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	I was born deaf. I'm now 44 years old. I have had a severe case of rheumatoid arthrits for 27 years. My deformed joints with subcutaneous nodules, especially my hands, are already damaged. I also have osteoporosis, inflammatory bowel syndrome (IBS) and some gastric erosions. I'm taking Arava, Tenoxicam, Actonel, Ranintide, calcuim and multivitamins with minerals. Do you have any suggestions on how someone might be able to prevent IBS and gastric erosions? Also, I cherish the use of my hands because I use American Sign language. Any thoughts on what might be done to stop my hands from getting worse in the future would be appreciated.
	To prevent your hands from worsening, the arthritis must be well controlled. Adding a biological agent like anti-tumour necrosis factor (anti-TNF e.g. etanercept) could lead to better control of the inflammation and joint damage. Cortisone injections into any inflamed hand and wrist joints could also be helpful. A physiotherapist and occupational therapist could provide you with an exercise program, splints and joint protection education and aids for your hands. Periodic consultations with a hand surgeon could detect problems at an early stage so that only minor surgery would be needed. The gastric erosions might improve by switching the tenoxicam (a nonsteroidal anti-inflammatory drug) to a COX-2 anti-inflammatory drug like celecoxib or rofecoxib and switching the ranitidine to a PPI (protein pump inhibitor) like omeprazole. I am not sure what you mean by IBS. There is "Irritable Bowel Syndrome" which is treated by diet and sometimes medications. There is also "Inflammatory Bowel Disease" which includes ulcerative colitis and Crohn's disease. The medications used are much like the medications used to treat rheumatoid arthritis. Crohn's disease can be helped by anti-TNF drugs. Inflammatory bowel disease can sometimes be made worse by nonsteroidal anti-inflammatory drugs. Also Arava can cause diarrhoea. Consultation with a gastroenterologist about your stomach and bowel is advisable.
	Answered on: January 10, 2003

	Has there ever been research into a possible connection between a woman's pre-menopausal phase and rheumatoid arthritis?
	There have been some studies in this area but not enough to draw definite conclusions. Up to 50% of women experience joint discomfort of various types through menopause. The peak incidence of rheumatoid arthritis (RA) in females is around the time of menopause. It does not seem to be related to a reduction in estrogen but there may be a relationship to the lack of progesterone and/or androgens ('male hormones' from the adrenal gland). Menopause may be associated with the worsening of the disease activity and the joint damage in pre-existing RA, but there is not enough evidence to be certain of this. The onset of RA is commoner when menopause occurs at a younger age. Abstinence from smoking cigarettes may reduce the risk of developing RA in post-menopausal women. One study showed that estrogen replacement in post-menopausal women did not protect against the occurrence of RA whereas another study did. One study showed a possible modest reduction in the risk of developing RA in the post-menopausal female with the brief use of progesterone but not of estrogen. However, there is no evidence that estrogen replacement therapy worsens RA. There is a definite reduction in the frequency of fractures due to osteoporosis in post-menopausal women with RA who take estrogen replacements.
	Answered on: January 06, 2003

	I am a volunteer who supports breastfeeding mothers. One of the benefits of breastfeeding which is often touted is that immunities are conferred on babies who are breastfed, through their mother's milk. Have there been any studies done which evaluated whether breastfeeding confers resistance or immunity to individuals from auto-immune diseases such as rheumatoid arthritis or lupus?
	I know of no studies that evaluated the chances of a BABY developing rheumatoid arthritis (RA) or lupus later in life depending on whether they were breastfed or not. However, breastfeeding may reduce the chances of the MOTHER developing RA or lupus. A study by Karlson EW et al from the Brigham & Women's Hospital in Boston was presented at the American College of Rheumatology meetings in New Orleans, November, 2002. It showed that women who spent a total of 2 years or more breastfeeding may be 50% less likely to develop RA than those who breastfed for less than 3 months. Cooper G et al, from the NIH (National Institutes of Health in the USA), published a study in the journal, Arthritis and Rheumatism, 2002, volume 46, pages 1830-39, that showed that women who breastfed had a lower chance of developing systemic lupus erythematosus (associated with the number of babies breastfed and the total number of weeks of breastfeeding).
	Answered on: January 02, 2003

	I am a 29-year-old male recently diagnosed with gout. I am an athelete and am having a lot of trouble meeting my protein needs, with my severe reduction of all animal protein. I have tried to introduce small amounts of animal products and everytime the next day the gout is worse. Any suggestions? I am also not into taking medications for the long run. Any natural ideas?
	You are young for gout. The diagnosis should be verified. Gout is related to an excess of uric acid in the body. A diet high in purines, alcohol, dehydration, diuretics and low doses of aspirin may raise these uric acid levels. Alcohol, diuretics and low doses of aspirin should be avoided. As an athlete, you may get dehydrated during your activities. You must make sure that you drink a lot of water so that your kidneys can adequately clear the uric acid from your body. Purines come from the nuclei of cells; cells will be found in meats especially organ meats like liver and kidney; fish and certain vegetables like lentils. However, not all protein sources contain cells and there are protein and amino acid supplements. It would be a good idea to see a dietician re: a high protein, low purine diet. The use of fish oils and plant seed oils like gamma-linolenic acid (GLA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) might prevent the gouty inflammation. They can be obtained in health food stores. Other types of omega-6 fatty acids ( found in e.g. safflower, corn, sunflower and cottonseed oils) might contribute to worsening the gouty inflammation so that you should avoid processed foods, some of the fat in meat and fried foods. Again this should be discussed with a dietician. Trauma to the big toes during athletics might precipitate gouty attacks in the big toes. Wearing good shoes and orthotics that protect the big toes might be helpful.
	Answered on: December 20, 2002

	I am 47, have flat feet and was diagnosed with patello-femoral syndrome some years ago. I have orthotics but they seem to throw my back out of alignment. I also do regular yoga practice, physiotherapy exercises and swim. Yoga and swimming appear to exacerbate the problem. What can I do to continue these forms of exercises and protect my knee?
	Patellofemoral syndrome is characterized by pain around and behind the kneecap (patella) and a sensation of weakness of the front thigh muscles (quadriceps). The pain is worsened by going up and down stairs, arising from a crouch or prolonged sitting and sports that involve running, jumping and quick stops and starts. If the cartilage behind the kneecap becomes damaged, it is referred to as chondromalacia patellae. This syndrome is caused by abnormalities in the position of the kneecap as it glides over the lower end of the thighbone (femur). Abnormalities of positioning can be due to tilting of the kneecap, a high-riding kneecap, overly tight or lax ligaments of the kneecap, weakness of the muscles stabilizing the kneecap (especially the vastus medialis) and abnormal limb alignment (e.g. knock-knees or turned-in (pronated) ankles and flat feet). It is most important to work with a physiotherapist experienced in patellofemoral syndrome. It may take up to 9 months of continuous exercise to strengthen and stretch the muscles, ligaments and tendons to resolve the pain. Strengthening the quadriceps especially the vastus medialis is required. The hamstrings become tight with patellofemoral syndrome and with low back problems causing more patellofemoral pain by increasing the flexion of the knees . The hamstrings must be stretched and loosened up. If the lateral retinaculum (a broad ligament that prevents the kneecap from moving too far medially) is tight, it should also be stretched. Activities that worsen the pain should be avoided as much as possible. If there is pain with prolonged sitting, sit in a high chair so that your legs dangle and/or put a stool under your feet so that you can straighten out your knees somewhat. The physiotherapist could also help identify aspects of your yoga and swimming that worsen your knee and back pain. Your shoes and orthotics should be reassessed. The arch supports may be too high. Your yoga and swimming techniques could be reviewed by competent instructors. A neoprene knee support with a hole for the patella could be tried. If the patellofemoral symptoms persist, than you should be seen by an orthopedic surgeon with expertise in such knee symptoms to determine the cause of the abnormal tracking of your kneecaps and to rule out other causes of similar pain such as a plica (an extra fold of synovial membrane entrapped behind the patellar mechanism that becomes irritated). Some of these problems could be amenable to arthroscopic surgery.
	Answered on: December 10, 2002

	I have had rheumatoid arthritis for two years and have been taking methotrexate and folic acid. I'm very concerned that I'm only seeing my family doctor and I feel that I need more care than he could provide. He's suggesting that any general practitioner can manage my care. I don't agree. How would you suggest I go about getting an appointment with a specialist?
	I have discussed your question with the authors of the book, "Rheumatoid Arthritis: Plan to Win" (by Cheryl Koehn, Taysha Palmer and John Esdaile. New York: Oxford University Press, 2002). Here is a quote from their book: "Given a rheumatologist�s expertise with arthritis, it comes as no surprise that in a clinical survey of arthritis patients, rheumatologists were found to provide more relief from the symptoms of arthritis than any other healthcare professional.11 People with RA under the care of rheumatologists also experience better long-term health outcomes through their treatment. However, we do suggest that if at all possible, you see a rheumatologist who has a major interest and experience in RA (as opposed to one of many other forms of arthritis, such as lupus, fibromyalgia or osteoarthritis). Ideally, your rheumatologist will be treating 100 or more people with RA." (pg 36). Someone who is having difficulty being referred to a rheumatologist by their GP should consider the following steps: Ask the GP for a referral to a rheumatologist If the GP resists but you like the general health care the GP is giving, assure the GP that you will continue seeing them, but that research shows (cite quote above) that by including a rheumatologist as part of the care team, folks with RA do better. In addition to your present drugs, other and newer medications and combination therapy, physiotherapy, occupational therapy, early orthopedic intervention, RA complications, joint examinations, need for X-rays etc. must be considered throughout the course of this disease. If the GP will not give the referral, then switch GPs. Your concerns should be addressed and your needs met when practical.
	Answered on: December 03, 2002

	My 71 year old mother has very bad osteoarthritis in her lower spine. Can you discuss the safety and side effects of cortisone shots? Please note she also has a heart condition and has had two heart attacks.
	Cortisone injections are relatively safe. Side-effects can be local or generalized (systemic). They can be due to the needle puncture, the cortisone and the local anaesthetic. Local side-effects caused by the needle puncture include bleeding, introduction of infection and nerve injury. Local side-effects caused by the cortisone include loss of pigment from the overlying skin, atrophy or wasting of the fat layer under the skin leading to a permanent depression and local inflammation with pain and tenderness lasting a few hours to a day or two. Generalized reactions to the cortisone may include flushing, sweating, elevation of the blood pressure, rise in the blood sugar, drop in the blood potassium, fluid retention, allergic reactions and transient emotional changes such as depression, nervousness and euphoria. Generalized side-effects can also be due to the local anaesthetic (usually xylocaine), for example, dizziness, drowsiness, numbness, allergic reactions, drop in blood pressure, slowing of the heart rate and confusion. The fluid retention, fluctuations of blood pressure, loss of potassium or slowing of the heart rate could aggravate the heart condition but suitable precautions taken beforehand would minimize the chances of anything serious happening. By and large, cortisone injections of the lower spine are safe even when there is a heart condition as long as the precautions are handled.
	Answered on: November 14, 2002

	I am 25 years old, and was diagnosed with psoriatic arthritis two years ago and with fibromyalgia one year ago. So far, problem areas for me have included fingers, wrists, jaw, lower back, and ankles. I take NSAIDS daily, but still experience some degree of pain everyday. A nine-month trial of methotrexate was ineffective. Lately, I have been noticing some pain in my mid-back when I take deep breaths. Could this be due to the fibromyalgia or might it be a sign that my back is fusing due to the spondyloarthropathy? Thank you.
	It is possible that the psoriatic arthritis is affecting the costovertebral joints. These are the joints that connect each rib to a thoracic vertebra. These joints are located on each side of the thoracic spine (the spine between the base of the neck and the low back). They move with breathing and even more with deep breaths. These joints can become fused so that the ability of the chest to expand is reduced. Your doctor can measure your chest expansion from a deep breath-in to a full breath-out with a tape measure. Repeated measurements can be used to follow the progression of arthritis in the costovertebral joints. Inflammation of the spinal joints is painful with certain back movements rather than with deep breathing. Fused joints become pain-free. Fibromyalgia can be associated with all kinds of pain and cannot be ruled out as a factor contributing to the type of pain that you describe.
	Answered on: November 07, 2002

	I'm 32 years old and was diagnosed with gout eight years ago. From then on I started taking allupurinol/purinase & colchicin. Almost always, the pain and the inflammation would disappear immediately after I take my medication. Lately, I've noticed that the relief is no longer as immediate as before. Also, when the disease originally surfaced it would only affect my big toe, but two years ago it started to affect many parts simultaneously (knees, toes, knuckles, wrists). Would the occasional recreational basketball (2 - 3 times a month) contribute to the severity of my gout? Do I need to have a special diet to help improve my condition?
	It is unusual for gout to begin at the young age of 24 years. The diagnosis should be confirmed. The gold standard for the diagnosis of gout is the demonstration of urate crystals in joint fluid. Gout most commonly presents in the big toe joint but it can develop in any and all joints. One of the commonest mistakes made in treating gout is the use of the medications that control the uric acid levels intermittently rather than continuously. The main such drug is allopurinol (also known as Apo-Allopurinol, Lopurin and Zyloprim in North America and Purinase in the Philippines). It should be taken on a continuous basis to keep the serum uric acid level (a blood test) well within the normal range. Taking the allopurinol only when one has an attack of gout will only worsen the condition. Any sudden drop or rise in the uric acid level can precipitate an attack of gout. Colchicine can be taken intermittently as it does not treat the uric acid level. It controls the inflammation of an acute attack and if taken on a continuous basis, can prevent acute attacks of gout. Injury to a joint can precipitate an acute attack of gout. If playing basketball does not injure any of your joints, then it is no problem to continue playing it. Good running shoes that support the toe joints are helpful. Diet can play a role. Alcohol increases uric acid levels and precipitates attacks of gout . Drinking a lot of water helps the kidney clear uric acid from the body. A low purine diet may reduce the production of uric acid. In summary, allopurinol should be taken continuously in a dose that keeps the serum uric acid level normal. The serum uric acid levels should be checked regularly to make sure that they are within the normal range. The colchicine should be maintained on a regular basis until the serum uric acid has been controlled for more than 6 months. Acute attacks of gout can be treated by using higher doses of colchicine or adding a nonsteroidal anti-inflammatory drug until the acute attack subsides. The allopurinol dosage should remain constant during acute attacks. It is fine to play basketball. Drink lots of fluid, avoid alcohol and keep high purine foods to a minimum.
	Answered on: November 04, 2002

	Is there such a thing as 'painful arch syndrome'? What is it?
	The 'painful ARCH syndrome' refers to chronic pain in the arch of the foot. The arch of the foot is the raised part of the midfoot on the inner aspect of the foot or instep. With this syndrome, pain occurs in the arch with walking and standing, rising up on the toes and ascending or descending stairs. It is often associated with a flat-foot (fallen arch). There may be strain of the spring ligaments (taut bands which join the bones in the arch) or the posterior tibial tendon (which keeps the arch elevated) or the plantar fascia ( a tight broad ligament running along the sole of the foot). Arthritis can also develop in the joints between the bones that make up the roof of the arch. Treatment includes nonsteroidal anti-inflammatory drugs, soft supportive shoes that fit well and have a strong arch support and firm counter heel (athletic shoes), over-the counter arch pads and insoles, custom-made orthotics, ice, heat, ultrasound, taping, stretching the calf muscles, reduced weight bearing especially if barefoot and weight loss if overweight.
	Answered on: October 31, 2002

	My 13-year-old daughter was diagnosed with juvenile rheumatoid arthritis (JRA) in July 2002. She has progressively gotten worse since then. Presently there are 23 joints involved. She is in constant horrible pain but our family doctor says to just keep taking the extra-strength tylenol (she takes about 12 a day) plus her anti-inflammatory. Nothing works. She just gets worse, and her days are spent crying. We don't get to see the specialists at Sick Kids in Toronto until Dec 5. In the meantime, she can hardly walk and is about to be homeschooled because she is in so much pain. Any suggestions?
	The problem appears to be one of timely access to needed medical resources. You must make your elected provincial and federal officials aware of this situation. The costs of medicare are being controlled by creating waiting lists. Your daughter needs an intensive arthritis program ASAP. She will need second line drugs,and possibly corticosteroids and stronger pain-killers. Your family doctor should phone one of the specialists at the Sick Kids Hospital to make them aware of the urgency of the case. Other therapies might be suggested before she could be seen and her appointment could be moved up. In the interim, your family doctor could arrange for an earlier consultation with a general pediatrician or an adult rheumatologist who might have some experience with JRA. The family doctor should speak to them personally rather than just have the receptionist make the appointment. Try to locate a support group for JRA in your area. The Arthritis Society may be able to help in this regard. Get these books: Raising a Child with Arthritis: A Parent's Guide. Atlanta: Arthritis Foundation, 1998 Your Child with Arthritis: A Family Guide for Caregiving. by Lori B. Tucker, Bethany A. DeNardo, Judith A. Stebulis, Jane G. Schaller. Baltimore: The John Hopkins University Press, 1996. Also go to the website of the American Juvenile Arthritis Organization: http://www.arthritis.org/communities/juvenile_arthritis/about_AJAO.asp With aggressive therapy with today's modern treatments your daughter could do very well.
	Answered on: October 24, 2002

	Can you please tell me if the product depomedrol 40ml can be injected in a facet block L4-5 and L5-S1. I have been told by the doctor that it can be used for the spine as facet block or as an epidural. Yet the manufacturer of this drug says that it is not to be used for any of the above mentioned uses, and that it is not approved for those injections by the government. I was told that this product is to be used for all small joints like fingers, knees, elbows, and wrists, and for use in muscle. Can you please tell me what the story is behind this product and whether it can or can't be used in the spine.
	In the Compendium of Pharmaceuticals and Specialities (CPS), a Canadian reference for health professionals, the manufacturer does state these contraindications. Depomedrol contains the additives benzylic alcohol and polyethylene glycol. Because there is some evidence that they can be neurotoxic, these contraindications exist. Also, adhesive arachnoiditis and meningitis were reported in patients receiving intrathecal methylprednisolone for multiple sclerosis. They are rare in other conditions. However, many centres including mine (St Paul's Hospital) use depomedrol to inject the facet joints (including L4-5 and L5-S1). There have been no neurological reactions to this drug that I know of when injecting these facet joints. Furthermore, methylprednisolone has been injected intrathecally to treat sciatica, postherpetic neuralgia, etc. without significant problems. In one study 89 patients with intractable postherpetic neuralgia received intrathecal methylprednisolone weekly for 4 weeks with good improvement and no side-effects. (See: Kotani N, Kushikata T et al : Intrathecal methylprednisolone for intractable postherpetic neuralgia. New Engl J Med 2000; 343, 1514-1519).
	Answered on: October 17, 2002

	I have mixed connective tissue disease (MCTD). I was diagnosed at age 12. My disease is in partial remission right now. I work full time and lead a fairly active lifestyle. I am now 26. Will I be able to have children? If yes, what are the odds that they will have this same illness?
	There is very little information about pregnancy in mixed connective tissue disease. The ability to get pregnant is not affected. Miscarriages appear to be more frequent. The birth weight of the babies born to mothers with MCTD are lower than average. One study showed that 40% of persons with MCTD had a flare-up of their disease during pregnancy whereas another study showed that there were no flare-ups of the MCTD during pregnancy or after delivery. Whether you should get pregnant depends on the manifestations of your MCTD such as the prescence of pulmonary hypertension or on the medications you are taking such as cyclophosphamide. You will have to discuss the pros and cons of becoming pregnant with the doctors looking after you. The odds that any children will also develop MCTD is very small. However, there are no studies that really answer this question.
	Answered on: October 10, 2002

	My doctor diagnosed me with Raynaud's disease a few years ago. Since then, I have had nothing but mild and sporadic attacks on my hands. These attacks occur when touching cold foods from the freezer and when marinating meats. My hands swell and are very painful. It takes 2 to 3 hours for them to return to a normal colour and feel. During a family vacation, I experienced a totally different attack. Although I knew the water was very cold, I could not resist playing in the water with my two kids who begged me for days to join them. I was in the water for just over a couple of minutes. When I got out, my body was completly covered in hives and my skin was very red and sore. My hands and feet were swollen and turned purple. A few minutes later, I felt nauseous. The nausea became dizziness and my vision became blurry then disappeared. My hearing was also affected and my breathing became weak. Luckily, I was surrounded with friends who helped me recover. It took about four to five hours before I fully recovered from this shocking experience. Would this experience be consistent with Raynaud's? Is it possible that the Raynaud's has developed into something else? What might that be? How can I prevent it from getting worse?
	The attack that you have described sounds like cold urticaria (hives). It is not Raynaud's, although both conditions are precipitated by cold. Occasionally the two can co-exist such as when a condition called cryoglobulinemia (especially type I) is present. Cold urticaria can also be due to cold agglutinin disease, cryofibrinogenemia and paroxysmal cold hemoglobinuria but usually no cause is found. There is a rare form that runs in families. In a person with cold urticaria, the total body exposure to cold (like swimming) releases massive amounts of histamine and other chemicals. As a result, sore or itchy red skin, hives and large areas of swelling occur. The histamine and the leakage of fluid into the skin cause the blood pressure to drop. The drop in blood pressure leads to dizziness, nausea, blurred vision and blackouts. The purple, swollen hands and feet are due to the cold water inducing the Raynaud's. Further investigation is needed such as checking your blood for abnormal proteins that precipitate in the cold. In the meanwhile, avoid cold. Antihistamines, cyproheptadine (Periactin), ketotifen and Doxepin are drugs that may reduce or prevent the symptoms. Further preventative measures will depend upon the outcome of the investigations.
	Answered on: October 07, 2002

	My mother is 70-years-old has both rheumatoid arthritis and osteoarthritis. A year ago she sprained her ankle and ever since her whole leg routinely swells up from her toes to her thigh. It gets better and worse depending on her level of exercise/movement. She is in excellent health otherwise, and has her blood tested regularly because of the medications she takes. What causes this constant swelling and can it be prevented or remedied in any way?
	The swelling could be due to problems of the veins, capillaries or lymphatics in the leg. Malfunction of the veins could prevent proper drainage of the fluid from the leg causing swelling that worsens when upright and improves when lying down. Malfunction of the lymphatics could prevent proper drainage of the fluid from the leg too, but such swelling is less likely to vary with gravity and less likely to 'pit' or leave a depression when pressed by a finger. Malfunction of the capillaries could cause swelling by leaking fluid into the adjacent tissues. The most likely cause of your mother's swollen leg is a problem with the veins. The veins could be obstructed or the valves in the veins could be destroyed. The veins could be obstructed internally by blood clots (phlebitis or deep vein thrombosis) that may have resulted from immobility following the sprained ankle. The veins could also be obstructed externally by the pressure of a mass like a popliteal (Baker's) cyst that sometimes forms at the back of an arthritic knee. Incompetent valves may result from varicose veins or previous blood clots. Lymphatic obstruction can be due to injury, infection or tumour, however, an ankle injury should not cause the entire leg to swell. Nor should capillary leaking from an ankle injury cause the entire leg to swell. Ultrasound studies of the leg should be done to assess the blood flow in the veins and to detect the presence of cysts or masses behind the knee or in the groin. Manual and ultrasound examinations of the pelvis may be needed to rule out any pelvic disease that could obstruct the flow in the veins or lymphatics. An opinion from a vascular surgeon could help establish a diagnosis and a treatment plan. Treatment might include lying down 3 or 4 times during the day with the leg elevated and wearing compression stockings during the day.
	Answered on: October 04, 2002

	I am 50 years old and have been diagnosed with rotar cuff impingement. I will be having shoulder surgery to remove a build up of bone. I have been lifting heavy weights all my life to stay in shape. Will I be able to return to lifting heavy weights after surgery?
	It will depend on your orthopedic surgeon's opinion. The surgeon will need to assess the role that the weight lifting played in causing the impingement in the first place and the condition of your shoulder at surgery. After surgery, you should be supervised by a physiotherapist. At first, passive range-of-movement exercises, stretching, mobilizations and hydrotherapy may be necessary. Then active range-of-movement exercises and muscle strengthening will be required. The muscle strengthening will be done by isometric exercises at first and then by isotonic exercises. The isotonic exercises can be done with resistance against elastic materials like Theraband or bungee cord and by using exercise machines like Cybex. When there is a full painless range-of-movement of the shoulder and restoration of the muscle strength, you might be able to return to lifting weights or you may have to continue with exercise machines like Cybex. You will have to make the final decision with the physiotherapist and orthopedic surgeon.
	Answered on: September 30, 2002

	I am a 22-year-old female with a 2-year-old daughter. I've been diagosed with juvenile rheumatoid arthritis and psoriatic arthritis. My left knee is bent on a 45 degree angle. Is my daughter going to get this disease? What is the best way to straighten my leg?
	The bent knee or flexion contracture is easier to prevent than reverse once it has occurred. The inflammation and pain in the knee must be controlled with medications and injections of cortisone while an extensive physiotherapy program that includes stretching, mobilizations, exercises, modalities and positioning with or without splints is pursued. The knee may need to be manipulated under anaesthesia. Serial casts might help some. Surgical release of the tight capsule and hamstrings at the back of the knee may have to be combined with arthroscopic or open surgical cleaning out of the knee itself. If the knee is quite damaged, knee replacement with release of the tight soft tissues may be required. There is very little information on the chances of a child developing psoriatic arthritis if a parent has it (juvenile or adult onset). The closest answer I could find comes from a study out of the University of Toronto's Psoriatic Arthritis Clinic. In that study 12/74 (16%) children of fathers with psoriatic arthritis developed psoriasis or psoriatic arthritis and 9/108 (8%) children of mothers with psoriatic arthritis developed psoriasis or psoriatic arthritis. The father having psoriatic arthritis is a greater risk than if the mother has it. According to this study, your daughter has less than a 10% chance of getting psoriasis or psoriatic arthritis.
	Answered on: September 27, 2002

	I am a 33-year-old female. I've just been diagnosed with osteoarthritis and back spurs in T8 and T9 of my spine. My main complaint is stiffness and a feeling of fire after being stationary. I know this is uncommon for someone my age and don't know if I'm going to become crippled or if it will just always be the somewhat minor discomfort that I have now. Will this get worse? Will this be disabling?
	Such a problem should not become disabling or crippling. It is usually due to a local problem such as an old injury that you may or may not recall, for example, a minor compression fracture of the T8 or T9 vertebral body. It would not be associated with an increased risk of developing osteoarthritis elsewhere. With proper exercises done regularly, good posture and good back supports on your chairs the symptoms could improve rather than worsen. Avoid being stationary for too long. Get up and stretch your back often.
	Answered on: September 23, 2002

	I am a 26-year-old female and have been suffering from almost constant pain in my elbows, knees, hips, hand, and occasionally my feet. While the pain is not constant in all areas, it is always there somewhere. The worst is in my hand and elbows. Most of the time I cannot fully extend my elbows. Doctors say that I should take Advil, but that seems to only offer mild temporary relief. I would like to know if there is anything else that might help ease the pain?
	It is most important that you get a diagnosis so that the most appropriate treatment can be prescribed. There are over 100 different types of arthritis and related conditions. Some types are treated in a more specific way than others. However, sometimes a specific diagnosis cannot be made right away. A diagnosis may sometimes take months or even years to make. During this time, symptoms can be managed in a non-specific manner. Other non-steroidal anti-inflammatory drugs (NSAID's) could be used on a regular basis, for example, naproxen 500 mg. twice daily. There are many different types of NSAID's to try until you find the one that is best for you. A physiotherapy/occupational therapy program should be set up for you to follow. It might include wax treatments for your hands, splints, orthotics, exercises, measures to keep your elbows straight, water therapy and education about joint protection. Liniments and acupuncture might help.
	Answered on: September 20, 2002

	Would you please explain what causes synovitis of the knee? Is there anything that can be done to prevent a reoccurrence?
	Synovitis refers to the inflammation of the synovial membrane that lines most joints. It is the basic process that results in an inflammatory arthritis. It has many different causes such as: Infection: for example, bacteria like staph(ylococcus) and tuberculosis and viruses like German measles (rubella) Crystals: for example, urate crystals in gout or calcium pyrophosphate crystals in pseudogout Trauma: for example, an injury of or bleed into a joint or penetration of the joint by a plant thorn Spondyloarthritis: for example, psoriatic arthritis, ankylosing spondylitis, reaction to bowel or genital infection Immune: for example, rheumatoid arthritis, lupus Unknown cause: often referred to as non-specific synovitis. Preventing a recurrence depends upon what is causing the synovitis; that is, to which of the above groups does the synovitis belong. The synovitis can be transient without recurrences, intermittently recurrent, persistent without joint damage or persistent with joint damage. If there is no specific cause that is treatable, then preventing injury or stress to the joint and keeping the associated muscles strong, might prevent a recurrence. But unfortunately, recurrences beyond our control still occur.
	Answered on: September 13, 2002

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