels of thyroid hormone in the blood are low, then the TSH will stimulate the thyroid gland to produce more Thyroid hormone.Hypothalamus disorders: This is an organ in the brain. This produces a hormone called TRH (Thyrotropin Releasing Hormone) which acts on the Pituitary gland to secrete TSH. So any disorder of Pituitary gland will indirectly effect the production and secretion of Thyroid hormones. These are very rare disorders.Congenital thyroid defects: Some babies are born with thyroid problems. This is due to the thyroid not being developed normally during pregnancy. Sometimes the thyroid gland does not function normal. This can be identified by screening for thyroid disorders in the first week after delivery. This is usually by a blood test using a small drop of blood from the baby’s heel. Who are at risk of developing Hypothyroidism? Women have a higher risk of suffering from hypothyroidism than men.Older people are at increased risk.People suffering from other autoimmune diseases like Coeliac disease, Type-1 Diabetes Mellitus, Vitiligo, Pernicious anemia, Multiple sclerosis, Rheumatoid arthritis, Addison’s disease etc.People with psychiatric conditions such as bipolar disorderPeople with Chromosomal abnormalities like Down syndrome, Turners syndrome also have a high risk of suffering from hypothyroidism. How to diagnose hypothyroidism? Blood tests: TSH: This hormone is made in the pituitary gland and it stimulates the thyroid gland to produce thyroxine. If the thyroxine levels are low in the blood, the pituitary gland produces and secretes more TSH into the blood to act on the thyroid gland to produce more thyroxine. A raised TSH level indicates hypothyroidism. Other tests are not usually necessary unless a rare cause of hypothyroidism.T4: A low level of thyroxine indicates hypothyroidism.T3: these levels are generally not needed to diagnose hypothyroidismAnti-Thyroid peroxidase antibodies (anti-TPO antibodies) or Anti- thyroglobulin antibodies are present in 90-95% of patient with autoimmune thyroiditis.Other blood tests include Creatinine Kinase, Serum Lipids, Complete blood picture etc.Ultrasound of the neck is done if the patient presents with a thyroid swelling. What is the treatment of hypothyroidism? Overt hypothyroidism is treated by synthetic Thyroxin hormone which should be taken every day on an empty stomach at least 30 – 45 minutes before breakfast. The treatment is continued for the rest of the patient’s life. Regular thyroid function tests are done once every 8 weeks-12 weeks to adjust the dose of the thyroxine in the initial period of diagnosis. Once the thyroxine dose is stabilised, the tests can be done even once a year. This treatment is quite effective. Sub-clinical hypothyroidism is only treated if the patient is a woman and is contemplating pregnancy, in patients with symptoms or if the TSH is quite high. What are the side-effects of thyroxine medication? There are few side effects if any. Most people tolerate these medications quite well. An important consideration before starting medication is to check if the patient has chest pain/angina. These people are started on the least available dose. If these patients are started on a higher dose they notice a worsening of their angina pains. Side effects mainly occur if the thyroxine dose is high which leads to hyperthyroidism. The symptoms of this could be palpitations 9increased heart beat), weight loss, profuse sweating, anxiety, irritability etc. There are some tablets which increase with thyroxine tablets. These include carbamazepine, iron supplements, calcium supplements, rifampicin, phenytoin, warfarin etc. What are the complications of hypothyroidism? If untreated hypothyroidism can lead to: heart problems like heart attack due to increased levels of bad cholesterol like LDL, or heart failure due to fluid retentionobesityinfertilityjoint painsdepressionA pregnant woman with hypothyroidism is at increased risk of giving birth to a baby with congenital hypothyroidism, also known as cretinism. Further, the woman may have pregnancy related complications like pre-eclampsia, premature delivery, low birth weight baby, anemia, post-partum haemorrhage (bleeding after delivery) etc.Myxoedema is another complication where the patient has extremely low levels of thyroid hormone. The body temperature drops drastically making the person lose consciousness or go into a coma. If you wish to discuss about any specific problem, you can consult an Endocrinologist. Regards Dr Sunil kumarDr. Sunil Kumar13 Likes19 Answers
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MAY BE HELPFUL !!! Plummer-Vinson syndrome !!! We bet you haven't seen anything like this before: associated with mutilans rheumatoid arthritis.In Arthritis mutilans, a patient's fingers become shortened by arthritis, and the shortening may become severe enough that the hand looks paw- like, with the first deformity occurring at the interphalangeal and metacarpophalangeal joints. The excess skin from the shortening of the phalanx bones becomes folded transversely, as if retracted into one another like opera glasses, hence the description la main en lorgnette. As the condition worsens, luxation, phalangeal and metacarpal bone absorption, and skeletal architecture loss in the fingers occurs.Arthritis mutilans occurs mainly in patients with psoriasis and rarely advanced rheumatoid arthritis, but can occur independently.The hallmark feature of rheumatoid arthritis (RA) is persistent symmetric polyarthritis (synovitis) that affects the hands and feet, although any joint lined by a synovial membrane may be involved. The severity of RA may fluctuate over time, but chronic RA most commonly results in the progressive development of various degrees of joint destruction, deformity, and a significant decline in functional status. Extra-articular involvement of organs such as the skin, heart, lungs, and eyes can also be significant.The most important possible etiological factor is iron deficiency. Other possible factors include malnutrition, genetic predisposition autoimmune processes. Plummer-Vinson syndrome can be treated effectively with iron supplementation and mechanical dilation. Since Plummer-Vinson syndrome is associated with an increased risk of squamous cell carcinoma of the pharynx and the esophagus, the patients should be followed closely.Dr. Mahmud Patel25 Likes23 Answers