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Diseases and Conditions

Empowerment Against Lyme Arthritis: A Guide to Victory

March 5, 2024
A thorough look at Lyme disease focusing on symptoms, diagnosis, and treatments, with an empathetic deep dive into Lyme arthritis

The battle against Lyme disease is a modern medical crusade, with Lyme arthritis as one of its quintessential adversaries. Understanding the intricacies of this condition, from its harbinger symptoms to the latest evidence-based treatment strategies, is crucial for both patients and medical professionals to combat and manage this insidious disease.

Lyme disease, caused by the spiral-shaped bacteria Borrelia burgdorferi and transmitted by the bite of an infected Ixodes tick, often manifests in multiple stages with distinguishing symptoms. Thus, the crux of today’s discussion centers upon recognition, diagnosis, and management, with a special focus on the rheumatic embodiment of this bacterial invasion: Lyme arthritis.

Understanding Lyme Disease: A Primer

Lyme disease begins stealthily, often with a characteristic rash called erythema migrans. It resembles a bull’s-eye, a clear central area surrounded by redness. But not everyone with Lyme disease gets or sees this rash. Fatigue, fever, chills, headache, and joint or muscle pain may follow suit. For some, this is just the onset. When Lyme disease progresses untreated, myriad complications can arise, including what is known as Lyme arthritis.

Diving Deeper into Lyme Arthritis

Lyme arthritis, a frequent late-stage manifestation of this bacterial infection, emerges as episodic bouts of swelling and pain, generally in the large joints, especially the knees. It is often overshadowed by its more serious counterparts—neurological and cardiac manifestations—but it carries a unique burden: chronic assault on the skeletal system.

The symptoms of Lyme arthritis can be severe, and they often mimic those of other diseases. The most common signs include:

Pain in one or more joints, especially the knees, ankles, elbows and wrists

  • Swelling in these same areas
  • Redness around the affected joints
  • Warmth over the affected area

The disease can also be confused with other conditions, such as rheumatoid arthritis or osteoarthritis.

Decoding the Diagnosis of Lyme Disease and Lyme Arthritis

The diagnosis of Lyme arthritis, much like other manifestations of Lyme disease, hinges on a synthesis of clinical, epidemiological, and diagnostic test findings. Clinically, Lyme arthritis typically presents as periodic bouts of inflammation and pain in the larger joints, predominantly affecting the knees. It is important to determine the risk of exposure to ticks in endemic areas, which forms an integral part of the epidemiological assessment.

To confirm the diagnosis, serological testing is employed. The Centers for Disease Control and Prevention (CDC) recommends a two-step process, beginning with an enzyme immunoassay (EIA) or an indirect immunofluorescence assay (IFA). If the result is positive or borderline, a Western blot test is conducted for verification. It’s important to note, however, that false positives can occur, and test results should be interpreted in context of the overall clinical picture.

Once Lyme arthritis is diagnosed, fluid from the affected joint(s) may be aspirated and tested to rule out other causes of joint inflammation and to confirm the presence of Lyme disease. It’s crucial to ensure accurate diagnosis to enable prompt and appropriate treatment.

The Clinical Practice Guidelines on Lyme Disease

Per the Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR),the approach to prevention, diagnosis, and treatment is methodical. For patients presenting with early signs without Lyme arthritis or other significant manifestations—such as fever or rash—oral antibiotics are the mainstay of therapy. The antibiotic of choice is doxycycline unless there is a contraindication. Other antibiotic choices include amoxicillin.

The Predicament and Approach to Lyme Arthritis

When Lyme disease evolves into Lyme arthritis, the treatment canon requires augmentation. The round of treatment is oral antibiotics. If this doesn’t work, a second round of oral antibiotics is recommended. If the second round doesn’t work, then intravenous antibiotics like ceftriaxone is started.

The Reinforcement Against Lyme Arthritis

Lyme arthritis, whilst potentially persistent and damaging, is generally responsive to antibiotic therapy. However, approximately 10% of patients may experience what’s termed antibiotic-refractory Lyme arthritis, a condition not relenting even after appropriate antibiotic treatment. In such scenarios, symptomatic management, including nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular steroids, or disease-modifying antirheumatic drugs (DMARDs), may be necessitated. Some of these DMARDs include hydroxychloroquine and methotrexate.

Chronic Lyme Disease—a term that has been the subject of much controversy, in part because it is used to describe a range of non-specific symptoms that persist after treatment. Clinical guidance emphasizes a guarded approach; the evidence supports treating Lyme arthritis clearly defined by objective signs, cautioning against prolonged antibiotic use without definitive Lyme disease evidence.

Advancing Towards Precision Medicine in Lyme Arthritis

The IDSA guidelines highlight the importance of personalized management plans, accounting for the variability in individual responses and the progression stages of Lyme disease and Lyme arthritis. The ability to study the genome and identify biomarkers for diagnosis and prognosis is a captivating horizon that could revolutionize our approach, allowing treatments tailored to an individual’s molecular makeup.

Combating Misinformation and the Future of Lyme Arthritis

The prevalence of misinformation about Lyme disease makes it important to reiterate that evidence-based medicine is the foundation for medical management, including Lyme arthritis.

Future endeavors include vaccines against Lyme disease, novel diagnostics, and even disease-modifying therapies that could alter the very foundations of Lyme arthritis treatment.

The Empathy Behind Lyme Arthritis Care

For some, Lyme arthritis is a chronic condition that can be difficult to diagnose and treat. In cases where medical therapies alone are not enough, a multi-pronged approach that combines physical therapy and lifestyle modifications can help to cushion the joints from further assaults.

One must never disregard the personal odyssey of those touched by Lyme arthritis—the pain isn’t merely physical but also psychological. Patient support groups and mental health care are equally pivotal in dealing with the repercussions of chronic illness.

In Conclusion: Your Lyme Arthritis Action Plan

Fighting Lyme arthritis is daunting, yet knowledge furnishes us with the weaponry to surmount this challenge. Remain vigilant for the signs, adhere to preventive measures, and if you suspect Lyme disease or arthritis, consult healthcare professionals promptly. They are your allies, guiding you through the forests of uncertainty toward a clearing of health.

With persistence, resilience, and informed choices, the journey with Lyme arthritis is not one of indefinite suffering but of hope, recovery, and triumph over adversity.

Call to Action

Remember, your proactive steps can signify the difference between lingering symptoms and reclaiming well-being. Take the information here as your starting point and journey towards a healthier future.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis, and treatment.

References

Lantos PM, Rumbaugh J, Bockenstedt LK, Falck-Ytter YT, Aguero-Rosenfeld ME, Auwaerter PG, Baldwin K, Bannuru RR, Belani KK, Bowie WR, Branda JA, Clifford DB, DiMario FJ, Halperin JJ, Krause PJ, Lavergne V, Liang MH, Meissner HC, Nigrovic LE, Nocton JJJ, Osani MC, Pruitt AA, Rips J, Rosenfeld LE, Savoy ML, Sood SK, Steere AC, Strle F, Sundel R, Tsao J, Vaysbrot EE, Wormser GP, Zemel LS. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis. 2021 Jan 23;72(1):1-8. doi: 10.1093/cid/ciab049. PMID: 33483734.

Diseases and Conditions RheumDoctor Learning Center

What is the Link Between HLA-B27 and Uveitis Explained

February 15, 2024

Introduction to HLA-B27

HLA-B27 is a gene that provides instructions for making a protein called major histocompatibility complex, class I, B 27 (MHC Class 1 B 27). This protein plays an important role in the immune system by presenting antigens to T-cells. Approximately 6-8% of the general population carries the HLA-B27 gene, though prevalence varies among different ethnic groups. HLA-B27 positivity is closely associated with a group of inflammatory joint conditions known as seronegative spondyloarthropathies. The most well-known of these is ankylosing spondylitis, where up to 90% of patients test positive for HLA-B27. Other associated conditions include reactive arthritis, psoriatic arthritis, inflammatory bowel disease, and acute anterior uveitis. While the exact mechanism is unclear, it is believed that HLA-B27 may present self-antigens to T-cells, triggering an autoimmune response that leads to chronic inflammation in the joints and eyes.

HLA-B27 and the Eye

The main ocular manifestation of HLA-B27 is uveitis, which is inflammation of the middle layer of the eye called the uvea. Up to 50% of cases of acute anterior uveitis are associated with HLA-B27. Although HLA-B27 is strongly linked to acute anterior uveitis, which involves the iris and ciliary body, it can also be associated with intermediate, posterior and panuveitis.

The exact mechanism for how HLA-B27 leads to increased uveitis risk is not fully understood. One theory is molecular mimicry, where HLA-B27 is similar in structure to molecules found in the eye, leading to cross-reactivity of the immune system. Another theory suggests HLA-B27 misfolds and elicits an inflammatory response. Regardless of the mechanism, HLA-B27 positive individuals have a greatly increased lifetime risk for developing recurrent uveitis.

Types of HLA-B27 Uveitis

The most common type of uveitis associated with HLA-B27 is acute anterior uveitis, which involves inflammation of the iris and ciliary body in the front of the eye. Up to 50% of all cases of acute anterior uveitis are linked to HLA-B27 positivity [1]. Anterior uveitis leads to redness, pain, and blurred vision.

While anterior uveitis is most typical, HLA-B27 positive individuals can also develop inflammation involving the posterior segment of the eye, including intermediate uveitis, posterior uveitis, and panuveitis [2]. Posterior inflammation is less common but can lead to more severe visual complications if not treated promptly.

Symptoms of HLA-B27 Uveitis

The most common symptoms of HLA-B27 associated uveitis are:

  • Acute onset of redness in one eye
  • Eye pain and discomfort, often severe
  • Blurred vision or reduced visual acuity
  • Photophobia or increased sensitivity to light
  • Tearing and discharge

Patients often describe a sudden onset of symptoms including severe pain, redness, and light sensitivity in one eye. Vision becomes blurred or cloudy. Discharge and tearing may occur as inflammation sets in. The symptoms arise rapidly and reach peak intensity over the course of a few days. Attacks often recur periodically in the same eye.

The acute anterior uveitis associated with HLA-B27 has a classic presentation but posterior uveitis involving the retina or choroid can also occur. Symptoms help differentiate anterior versus posterior inflammation. Vision loss, floaters, and photopsias point more to posterior segment issues.

In summary, the typical symptoms of HLA-B27 uveitis are unilateral red eye with blurred vision, pain, and tearing. The acute onset and recurrent nature helps differentiate it from other types of uveitis. Prompt diagnosis and treatment is key to prevent complications from repeated bouts of inflammation.

Diagnosis

Diagnosing HLA-B27 uveitis involves a comprehensive eye examination, medical history assessment, and laboratory tests. Ophthalmologists may use several methods to evaluate the type and severity of uveitis:

Slit lamp exam – This allows close inspection of the front structures of the eye. Signs of inflammation in the anterior chamber such as flair and inflammatory cells can be observed. The architecture of the iris and lens are also examined for abnormalities.

Intraocular pressure measurement – Increased pressure may indicate inflammation of the trabecular meshwork or steroid response. Low pressure can occur with severe inflammation.

Dilated pupil exam – Drops are used to open up the pupil so the ophthalmologist can thoroughly inspect the posterior segment with an ophthalmoscope. Active inflammation of the retina or choroid may be visible.

Optical coherence tomography (OCT) – This non-invasive imaging technique can reveal subtle changes in the retina and measure areas of macular edema.

Fluorescein angiography – A dye injected into the arm travels to the blood vessels in the eye. This allows detailed visualization of retinal vasculitis, vascular leakage, and macular edema.

Lab tests – HLA-B27 blood testing confirms the genetic marker. Complete blood count, inflammatory markers, syphilis testing, and x-rays may be ordered to rule out other potential causes of uveitis.

Treatment

Treatment for HLA-B27 uveitis focuses on controlling acute flare ups and preventing recurrent episodes of inflammation. The main treatments include:

  • Topical corticosteroid eye drops such as prednisolone or dexamethasone are used to rapidly decrease inflammation and symptoms during an acute attack. High potency drops may be given frequently (up to every hour) upon onset of a flare up.
  • Immunomodulatory medications can be used to reduce the body’s autoimmune response and prevent recurrent episodes of uveitis. Common options include methotrexate, mycophenolate mofetil, cyclosporine, and newer biologic agents like adalimumab or infliximab. These are often used along with low-dose corticosteroid drops to maintain remission.

According to research, “Treatment for HLA-B27 uveitis can range from local corticosteroids to immunosuppressive drugs, and now numerous studies have highlighted the benefits of tumor necrosis factor alpha inhibitors in the management of HLA-B27-associated uveitis” (Source)

The treatment plan is tailored to the individual patient based on the severity and recurrence pattern of their inflammation. The goal is to find the lowest effective doses needed to control the uveitis long-term.

Monitoring

Ongoing monitoring by an ophthalmologist is important for HLA-B27 uveitis patients to screen for potential complications and recurrent inflammation. According to the American Academy of Ophthalmology, patients should be examined 1-2 weeks after an acute attack and then every 3-6 months indefinitely if the condition is chronic. More frequent follow-up is required if ocular complications develop.

During monitoring exams, the ophthalmologist will perform a slit lamp exam to carefully inspect the anterior chamber for signs of recurrent inflammation. Intraocular pressure will also be checked to screen for steroid-induced glaucoma. Dilated fundus exam and optical coherence tomography may be done to check for cystoid macular edema and other posterior segment complications. Patients are instructed to contact their ophthalmologist immediately if symptoms of recurrent uveitis flare up between scheduled visits.

Regular monitoring aims to achieve quiescence of inflammation and prevent permanent vision loss from complications. Studies show that 60-90% of patients respond well to proper management and maintain 20/20 visual acuity long-term. However, ongoing adherence to treatment and follow-up care is imperative.

Complications

Chronic inflammation due to HLA-B27 uveitis can lead to several complications that threaten vision and eye health. The most common complications include:

Posterior Synechiae

Up to 40% of patients develop posterior synechiae, which are adhesions between the iris and lens [1]. These adhesions can permanently damage the drainage system and cause angle closure glaucoma.

Cataract

Around 20% of HLA-B27 uveitis cases result in cataract formation, particularly with repeated inflammation [2]. Cataracts cause blurred vision and eventual blindness if left untreated.

Glaucoma

Increased eye pressure is common in HLA-B27 uveitis. Glaucoma develops in up to 10% of patients and can lead to optic nerve damage and vision loss if uncontrolled [3].

Cystoid Macular Edema (CME)

Chronic inflammation can also result in CME, which is fluid accumulation in the macula causing blurred central vision. Regular eye exams are key to detecting CME early.

Prognosis

With timely diagnosis and proper management of HLA-B27 associated uveitis, the prognosis for vision is generally good. Studies show that with consistent steroid and immunomodulatory treatment to control inflammation, most patients can maintain useful vision and experience minimal complications.

According to a 10-year study published in Ocular Immunology and Inflammation, 95% of HLA-B27 positive uveitis patients achieved complete remission or only rare episodic inflammation when treated with systemic immunosuppression along with steroid eye drops. The study concluded that recurrent HLA-B27 anterior uveitis responds well to therapy and monitoring.

Patients need to work closely with their ophthalmologist for regular exams and screenings to detect recurrences early. With vigilant monitoring and treatment compliance, most can retain 20/20 vision despite having a chronic uveitis condition.

Conclusion – the importance of recognizing HLA-B27 uveitis and controlling inflammation

HLA-B27 associated uveitis can lead to significant ocular complications and vision loss if left uncontrolled. However, with prompt diagnosis and proper management, the prognosis for maintaining good vision is favorable. It is critical for both patients and physicians to be aware of the connection between HLA-B27 and uveitis.

Patients who test positive for HLA-B27 should have regular dilated eye exams to screen for signs of uveitis, even in the absence of symptoms. At the first sign of inflammation, aggressive treatment is needed to eliminate active disease and prevent recurring attacks. Though challenging to manage, chronic uveitis in HLA-B27 patients can typically be well-controlled with corticosteroid therapy and secondary immunosuppressive medications as needed.

Close monitoring for elevated eye pressure, cataracts, macular edema and other complications is also essential. Early intervention with surgery may be required in some cases. With a tailored treatment approach and ongoing care, most HLA-B27 positive patients can achieve lasting remission and preserve their vision.

Medical Disclaimer

The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this article is for general information purposes only and does not replace a consultation with your own doctor/health professional

Diseases and Conditions Journal Club

Exploring New Ways to Keep ANCA Vasculitis in Check

February 12, 2024

ANCA Vasculitis is a rare but serious condition where the body’s immune system mistakenly attacks its own blood vessels, causing inflammation. This falls into a group of illnesses known as autoimmune diseases. Each year, about 3 out of every 100,000 people get diagnosed with it, mainly those who are between 50 and 70 years old. One of the biggest hurdles in treating ANCA Vasculitis is preventing it from coming back, which calls for some creative solutions to keep the disease in remission.

A groundbreaking study titled “Maintenance of Remission of ANCA Vasculitis by Rituximab Based on B Cell Repopulation Versus Serological Flare: A Randomised Trial” sheds light on a novel tactic for tackling this challenge. It zeroes in on the drug Rituximab, which helps calm the immune system’s overreaction that’s at the heart of this condition.

Why Focus on Rituximab for ANCA vasculitis?

Rituximab targets B cells, which play a big part in the body’s overactive immune response seen in ANCA Vasculitis. Doctors usually give this medication when they notice B cells coming back after treatment or when there’s a spike in ANCA levels, which can mean the disease is flaring up.

The Two Approaches Explained

The study looks at two ways of deciding when to give extra doses of Rituximab:

  • The first way is based on whether B cells are starting to show up again after being knocked down by treatment.
  • The second way relies on monitoring ANCA levels in the blood, even if the patient isn’t showing any symptoms, to catch any potential flare-ups.

What the Study Found

This research offers new insights by comparing these two strategies. It found that using Rituximab based on the return of B cells leads to fewer relapses than waiting for ANCA levels to rise, over an average follow-up of 4.1 years. This result supports the idea that tailoring treatment to each patient’s specific situation can really make a difference in managing complex autoimmune diseases like ANCA Vasculitis.

However, both methods have their challenges, such as predicting disease flares accurately and the feasibility of frequent testing. The study also closely monitored safety, noting similar side effects in both groups but a slightly higher risk of serious issues related to COVID-19 in those treated based on B cell repopulation.

Personalized Care for ANCA Vasculitis is Key

The findings highlight that there’s no one-size-fits-all answer to treating ANCA Vasculitis. Some patients might do better with one approach over the other, emphasizing the importance of customizing treatment plans.

Looking Ahead

This study is a significant step forward in improving how we maintain remission in ANCA Vasculitis. It encourages us to keep asking questions and searching for better ways to care for those affected by this disease.

Even though the medical terms might sound complex, they’re part of understanding how to best manage ANCA Vasculitis. As we work to unravel these complexities, it’s crucial to keep learning, adapting, and showing compassion for those living with this condition.

This research marks an important progress in our journey, and we’re committed to sharing the latest and most accurate information to help make informed health decisions. Our dedication to understanding and empathizing with your health challenges stands firm.

References

Zonozi R, Cortazar FB, Jeyabalan A, Sauvage G, Nithagon P, Huizenga NR, Rosenthal JM, Sipilief A, Cosgrove K, Laliberte KA, Rhee EP, Pendergraft WF 3rd, Niles JL. Maintenance of remission of ANCA vasculitis by rituximab based on B cell repopulation versus serological flare: a randomised trial. Ann Rheum Dis. 2023 Dec 11:ard-2023-224489. doi: 10.1136/ard-2023-224489. Epub ahead of print. PMID: 38123922.

Medical Disclaimer

The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this article is for general information purposes only and does not replace a consultation with your own doctor/health professional

Diseases and Conditions Tips and Tricks

How to Care for Your Oral Health with Sjogren’s Syndrome

February 6, 2024

Today we’re going to learn about Sjogren’s syndrome oral health and steps you can take to protect your teeth and gums. But before we delve into the matter, let’s talk about Sjogren’s Syndrome.

Introduction to Sjögren’s Syndrome

Sjögren’s syndrome is an autoimmune disorder that affects the body’s moisture-producing glands like the salivary and tear glands. This causes symptoms of dry eyes and dry mouth and can negatively affect your oral health. Sjögren’s syndrome mostly affects middle-aged women, with 9 out of 10 Sjögren’s patients being female. The condition can occur at any age though, including childhood.

Sjögren’s syndrome is considered a systemic disease because it can affect organs and body systems beyond the eyes and mouth. However, the hallmark symptoms remain dry eyes and dry mouth due to impaired gland function. According to a 2014 study, the prevalence of primary Sjögren’s syndrome ranges from 0.01 to 0.72% of the population).

How Sjögren’s Syndrome Affects Saliva Production

Sjögren’s syndrome is an autoimmune disease that attacks the body’s exocrine glands, including the salivary glands. This leads to significant reductions in saliva and tear production. The hallmark symptom of Sjögren’s is dry mouth, also known as xerostomia. With Sjögren’s, the salivary glands become inflamed and damaged, impairing their ability to produce saliva. This results in chronic feelings of dry mouth.

Saliva plays a critical protective role in oral health. Having minimal saliva in the mouth due to Sjögren’s syndrome can allow bacteria to grow, leading to increased risk of tooth decay and fungal infections. Lack of saliva also makes chewing and swallowing food more difficult. According to the National Institutes of Health, nearly all patients with primary Sjögren’s syndrome report symptoms of dry mouth.

Without adequate saliva to lubricate and rinse the teeth and gums, Sjögren’s patients face heightened risk of cavities, gum disease, mouth sores, and other dental problems. Ensuring proper oral hygiene is especially important for Sjögren’s patients due to reduced saliva production.

Dry Mouth and Sjogren’s Syndrome Oral Health Complications

Sjögren’s syndrome dramatically reduces saliva production, resulting in a chronic dry mouth condition known as xerostomia. Saliva is critical for oral health, and without adequate saliva flow, Sjögren’s patients experience uncomfortable dry mouth symptoms and an increased risk of dental problems.

Common dry mouth symptoms caused by Sjögren’s syndrome include:

  • Chapped or cracked lips
  • Burning or tingling sensation in the mouth
  • Difficulty chewing, speaking, and swallowing
  • Dry, sticky, or burning tongue
  • Mouth sores or infections
  • Bad breath

With decreased saliva production, Sjögren’s patients are also at higher risk for complications like gum disease, tooth decay, and oral fungal infections. Dry mouth creates an environment favorable to bacteria growth, acid damage, and irritation.

Specifically, Sjögren’s patients may experience:

  • Increased dental cavities due to lack of saliva’s buffering capacity and remineralization properties
  • Gingivitis and periodontitis as saliva is not present to wash away plaque and acids
  • Oral thrush or candidiasis fungal infections in the mouth

Left untreated, dry mouth can seriously impact oral health over time. That’s why managing symptoms and dental care are so important for Sjögren’s patients.

Other Sjogren’s Syndrome Oral Health Problems

In addition to dry mouth, Sjögren’s syndrome can lead to several other oral health issues including:

Tooth decay – With less saliva to wash away food and neutralize acids, cavities can develop more frequently (https://pearlypros.com/category/cosmetic-dentistry/oral-health-tips/).

Gum disease/infections – Dry mouth allows bacteria to grow, increasing risk of gingivitis, periodontitis and other infections (https://m.facebook.com/kabanidental/posts/4169354456419345/).

Fungal infections – Candida fungus thrives in the dry mouth environment.

Mouth sores – Lack of protective saliva causes sensitive tissue in mouth to crack and ulcerate.

Loss of taste – Saliva helps stimulate taste buds. Reduced saliva flow can diminish the sense of taste.

Importance of Saliva for Oral Health

Saliva is critical for maintaining good oral health. It serves several key functions:

Lubricates and Protects Tissues – Saliva acts as a lubricant for the mucous membranes in the mouth and throat. This helps protect against friction that can cause irritation or damage. The lubricating properties of saliva also keep the mouth comfortable and aid in functions like talking and swallowing.

Neutralizes Acids – Saliva contains minerals like calcium and phosphate that help neutralize acids in the mouth. Acids are produced when plaque bacteria metabolize sugars and attack tooth enamel. Saliva helps restore a neutral pH balance to prevent acid erosion of enamel.

Contains Minerals That Strengthen Enamel – Saliva provides a constant source of calcium, phosphate, and fluoride ions that are essential for re-mineralizing and strengthening tooth enamel. Minerals in saliva help protect teeth from bacterial acids and also aid in repairing early tooth decay.

With reduced saliva production, these protective factors are diminished. This puts Sjögren’s patients at a much higher risk of gum disease, tooth decay, and other problems.

Managing Dry Mouth

There are several methods Sjögren’s syndrome patients can use to help manage dry mouth symptoms and increase comfort:

  • Sipping cool water – Keeping hydrated by frequently sipping cool water can help provide relief and moisture.
  • Saliva substitutes – Artificial saliva sprays or gels can serve as saliva substitutes to coat and lubricate the mouth. Some examples are Biotene, Oasis, and Xerolube.
  • Alcohol-free mouth rinses – Swishing with alcohol-free oral rinses without irritating ingredients can help moisten the mouth. Some options are Biotene, ACT Total Care, and Crest Pro-Health rinses.
  • Chewing gum – Chewing sugar-free gum stimulates saliva production and can help keep the mouth moist. Look for brands containing xylitol.
  • Moisturizing sprays and gels – Moisturizing oral sprays and gels provide quick, temporary relief. Products like Mouth Kote and Oasis moisturizing gels can coat and hydrate the mouth.

Patients should work with their dentist to determine the best dry mouth remedies based on their symptoms. Using a combination of methods throughout the day provides the most effective relief.

Source: https://sjogrens.org/sites/default/files/inline-files/Sjogrens-DryMouth.pdf

Daily Sjogren’s Syndrome Oral Health Recommendations

Maintaining good oral hygiene is essential for Sjögren’s patients to prevent cavities, gum disease, and other dental problems. Here are some tips for keeping your mouth healthy on a daily basis:

Brush gently with a soft-bristled toothbrush. Use gentle, circular motions when brushing and avoid scrubbing aggressively on your teeth and gums. This helps prevent abrasions or irritation of the soft tissues.

Use a fluoride toothpaste. Fluoride helps strengthen enamel and prevent cavities, which is very important for those with dry mouth. If your mouth is very dry, look for toothpastes specially formulated for dry mouth.

Floss once daily. Flossing removes plaque and food particles between teeth that brushing misses. Be very gentle when flossing if you have inflamed gums.

Ask your dentist about fluoride treatments. In-office fluoride treatments or prescription high-concentration fluoride gels can help protect your teeth by strengthening weakened enamel.

Don’t forget to brush your tongue to help freshen breath. End each day with a thorough brushing and flossing to keep your mouth clean while sleeping.

Seeing the Dentist Regularly

It is critical for Sjögren’s patients to see their dentist regularly, every 6 months, so they can monitor symptoms and get preventive treatments.

During dental checkups, patients should discuss any dry mouth symptoms, cavities, tooth sensitivity, gum recession, and other issues with their dentist. Getting exams twice a year allows dentists to track changes in oral health over time.

The dentist may recommend more frequent cleanings or fluoride treatments to help prevent cavities in Sjögren’s patients. They can also advise patients on proper brushing techniques for sensitive teeth and receding gums.

Other preventive dental treatments that may help Sjögren’s patients include dental sealants to protect teeth from decay and prescription strength fluoride toothpaste or varnish.

Finding a dentist experienced in treating Sjögren’s patients can provide specialized care and advice. Research local dentists to find one familiar with dry mouth management and preventive dental care.

With routine exams and treatments, Sjögren’s patients can minimize oral health issues despite reduced saliva. Seeing the dentist regularly is key to maintaining dental health.

Sjogrens Syndrome Oral Health Considerations

There are some special dental considerations for Sjögren’s syndrome patients to be aware of.

Toothpaste for Dry Mouth

Using a toothpaste made specifically for dry mouth can help Sjögren’s patients protect their teeth. These toothpastes are formulated to be extra gentle and to help stimulate saliva production. They also contain ingredients like xylitol and calcium to help strengthen tooth enamel and neutralize mouth acids.

Finding Support for Oral Health

Living with Sjögren’s syndrome and dealing with the oral health complications can feel overwhelming at times. However, there are excellent resources and support systems available to help you manage your oral health:

  • Connect with national and local patient foundations like the Sjögren’s Syndrome Foundation (SSF). The SSF provides education, awareness, and support programs to empower patients. Joining local support groups can also help you connect with other patients facing similar challenges.
  • Build a collaborative relationship with your dentist so you can work as a team to protect your oral health. Make sure to discuss all your symptoms openly and get specialized guidance for your unique needs.
  • Ask your dentist to coordinate with your rheumatologist for a more integrated treatment approach.
  • Consider getting a second opinion if you feel your oral health needs are not being adequately addressed.
  • Stay on top of regular dental visits and cleanings every 6 months.

You don’t have to manage Sjögren’s oral health complications alone. By utilizing available resources and being your own advocate, you can maintain better dental and gum health.

Medical Disclaimer

The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this article is for general information purposes only and does not replace a consultation with your own doctor/health professional

Diseases and Conditions

Is Knuckle Cracking Bad for Arthritis?

January 23, 2024

Is Knuckle Cracking Bad

The distinct pop and crack of knuckles being pulled and stretched is a familiar sound to many. You may not even realize how often you crack your knuckles until you consciously try to stop the habit. Up to 54% of people report regularly cracking their knuckles, whether for stress relief, simple habit, or just liking the sensation. But is this harmless fidgeting or is knuckle cracking bad for arthritis?

Anatomy of Knuckles

The knuckles are the joints that connect the bones of the fingers. Each finger has three joints called the distal interphalangeal (DIP), proximal interphalangeal (PIP), and metacarpophalangeal (MCP) joints 1. The thumb only has an MCP and DIP joint.

The MCP joints are where the main part of your hand meets your fingers, letting your fingers bend and straighten. The PIP joints are in the middle of your fingers, helping them to move too. The DIP joints are at the very end of your fingers and they let you bend the tips of your fingers. 2

The knuckles are covered by a special pocket of filled with a fluid. This fluid is called synovial fluid and it helps them move without any friction. There are strong bands called ligaments on the sides of the knuckles that keep them in place, and there are also protective plates in front of them. The finger bones are connected to the muscles of the hand and forearm by tendons, which help you move your fingers.

What Creates the “Cracking” Sound

The cracking or popping sound when knuckles are cracked is not caused by the bones themselves cracking, but rather by the gases being released from the fluid inside the knuckle joints. The current theory is that it is caused by the gases rapidly coming out of solution from the synovial fluid inside the joint capsules.

As Dr. Robert Klapper, an orthopedic surgeon at Cedars-Sinai Medical Center explains, “The noise of cracking or popping in our joints is actually nitrogen bubbles bursting in our synovial fluid” (source).

Similarly, according to a Scientific American article, “The cracking or popping sound is thought to be caused by the gases rapidly coming out of solution, allowing the capsule to stretch a little and decompress the joint” (source).

So in summary, the cracking sound comes from the release of gases from the joint fluid, not from the actual bones cracking or breaking.

Short Term Effects

When you crack your knuckles, you may experience some short term effects in the minutes and hours afterwards. One common sensation is a feeling of relief or release after cracking knuckles. This is likely due to the stretching and loosening of ligaments surrounding the joint during the cracking process.

Some research has found that immediately after cracking knuckles, grip strength can increase by up to 25% for a brief period. Castellanos and Axelrod (1990) measured hand strength before and after knuckle cracking and observed this temporary boost in grip force.

However, other short term effects are less beneficial. There may be some mild swelling and inflammation around the joint capsule after cracking. One study using MRI scans found more joint swelling in the knuckles of habitual knuckle crackers compared to non-crackers. This suggests frequent knuckle cracking could irritate the joint tissue.

Long Term Effects

The main question around knuckle cracking is whether or not it increases your risk of developing arthritis over time. There have been several key studies that have looked into this.

One study published in the Journal of the American Board of Family Medicine looked at 215 people ages 45-89 who had cracked knuckles on one hand for many years. They did not find any increased signs of arthritis on x-rays in the hand they cracked vs the one they did not.1

Another study followed 300 people over 50 years. Some were habitual knuckle crackers while others were not. But there was no difference in the incidence of arthritis between the two groups, leading the researchers to conclude knuckle cracking does not appear to increase arthritis risk.2

So the evidence indicates that knuckle cracking itself does not cause or worsen arthritis. However, a study in 1990 and 2018 did find that people who cracked knuckles frequently had more swollen hands and reduced grip strength compared to those who did not crack often. So while it may not directly lead to arthritis, habitual knuckle cracking can increase inflammation and impact hand strength and dexterity over time.

Other Risks

Although habitual knuckle cracking is generally harmless, there are risks with too forcefully or excessively cracking the knuckles. Cracking the knuckles with excessive force can potentially cause ligament or tendon injuries, though this is very rare. Sometimes it can it cause a finger to dislocate but this is very rare.

Additionally, the sound of knuckle cracking can be annoying or disruptive to those around you, especially if done frequently throughout the day. While not inherently dangerous, the noise and habit can be bothersome. According to a study cited by Harvard Health, knuckle cracking is associated with other habits like nail biting, smoking, and drinking alcohol 3.

Conclusion

Overall, research indicates knuckle cracking is not inherently dangerous or harmful when done in moderation. While the sound may be disconcerting, studies show it does not do damage to the joints or increase risk of arthritis. However, those who crack habitually and aggressively should exercise caution, as this can irritate the joints and tendons and lead to reduced grip strength.

Though not conclusively proven to be benign, cracking knuckles generally does not cause serious issues for most people. It appears to be more of an annoying personal habit than a major health concern. However, moderation is still advisable, as excessively forceful cracking could potentially injure joints and ligaments.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis 

Diseases and Conditions When to see a rheumatologist

Signs you may be at risk for psoriatic arthritis

January 16, 2024
signs you may be at risk for psoriatic arthritis

Psoriatic arthritis is a type of inflammatory arthritis that occurs in people with psoriasis, an autoimmune condition affecting the skin. It causes swelling, stiffness and pain in the joints as well as nail changes and overall fatigue.

Psoriatic arthritis can be difficult to diagnose in its early stages but it’s important to identify and treat it quickly. Early treatment helps relieve symptoms, improve quality of life, and potentially slow down the progression of joint damage that can occur if the disease advances untreated.

Joint Pain

One of the most common early symptoms of psoriatic arthritis is persistent joint pain, swelling, and stiffness (Mayo Clinic). This pain often affects the large joints like the knees, ankles, elbows, and wrists, but can also impact smaller joints like those in the hands and feet.

The joint pain of psoriatic arthritis tends to be asymmetric, meaning it occurs on just one side of the body rather than symmetrically on both sides. The pain and stiffness tend to be worse when joints are at rest, and improves with movement. Psoriatic arthritis joint pain may also alternate between periods of flare ups and remission.

It’s important to note that psoriatic arthritis joint pain can occur even in people who do not have skin psoriasis. The joint symptoms may precede the skin lesions in some cases. Persistent joint pain, swelling, and stiffness, especially when asymmetric and alternating between flares and remission, can be an early sign of psoriatic arthritis.

Fatigue

Fatigue is a very common symptom of psoriatic arthritis, with studies showing that up to 80% of people with PsA experience some degree of fatigue (SOURCE). The chronic inflammation associated with PsA can contribute to feelings of tiredness and lack of energy (SOURCE). This type of fatigue is different than normal tiredness after a long day – it is often described as an overwhelming, debilitating exhaustion that affects your ability to perform daily activities.

Psoriatic arthritis fatigue can range from mild to severe. You may feel generally run down or constantly drained. Simple tasks like grocery shopping, cleaning or caring for your family may wipe you out. This fatigue can be mentally exhausting as well, making it hard to concentrate or be productive. Unlike normal tiredness which gets better with rest, psoriatic arthritis fatigue may persist even when you get adequate sleep.

If you are experiencing new, unexplained and persistent fatigue along with other psoriatic disease symptoms like joint pain, stiffness or skin changes, be sure to contact your doctor. Finding the right treatment can help manage inflammation and greatly improve psoriatic arthritis fatigue.

Joint Redness and Warmth

One early symptom that should prompt suspicion of psoriatic arthritis is redness and warmth over the joints, especially when it is confined to one side of the body. Unlike regular aches and pains, the joints affected by psoriatic arthritis often become noticeably red and feel warm to the touch. This occurs when the immune system mistakenly attacks the joints, causing inflammation. According to the Mayo Clinic [“results”][0][“url”]}>, this redness and warmth is a hallmark feature of inflammatory types arthritis like psoriatic arthritis.

Some people first notice the redness and warmth before feeling any arthritic pain or stiffness. The joints most likely to develop redness and warmth are those in the hands, wrists, elbows, knees, ankles and feet. If you notice persistent redness and warmth in these joints, particularly if it is asymmetric and predominately affecting one side, be sure to point this symptom out to your doctor during your appointment. Redness and warmth in your joints in combination with other psoriatic symptoms should prompt referral to a rheumatologist for further evaluation for psoriatic arthritis.

Swollen Fingers/Toes

One early sign of psoriatic arthritis is dactylitis, also known as “sausage digit.” This refers to swelling in the fingers or toes that causes them to appear sausage-like. Dactylitis is caused by inflammation of the tendons and soft tissues of the digits. According to the National Psoriasis Foundation, dactylitis affects roughly 40-50% of people with psoriatic arthritis[1]. It often presents before any joint damage is apparent.

Dactylitis most commonly affects the middle joint of the fingers or toes, though it can occur in the wrist, ankles, and feet as well. The swelling and inflammation is often asymmetric, meaning it appears on just one finger or toe at a time, rather than symmetrically on both sides. Dactylitis causes stiffness, pain, and limited mobility in the affected digits. If you notice sausage-like swelling in your fingers or toes, it is important to see a doctor promptly, as it may be an early red flag for psoriatic arthritis[2].

Nail Changes

Nail changes are a common early sign of psoriatic arthritis. The most frequent nail manifestations are pitting, grooves, and detachment of the nail from the nail bed (onycholysis).

Pitting appears as small depressions or holes in the nail surface and gives the nail a spotted look. These pits are caused by defects in nail growth. Pitting occurs in up to 50% of those with psoriatic arthritis[1].

Nail grooves are furrows or channels that run vertically down the nail. They may be deep or superficial lines. Grooves are present in around 25% of psoriatic arthritis patients[2].

Onycholysis refers to separation of the nail from the nail bed. The nail becomes detached from the skin underneath. This occurs when inflammation damages the nail matrix. Onycholysis is seen in approximately 10-15% of those with psoriatic arthritis[3].

Getting early treatment for psoriatic arthritis can help prevent permanent nail deformities. See a doctor if nail changes accompany joint pains.

Lower Back Pain

Lower back pain is a common symptom of psoriatic arthritis. About 30-50% of people with psoriatic arthritis will experience pain and stiffness in their lower back caused by inflammation of the joints in the spine 1. This is known as axial arthritis or spondylitis. The lower back is commonly affected before other areas of the spine.

Lower back pain from psoriatic arthritis often comes on slowly and worsens over time. It can range from mild to severe. The pain and stiffness tend to be worse in the morning and improve with movement and activity. However, prolonged sitting or standing can also aggravate the pain. Lower back pain from psoriatic arthritis may switch between sides or stay on one side consistently.

If you have lower back pain along with other symptoms of psoriatic arthritis like joint swelling and skin changes, be sure to see a rheumatologist. Getting an early and accurate diagnosis is key to preventing permanent spinal joint damage. Treatment for psoriatic spondylitis aims to relieve pain, improve function, and slow the progression of the disease.

Signs you may be at risk for psoriatic arthritis

If you experience any symptoms of psoriatic arthritis, it’s important to schedule an appointment with your doctor to get an evaluation. The earlier psoriatic arthritis is diagnosed, the better the outcome with treatment. You should see a doctor if you have:

  • Joint pain, swelling, or stiffness that persists for more than 2 weeks (https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/symptoms-causes/syc-20354076)
  • Redness or warmth over joints
  • Swollen fingers or toes that look like sausages
  • Morning joint stiffness lasting over 30 minutes
  • New pitting, ridges, or separation of the nails (https://www.healthline.com/health/psoriatic-arthritis-early-signs)
  • Fatigue that is not relieved by rest
  • Lower back pain, especially with joints affected elsewhere

Don’t dismiss unexplained joint pain or wait and see if it goes away. The sooner psoriatic arthritis can be diagnosed, the better the outcome with early treatment to relieve symptoms and slow disease progression. See a doctor right away if you have psoriasis and develop any joint pain or swelling.

Medical Disclaimer

The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional