NJH-CME on Arthritis-Nov-98
NATIONAL JOURNAL OF HOMOEOPATHY 1997 Jan / Feb VOL VI NO 1.
Dr Rashmi Nagar
Continuing the NJH Bi-monthly CME sessions, this one on 28 Nov '98 was devoted to Arthritis. Dr C H Asrani narrated the common causes of Joint pain seen in routine practice. It was a very informative talk in easily comprehensible manner with diagnostic tips. It should really be titled Arthritis made easy by Dr Asrani.
He began with an emphasis on knowing what all are we treating and claiming to cure. Before blindly making a claim of curing arthritis, we, as Homoeopaths, must know whether it was arthralgia, arthritis or something else. Some pointers are:
- Look for age and onset of the diseases + signs of inflammation.
- Differentiation is to be between osteo-arthritis, rheumatoid arthritis, gout, SLE or psoriatic arthritis.
- Signs of inflammation can be seen in rheumatoid arthritis, SLE, gout or injury.
- If there are no signs of inflammation, the diagnosis has to be osteoarthritis.
- If SINGLE (MONO) JOINT is involved: gout, trauma or septic arthritis.
- Oligo arthritis - 2 joints involvement: psoriatic arthritis or bowel diseases.
- Polyarthritis: 5 or more joints: SLE or rheumatoid arthritis.
- Site: distal interphalangeal joints: osteoarthritis. Look for Haberden's nodes.
- Metacarpo-phalangeal and wrist involvement: common in rheumatoid arthritis.
- MP joint of Big toe is affected in gout. KNEE: always osteoarthritis unless proved otherwise.
- Risk Factors: Weight, accidents and athletes especially when they give up vigorous sports.
- If joints are well handled, changes set in late.
- Look for systematic pyogenic diseases like tooth infection, TB etc
- Osteoarthritis is degenerative in nature. May involve knee, hip or ankle.
- Gout: The important thing is to always do S uric acid levels test. Cases to monitor remission or cure because even if the joint is normal, patient has a risk of hypertension and renal calculus. Monitor in 3 months. In cases of trauma, do uric acid later as uric acid is deposited at the site of trauma and may give a normal reading
- RHEUMATOID ARTHRITIS: Has insidious onset, small joints are involved first. Supporting structures are eroded. Do not wait for deformity to occur. Exertion, trauma or stress can precipitate the process.
- SLE: Has genetic predisposition: malar rash on both cheeks. ESR occult blood and ANA should been done.
- In cases of Knee joint, insist on X-ray in standing position for correct assessment.
- If no joint space is seen, it requires surgical treatment.
- Do not permit squatting.
Other Important Points
1. Examination of synovial fluid is important in osteo-arthritis and rheumatoid arthritis. Polymorphs are increased with clot formation: septic arthritis. No clot formation is gout.
- ESR is increased in inflammatory and systemic disease. One must do ESR because X-Ray changes take 3 to 6 months to show.
- Simple CBC gives much information. In rheumatoid arthritis and SLE, WBC, thrombocytic count and Hb decrease can be seen.
- Look for Proteinuria.
- RA test must be done with titers. Present diagnostic criteria are 1:32 1:64 has worst prognosis. Titer's can monitor the progress of the disease.
- Sero-negative group includes septic, psoriatic, arthritic and ankylosing spondylitis. CT & MRI should be done to differentiate.
- Then he added some Thumb Rules:
- Morning stiffness, if better in 5 to 10 minutes, it is mild. If there is extreme difficulty in turning, lethargy throughout the day, rheumatoid arthritis and ankylosing spondilitis must be ruled out.
- In psoriatic arthritis look for skin patches.
- In Reiter's disease there is conjunctivitis, balanitis and arthritis. Ask H/o stn. Pharmacological.
- Take care of your P.M (evenings) and AM (morning) will be non-stiff. Counseling, rest, relaxation and splints are of utmost importance.
- Diet like sour food Agg does not have any scientific backing.
- Exercising in water has good result.
- Movement and walking must be encouraged.