Rheumatoid arthritis
Rheumatoid Arthritis under Ix with UTI? Chief Complaints A 50 yr old female has come with pain in multiple joints for past 14 yrs. There is also associated alopecia and recurrent mouth ulcer. Pt is also suffering from depressive illness. No H/O HTN, T2DM, Thyroid Disorder, Substance abuse. Normal Menstrual cycle. O/E symmetric small joints of small hand, wrist, knee joint and ankle are involved without any visible deformity. Pt has pallor.. Rest findings are normal. Routine Ix along with ESR, CRP, RA factor, Xray of chest, digits and knee jt was done. Also Routine Urine examination. Reports have shown positive RA factor, raised ESR, low Hb, pus cells and hematuria in urine and juxta articular osteopenia and cavity of digits. As per ACR -EULAR criteria pt fits the Dx of Rheumatoid arthritis. Will send sample for anti ccp. Has admitted the pt and started symptomatic management. Also sent sample for Urine C/S, USG W/A, 24 hr urinary protein etc.
A female patient with polyarticular arthritis, oral ulcers, alopecia, raised ESR, but negative CRP, Urine showing RBCs. Please also send ANA by IF method (in addition to Anti-CCP) as she could be having connective tissue disease instead of RA. A rheumatologist should be involved in the care of such patients.
Cases that would interest you
- Login to View the image
Rheumatoid arthritis *Chief Complaints* A 59 yr old male has come with pain and swelling in multiple joints of foot, knee jt, small joints of hand, wrist, shoulder and sterno clavicular joint for past 2 yrs. Pt stated that he is a known diabetic and taking Ayurvedic and homeopathic treatment. Also pt had associated alopecia, facial puffiness, vasculitic lesion of skin(suspected). No H/O HTN, thyroid disorder, substance abuse, fever, chest pain, cough, kidney disorder etc. We suspected it as connective tissue disorder and did RA factor, ESR, CRP and CBC, which came to be positive today. Xray of this pt showing juxta articular osteopenia and Erosions classical of RA. In ACR EULAR criteria pt fulfills the criteria with 9 points. Anti ccp is raised. Today admitted the pt and started RA specific treatment. Pt is doing well on medication and is on regular follow up.
Dr. Ashutosh Chandan Dubey0 Like2 Answers - Login to View the image
*PSORIASIS* Skin lesion characterized by erythematous, scaly papule or plaque. Sharply defined skin lesion. *SITE:* Usually Extensor surface involved mainly knee, elbow, hand, lumbosacral region, scalp involved. Lesion developed at site of trauma *(KOBNER’S PHENOMENON)* also seen in Lichen Planus, Viral warts, Pityriasis rubra piloris. Skin lesion covered with Silvery Scales. On scrapping of scales leaves behind punctuate bleeding spot called *AUSPITZ SIGN.* *Different Clinical Forms of Psoriasis:* *Nummular (Discoid) Psoriasis:* Most common form, coin shaped lesion. *Guttate Psoriasis :* Rain Drops like small lesion. *Palmo-plantar Psoriasis :* Sterile pus in palm and soles. *Genital Psoriasis :* Lesion on Penis or Vulva. *Erythrodermic Psoriasis :* Exfoliative dermatitis like lesion. *Generalised Psoriasis:* Lesion over whole body. *Scalp Psoriasis :* Lesion Present but no Alopecia. *Nail Psoriasis :* Nails are affected. *Histological Changes in Skin Lesion:* *Parakeratosis :* Immature cell in stratum corneum. *Acanthosis :* Hyperplaisa of Stratum Malphighian layer. Loss of glandular cell layer. Dialated and tortuous blood vessesls around dermal Papillae. *Nail Changes in Psoriasis :* Pitting Subungual hyperkeratosis. Destruction of Nail Palate. Oncholysis (Separation of nail Palate from nail bed). Discolouration of Nail Palate. Psoriatic arthritis : Asymetrical oligoarthritis(Most of Cases) Symettrical seronegative arthritis (RF-ve). Arthritis of DIP joint. *Homoeopathic Treatment:* ARSENICUM ALBUM : Dry, rough, scaly eruptions with Itching followed by burning. Generally worse after cold and scratching. Sometimes SULPHUR one dose require where arsenic is prescribed to complete the case as it is complementary of Arsenic. BORAX : Itching on back of finger joints with intense itching and stinging. Aggravated from warm and ameliorated from cold weather. Unhealthy skin. KALIUM ARSENICUM : Dry, Scaly ruption with intense itching worse after undressing ,change of weather , warmth. Patient is chilly and sensitive to cold. ARSENICUM IODATUM : Dry, scaly eruptions with exfoliation of skin in large scales leaving raw excluding surface beneath. If history of TUBERCULOSIS is present then it acts better than any remeady. HYDROCOTYLE ASIATICA : Excessive thickening of skin with marked exfoliation of skin. Specially indicated in “Psoriasis Gyrate” . SEPIA OFFICINALIS : Dry, scaly thick crust upon joints and on elbows. Psorotic lesion especially over bends of the joints. Peeling off skin of palms and soles. MEZERIUM : Especially for Scalp Psoriasis where there is thick exudates of purulent pus under the crust. Itching aggravate in bed. CHRUSAROBINUM : Especially indicated in psoriasis with vesicular eruptions, foul smelling discharge with crust formation. *DrSaurabh Suman Prasad* *Intern* Dr. Yarubir Sinha Homoeopathic Medical College and Hospital laheriasarai,Darbhanga *Bihar*
Dr. Saurabh Suman Prasad19 Likes27 Answers - Login to View the image
30 year old male pt c/o these type lesions in beard and scalp for 1month plz dx & rx...
Dr. Arif Khan3 Likes25 Answers - Login to View the image
Friends today I am discussing about a problem known as Alopecia Areata. What is alopecia areata? Alopecia areata is a disease that causes hair to fall out in small patches, which can remain unnoticeable. These patches may eventually connect and then become noticeable, however. This disease develops when the immune system attacks the hair follicles, resulting in hair loss. Sudden hair loss may occur on the scalp, and in some cases the eyebrows, eyelashes, and face, as well as other parts of the body. It can also develop slowly, and recur after years between instances. The condition can result in total hair loss, called alopecia universalis, and it can prevent hair from growing back. When hair does grow back, it’s possible for the hair to fall out again. The extent of hair loss and regrowth varies from person to person. There’s currently no cure for alopecia areata. However, there are treatments that may help hair grow back more quickly and that can prevent future hair loss, as well as unique ways to cover up the hair loss. Resources are also available to help people cope with the stress of the disease. What are the symptoms of alopecia areata? The main symptom of alopecia areata is hair loss. Hair usually falls out in small patches on the scalp. These patches are often several centimeters or less. Hair loss might also occur on other parts of the face, like the eyebrows, eyelashes, and beard, as well as other parts of the body. Some people lose hair in a few places. Others lose it in a lot of spots. You may first notice clumps of hair on your pillow or in the shower. If the spots are on the back of your head, someone may bring it to your attention. However, other types of diseases can also cause hair to fall out in a similar pattern. Hair loss alone isn’t used to diagnose alopecia areata. In rare cases, some people may experience more extensive hair loss. This is usually an indication of another type of alopecia, such as: alopecia totalis, which is the loss of all hair on the scalp alopecia universalis, which is the loss of all hair on the entire body Doctors might avoid using the terms “totalis” and “universalis” because some people may experience something between the two. It’s possible to lose all hair on the arms, legs and scalp, but not the chest, for example. The hair loss associated with alopecia areata is unpredictable and, as far as doctors and researchers can tell, appears to be spontaneous. The hair may grow back at any time and then may fall out again. The extent of hair loss and regrowth varies greatly from person to person. What causes alopecia areata? Alopecia areata is an autoimmune disease. An autoimmune disease develops when the immune system mistakes healthy cells for foreign substances. Normally, the immune system defends your body against foreign invaders, such as viruses and bacteria. If you have alopecia areata, however, your immune system mistakenly attacks your hair follicles. Hair follicles are the structures from which hairs grow. The follicles become smaller and stop producing hair, leading to hair loss. Researchers don’t know what triggers the immune system to attack hair follicles, so the exact cause of this condition isn’t known. However, it most often occurs in people who have a family history of other autoimmune diseases, such as type 1 diabetes or rheumatoid arthritis. This is why some scientists suspect that genetics may contribute to the development of alopecia areata. They also believe that certain factors in the environment are needed to trigger alopecia areata in people who are genetically predisposed to the disease. Alopecia alongside other skin conditions People with an autoimmune disease, like alopecia areata, are also more prone to having another autoimmune disease, including those that also affect the skin and hair. If you’ve been diagnosed with alopecia areata and another skin condition, you may find that treating one helps the other. In other cases, however, treating one may make the other worse. Psoriasis Psoriasis causes a rapid buildup of skin cells. It happens when the immune system mistakenly attacks the skin cells and causes the skin cell production process to go into overdrive. This results in thick patches of skin called plaques, as well as red, inflamed areas of skin. Treating psoriasis with alopecia can be tricky. The scaling associated with psoriasis can make the skin itchy, and scratching can make hair loss worse. In addition, biologic treatments often used for psoriasis, called TNF inhibiters, have been associated with hair loss in some people. For others, treating the psoriasis may help regrow hair. In one small study, over two-thirds of participants with alopecia areata who took a common psoriasis treatment called methotrexate had hair regrowth greater than 50 percent. Another case study found that a new psoriasis treatment called apremilast (Otezla) helped one woman with both psoriasis and alopecia regrow the hair on her scalp in 12 weeks. Atopic dermatitis (eczema) Researchers have established a link between alopecia and atopic dermatitis, a condition in which inflammation on the skin causes itchy, red rashes. Atopic dermatitis is more commonly known as eczema. Many treatment options for atopic dermatitis, like steroid creams and phototherapy, overlap with alopecia treatments, so it’s possible that treating one condition will help treat the other. One area of interest for treating both atopic dermatitis and alopecia is a class of drugs called JAK inhibitors. They’re currently used to treat rheumatoid arthritis and other conditions. One oral JAK inhibitor known as tofacinitib has already shown promise in small clinical trials for both atopic dermatitis and alopecia areata. Another biologic treatment called dupilumab (Dupixent), which has recently been approved by the FDA to treat atopic dermatitis, is also a drug of interest for treating alopecia. A clinical study evaluating dupliumab in people with alopecia — both with and without atopic dermatitis — is currently underway. How is alopecia areata diagnosed? A doctor will review your symptoms to determine if you have alopecia areata. They may be able to diagnose alopecia areata simply by looking at the extent of your hair loss and by examining a few hair samples under a microscope. Your doctor may also perform a scalp biopsy to rule out other conditions that cause hair loss, including fungal infections like tinea capitis. During a scalp biopsy, your doctor will remove a small piece of skin on your scalp for analysis. Blood tests might be done if other autoimmune conditions are suspected. The specific blood test performed depends on the particular disorder the doctor suspects. However, a doctor will likely test for the presence of one or more abnormal antibodies. If these antibodies are found in your blood, it usually means that you have an autoimmune disorder. Other blood tests that can help rule out other conditions include the following: C-reactive protein and erythrocyte sedimentation rate iron levels antinuclear antibody test thyroid hormones free and total testosterone follicle stimulating and luteinizing hormone How is alopecia areata treated? There’s no known cure for alopecia areata, but there are treatments that you can try that might be able to slow down future hair loss or help hair grow back more quickly. The condition is difficult to predict, which means it may require a large amount of trial and error until you find something that works for you. For some people, hair loss may still worsen despite treatment. Medical treatments Topical agents You can rub medications into your scalp to help stimulate hair growth. A number of medications are available, both over-the-counter (OTC) and by prescription: Minoxidil (Rogaine) is available OTC and applied twice daily to the scalp, eyebrows, and beard. It’s relatively safe, but it can take a year to see results. Anthralin (Dritho-Scalp) is a drug that irritates the skin in order to spur hair regrowth. Corticosteroid creams such as clobetasol (Impoyz), foams, lotions, and ointments are thought to work by decreasing inflammation in the hair follicle. Topical immunotherapy is a technique in which a chemical like diphencyprone is applied to the skin to spark an allergic rash. The rash, which resembles poison oak, may induce new hair growth within six months, but you’ll have to continue the treatment to maintain the regrowth. Injections Steroid injections are a common option for mild, patchy alopecia to help hair grow back on bald spots. Tiny needles inject the steroid into the bare skin of the affected areas. The treatment has to be repeated once every one to two months to regrow hair. It doesn’t prevent new hair loss from occurring. Oral treatments Cortisone tablets are sometimes used for extensive alopecia, but due to the possibility of side effects, this option should be discussed with a doctor. Oral immunosuppressants, like methotrexate and cyclosporine, are another option you can try. They work by blocking the immune system’s response, but they can’t be used for a long period of time due to the risk of side effects, such as high blood pressure, liver and kidney damage, and an increased risk of serious infections and a type of cancer called lymphoma. Light therapy Light therapy is also called photochemotherapy or just phototherapy. It’s a type of radiation treatment that uses a combination of an oral medication called psoralens and UV light. Alternative therapies Some people with alopecia areata choose alternative therapies to treat the condition. These may include: aromatherapy acupuncture microneedling probiotics low-level laser therapy (LLLT) vitamins, like zinc and biotin aloe vera drinks and topical gels onion juice rubbed onto the scalp essential oils like tea tree, rosemary, lavender, and peppermint other oils, like coconut, castor, olive, and jojoba an “anti-inflammatory” diet, also called the “autoimmune protocol,” which is a restrictive diet that mainly includes meats and vegetables scalp massage herbal supplements, such as ginseng, green tea, Chinese hibiscus, and saw palmetto Most alternative therapies haven’t been tested in clinical trials, so their effectiveness in treating hair loss isn’t known. The effectiveness of each treatment will vary from person to person. Some people don’t even need treatment since their hair grows back on its own. In other cases, however, people never see improvement despite trying every treatment option. You might need to try more than one treatment to see a difference. Keep in mind that hair regrowth may only be temporary. It’s possible for the hair to grow back and then fall out again. Homeopathic Medicines for Alopecia Areata 1. Arsenic Album – Homeopathic Medicine for Alopecia Areata Accompanied by Itching and Burning on the Scalp Arsenic Album is a recommended homeopathic treatment for alopecia areata which appears as circular bald patches along with itching and burning on the scalp. These symptoms aggravate at night. In some cases, the scalp is also sensitive. 2. Vinca Minor – Another Useful Homeopathic Medicine for Alopecia Areata Vinca Minor is another useful homeopathic medicine for alopecia areata. It works well in cases where there is a tendency for hair to fall in spots which are then replaced by white hair. Along with this, itching and violent scratching over the scalp may also be present. 3. Baryta Carb, Lycopodium, and Silicea – Homeopathic Medicines for Alopecia Areata in Young People The most prominently indicated homeopathic medicines for alopecia areata in young people are Baryta Carb, Lycopodium, and Silicea. Baryta Carb helps in recovering from bald patches that occur on the top of the scalp. Lycopodium works well for bald patches on the temples. Silicea is a good homeopathic treatment for alopecia areata occuring on the back of the scalp. 4. Fluoric Acid – Excellent Homeopathic Medicine for Alopecia Areata Fluoric Acid is among the top grade homeopathic remedies for alopecia areata. Fluoric Acid helps in the regrowth of hair in the bald patches. Fluoric Acid is also a highly suitable homeopathic medicine for hair fall after fever. 5. Phosphorus – A Wonderful Homeopathic Medicine for Alopecia Areata Another homeopathic medicine that has shown its effectiveness in alopecia areata cases is Phosphorus. Phosphorus works well in cases where a person suffers from the loss of hair in patches. Along with hair loss, dandruff on the scalp is also present. In some cases, there is itching on the scalp along with hair fall. Phosphorus also seems to help cases of traction alopecia. In such situations, there is a receding hair line. Hair fall from the forehead is prominent. A person needing Phosphorus may crave cold drinks and ice creams.
Dr. Rajesh Gupta6 Likes11 Answers - Login to View the image
Alopecia Areata (Indralupta): A case successfully treated3 with Ayurvedic Management A 32 yrs old married female was presented with history of patchy hair loss on scalp, with mild itching over affected area and gradual increment since 4 years. There was no personal history of autoimmune disorders (like Atopic dermatitis, psoriasis, Vitiligo, Asthma, Urticaria, Rheumatoid arthritis, Thyroiditis) or family history in first degree relation suggestive of these disorders.There was no personal history of recurrent patchy skin lesion either on scalp or on other body parts, major psychological disorder, or history of treatment from psychiatrist, endocrinal disorder (Diabetes), hair plucking habit, local recurrent friction or trauma or surgery, prolonged medicinal treatment before appearance of lesions. There were patchy hair loss measuring about 4x6 cm and 2x2 cm on left temporal region and occipital region respectively. There was mild dryness over patches with extremely sparse, few white and black hairs along with blackish spots. Scaling was observed on the rest area of scalp indicative of dandruff. The patient had taken the Allopathy treatment for two years and did not found control over the disease. The patient was prescribed medicines(in ayurveda centre) Manjishthadi Kwatha 20 ml twice a day, empty stomach in morning andbefore dinner was prescribed. Combination of Arogyavardhinirasa.Saptamrut Lauha,Guduchi Churna,Amalaki nd Vidanga [was prescribed twice a day along with honey before meal. Externally, Gunjabeeja Lepa was advised to be prepared at home by the patient by soaking Gunjabeeja in curd for a night and then triturating it .Then it was advised to rub over the affected part with application of the Lepa for five to ten minutes along with any liquid. Gunjaditaila was prescribed for local application after removal of Lepa. All the possible pathological factors involved in the disease were strictly stopped. Patient was allowed to visit after every 15 days as she was coming from distant city. On second visit (after 15th day), patient complained of itching and burning after application of Gunjadilepa. Redness in scalp was observed. Patient was prescribed Yashtimadhu Churna for local application along with ghrita at the time of severe itching. On third visit (after a month), no improvement was observed on the patches but dandruff was decreased. Preliminary some brownish and some whitish thin hairs appeared in some part of the bald patches [on forth visit (45th day)], then small brownish black hairs grown [on fifth visit (60th day)] and finally blackish hairs started to grow [on seventh visit (90th day)]. Both the patches were completely filled up with small hairs after four month of the treatment. Gunjadilepa was stopped then and only Gunjaditaila was continued. Spots over patches were reduced in 3rd visit and were invisible after 8th visit. The hairs on the patches gradually grown longer and after ten months, they grown as sufficient and similar as that of neighbouring area. Patient was followed every two months then after for period of two years. No recurrence was observed during this period. Reference of roga in samhita: Acharya Charaka mentions that Tejas by involving VatadiDosha when reaches the scalp, it results in Khalitya (Indralupta).According to Acharya Sushruta, Pitta along with Vata by involving the roots of hair (Romakoopa) causes fall of hair and thereafter Shleshma along with Shonita obstructs the channel of Romakoopa leading to the stoppage of the regeneration of hair and this condition is known as Indralupta, Khalitya or Ruhya.Thus Vata, Pitta and Kapha Dosha and Rakta Dushya are the main internal causative factors of Indralupta. Charaka in Vimanasthana, while describing the disorders occurring due to over indulgence in Kshara, Lavana and Viruddha Ahara has mentioned the occurrence of Hair Loss as a consequence. It has been mentioned that the Viruddha Ahara like, simultaneous intake of Lavana with milk in the diet induces Indralupta, as observed in the people of Saurashtra and Bahlika. Thus, it can be said that a person habituated to excessive Lavana or Kshara intake and taking Viruddha Ahara in routine is prone to have Indralupta.Mithya Ahara and Vihara Manoabhighata like mental stress, fright, anger, shock etc. may collectively increase the Pitta and Vata Dosha. The Ushna and Tikshna properties of Pitta get augmented whereas the Vata suffers an aggravation in Ruksha, Khara and Chala properties. Here an aggravated Pitta (Bhrajaka Pitta) supported by the vitiated Dehoshma burns the Keshabhoomi whereas an increased Vata gives rise to more frequent and comparatively prolonged ShiraSankocha by its Ruksha and Khara Guna. The Snigdhatva and the Pichchhilatva of the normal Kapha Dosha is prevalent throughout the pores of the skin so as to keep it soft and moist. By the augmentation of the Ushna, Tikshna, Ruksha and Khara properties of Pitta and Vata Doshas respectively, the Sneha and the Pichchhilatva of the Kapha Dosha are dried up within the pores of the skin of the scalp thus, obstructing the growth of new hairs, causing Indralupta. Prescribed drugs discussion: Manjisthadikashaya pacifies vitiation of kapha and pitta humours. However, it is formulated such a way that it can be effective in all types of diseases cause by all three dosha. It is mainly blood purifier. It detoxifies blood and aids to eliminate toxins accumulated in the body. It increases skin glow. Formulations Arogyavardhini Rasa, Saptamrutlauha and Vidanga causes Apatarpaan, which helps in opening the blockage of strotasa. Saptamrutlouha also helps to cure anaemic condition. Guduchi and Amalaki are rasayana drugs which help in rejuvenation process. This combination is helpful in removal of excessive fat, clearing of various types of toxins from the body and helps in reduction of accumulated cholesterol in the body. It promotes digestive fire, clears body channels for the nutrients to reach to the tissues, balances fats in the body and removes toxins by improving the digestive system. Triphala Guggulu shows detoxifying and rejuvenating actions of oral Triphala along with the anti-inflammatory and anti-infective action of guggulu was found to have a marked effect in treatment of alopecia. Triphala also heals the tissue along with increasing the digestion of the patient at the same time acting as a mild laxative. In bhaishajyaratnavali, in the treatment of Indralupta it is suggested for scraping the scalp with paste of Gunjabeeja and applied the paste for some duration. Scraping helps in removal of hair root obstruction. Application of Gunja tail after the removal of the lepa helps in itching. Triphala Kwatha helps in external purification of skin of scalp and removal of dandruff. Nidana Parivarjana was also found helpful in the management of the disease. For more information Abstract Article Link: http://www.ayurvedjournal.com/JAHM_201733_02.pdf #CurofyCampusAmbassadorAyush
Anshul Bahl17 Likes9 Answers
2 Likes