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	My wife has had rheumatoid arthritis for 32 years and is about to have her 5th hip replacement. She has had a persistant productive cough for the last 8 months. She has had X-Rays, blood and sputum tests and we are now awaiting the results of a CT scan. If this proves everything is okay, can you give us a clue as to the cause of the cough? Could it have something to do with her arthritis?
	The productive cough could be due to the rheumatoid arthritis (RA), to drugs or to an unrelated problem. Rheumatoid arthritis can affect the lung tissue, the airways, the pleura (membrane surrounding the lungs) and the blood vessels of the lung. The lung tissues can be inflamed (interstitial pneumonitis) or scarred (interstitial fibrosis) or riddled with rheumatoid nodules. A dry cough may result but not a productive cough. These conditions are diagnosed with the help of x-rays, CT scans and pulmonary function tests. The pleura can become inflamed causing pleuritis (sharp pain on deep breaths) and pleural effusions (fluid between lung and chest wall which might cause shortness of breath) but neither are associated with a productive cough. The joints around the voice box (crico-arytenoid joints) can become inflamed but a productive cough does not result. The airways (bronchi and bronchioles) can develop bronchiolitis obliterans and bronchiectasis which might cause a productive cough. CT scans and pulmonary function tests can aid in the diagnosis. The blood vessels of the lung can be affected by pulmonary hypertension and vasculitis but these are rare and not likely to produce a productive cough (although vasculitis might result in blood being coughed up). Various drugs used to treat RA can affect the lung. These include non-steroidal anti-inflammatory drugs like naproxen, gold injections, penicillamine, sulfasalazine, methotrexate, azathioprine and cyclophosphamide. Many of them can cause coughing but it is usually not productive. Other causes of productive cough include infection, chronic bronchitis secondary to smoking, allergies, sinusitis with post-nasal drip and reflux from the esophagus.
	Answered on: July 17, 2003

	When I was 9-years-old, my mother died from complications of scleroderma and Raynaud's. I am now 39 and experiencing symptoms that I thought important enough to discuss with my doctor. Currently my doctor has been running gastrointestinal tests and blood tests. I've read that as a "general rule" scleroderma is not hereditary? Does the use of the term "general rule" suggest there are instances (however few) where hereditary may play a factor? Can you shed some light on the hereditary factor?
	As a general rule, scleroderma is not inherited. However, certain aspects of the immune system may be inherited that could predispose someone to developing scleroderma. Both identical twins will have scleroderma 5.9% of the time (300 times the frequency of sporadic cases). Otherwise, more than one family member having scleroderma is rare. There is a higher frequency of Raynaud's phenomenon and of anti-nuclear antibodies in first-degree relatives of persons with scleroderma. Of scleroderma sufferers, 99% have no first-degree relatives with scleroderma, and 98% have no relatives at all with scleroderma. Population studies suggest an inherited factor, but the results could also be supportive of an environmental factor if the population studied lived in the same environment. Scleroderma is more common in the Choctaw Indians in southwest Oklahoma and in the Japanese. It occurs more often in black people, Thais, and Chocktaw Indians than in Europeans, white Americans and Australians. HLA antigens are surface markers on cells that are genetically determined and closely related to the immune system. HLA-DR1 is associated with limited scleroderma and HLA-DR5 is associated with diffuse scleroderma. HLA-DR3 and the inherited C4A complement deficiency are also linked to the development of scleroderma. These genetic markers are statistically more common in scleroderma; it is not a 100% relationship. Not all cases of scleroderma have these gene markers nor do all the people with these gene markers develop scleroderma. Therefore, they cannot be used to predict whether someone will develop scleroderma or not.
	Answered on: July 10, 2003

	In January 2002, I had an Oxford Knee Transplant. Since then, I've had enough constant pain to make me cry. I still can't put my weight on it to come up stairs. It is numb, and feels spongy. It has absolutely worn me out. I recently went for an ultrasound and x-rays. The technician spent thirty minutes going over my knee and then the doctor came in and spent another five. He concluded it was full of inflammation and it is possible that the numbness will never go away. I'm now wishing I had never had this operation. I am a young 65 and am now back on the treadmill even though it kills me. My 'good' knee is worse than my bad knee was before the operation. I have heard exercise is the best thing you can do for it. Is it ok for me to go on the treadmill even though it hurts so much in both knees?
	An Oxford Knee Transplant is a type of artificial knee replacement used to treat osteoarthritis that affects mainly one compartment of the knee. It replaces the surfaces of only one of the 3 compartments in the knee. The end of the femur (thighbone) is replaced with a metal cap. The tibial (shinbone) surface is replaced by a metal plate that is covered with a plastic bearing that is mobile (compared with many other types of knee replacements that have a fixed or non-mobile plastic component). You require a thorough assessment of the knee. Inflammation could be due to low-grade infection or reaction to the plastic. The sponginess may be due to improper alignment of the plastic mobile bearing. One of the metal components may have loosened. The original osteoarthritis may have accelerated in the other 2 compartments. Before exercises can be prescribed, the problem in your knee must be sorted out. If you cannot get a satisfactory solution from your surgeon, then you should seek a second opinion.
	Answered on: July 03, 2003

	Our 18-month-old daughter recently had a five-day vomiting illness followed ten days later by hip pain and fever. The hip pain lasted intermittently for two weeks. She also developed puffy, inflamed and red skin around her eyes at the same time (not conjunctivitis). The hip pain has settled but the sore eyes persist. Our doctors have diagnosed the hip pain as reactive arthritis which they tell us may recur. She is being investigated for allergy for the puffy eyes. This Web site talks about reactive arthritis being common in 20 to 50 year olds. How common is reactive arthritis is in childhood? The fact sheet on Reiter's syndrome mentions eye problems but is not specific. Should it be considered as well?
	REACTIVE ARTHRITIS refers to a group of conditions in which an infection somewhere in the body is followed by arthritis but the responsible microorganism is not found in the inflamed joints by the usual techniques. It differs from SEPTIC ARTHRITIS where the microorganism causing the arthritis is found in the joint. Septic arthritis responds to antibiotics whereas reactive arthritis does not. Reiter's syndrome is one type of reactive arthritis that follows certain bowel or genito-urinary tract infections. The syndrome consists of arthritis, conjunctivitis and nongonococcal urethritis. Rheumatic fever is another type of reactive arthritis that follows certain types of 'strep' (streptococcus) infections of the throat. The bowel infections associated with reactive arthritis/Reiter's syndrome are manifested by diarrhoea caused by such organisms as Yersinia, Salmonella or Shigella. Your daughter did not have diarrhoea so it is unlikely that she has this type of reactive arthritis. However, there is a common condition in children less than 10 years of age, called toxic or transient synovitis of the hip. It follows common infections such as colds. The arthritis lasts a few weeks then disappears for good. In 10-20% of children it may recur with another viral illness. It causes no joint damage. The vomiting, fever and rash and swelling around the eyes may represent a viral illness. Roseola infantum (Sixth disease) is a mild viral infection in children less than 3 years of age that can cause puffy eyes. The persisting swelling around the eyes may be a drug allergy. Aspirin and other nonsteroidal anti-inflammatory drugs could be the culprit. Dermatomyositis (a disease that inflames muscles) can also cause swelling around the eyes. The Reiter's syndrome type of reactive arthritis is uncommon in toddlers. The main eye problems in Reiter's syndrome are mild non-infectious conjunctivitis (usually both eyes) and iritis or uveitis (usually painful, in one eye at a time). Hopefully your daughter just had a post-viral transient synovitis of the hip. I agree that allergy should be investigated as a possible cause of the puffy eyes.
	Answered on: June 23, 2003

	l recently heard something about allergies causing a flare in arthritis. Is this true? What kind of allergies might trigger a flare?
	Allergies play a very small role in arthritis. In fact, hay fever is less common in persons with rheumatoid arthritis (RA) (4%) than in persons without RA (8%). And generally those RA patients with hay fever tend to have less active arthritis than those without hay fever. However, there are reported cases of certain foods or drugs that seemed to have flared up arthritic diseases. Flare-ups of systemic lupus erythematosus (SLE) have occurred with allergic reactions to sulpha drugs. Alfalfa flared-up SLE in at least one person. A person with Behcet's disease flared up after eating English walnuts. A dermatologist with palindromic rheumatism had flare-ups after eating preservatives containing sodium nitrate. There have been reports of RA flaring up after the ingestion of milk and dairy products or wheat or corn or red meat or tartrazine dyes (found in certain food colouring). If one thinks that an allergy is flaring up their arthritis, try to eliminate the allergic substance (allergen) to see if the arthritis improves. If the arthritis improves, and if it is safe to rechallenge oneself with the allergen, test to see if re-exposure to the alleged allergen flares up the arthritis. If it does, then this evidence suggests a relationship between the allergen and the arthritic flare-ups.
	Answered on: June 16, 2003

	I have rheumatoid arthritis and am presently taking Arava, Prednisone and Surgam SR. My arthritis is very well controlled. I have been seriously thinking of getting saline breast implants. Would that be a problem?
	Many studies have shown that there is likely no relationship between silicone breast implants and definite connective tissue diseases. Saline breast implants would be even safer in this regard. I know of no studies suggesting that saline breast implants would worsen rheumatoid arthritis. Might there be problems discovered in the future after a longer period of observation? No one knows for sure. Prednisone and possibly Arava might slow the healing of the incisions and predispose to infection.
	Answered on: June 09, 2003

	My family doctor has recently diagnosed me as having osteoarthritis in the hip. I am 35 years old. I am in pain when I sit for a few minutes, and when I stand for too long (15 minutes). Simple tasks such as getting into a car can be excruciating. My pain is like an electric shock that goes down both legs like a pinched nerve. With what tests do medical expects correctly distinguish between a pinched-nerve situation and osteoarthritis?
	A good history and physical examination are the best way to distinguish between osteoarthritis of the hip joint and a pinched nerve. A pinched nerve is usually caused by a protruded disc pressing on a nerve as it exits from the lumbar spine. It is possible to have both conditions simultaneously. Osteoarthritis of the hip joint causes pain in the groin and thigh whereas a pinched nerve (often called 'sciatica') causes pain in the buttock, back of the thigh and calf. 'Electric shock' sounds more like nerve pain. And if the pain is going down both legs, then the disc must be protruding centrally pinching both the right and left nerve (rather then the disc protruding laterally and just pressing the nerve on one side (which is a much more common situation). If the pain is due to osteoarthritis of the hip, then both hip joints would have to be involved for the pain to go down both legs. Examination of an osteoarthritic hip by the doctor would reproduce the pain with certain movements and would demonstrate restricted movement and a grinding sound. If a pinched nerve is present, then certain manoeuvres such as 'straight leg raising' would reproduce the pain. An examination of the nerves in the legs might also show abnormal reflexes and sensation and reduced power in some of the muscles innervated by the pinched nerve. Although plain x-rays will detect osteoarthritis of the hip, they cannot by themselves determine that it is the definitive source of the pain. Similarly, x-rays, CT scan and/or MRI of the lumbar spine can help detect a protruded disc but they cannot by themselves determine that it is the definitive source of the pain. Sometimes it is necessary to inject the hip joint with local anesthetic under ultrasound or x-ray guidance. If the anesthetic alleviates the pain for a short time, then the osteoarthritis in the hip joint is the likeliest cause of the pain.
	Answered on: June 02, 2003

	I recently fell and shattered my calcaneous. I was told I had very little calcium in my bones. I have been on a Didrocal regime for 5 years, as well as hormone therapy. I have always been a good calcium intake person (lots of milk, cheese, yogurt, etc). I am 57 now. As I age even more, how do I prevent even further decrease in the bone density?
	Medical conditions that could worsen bone density like hyperthyroidism, hyperparathyroidism, malabsorption etc. should be ruled out. Medications like cortisone, too much thyroid replacement, anti-epilepsy drugs, too much vitamins A and D, antacids with aluminium etc could also worsen bone density. Smoking must be stopped. No more than 3 cups of coffee/tea per day and no more than 4 oz. of alcohol per day should be consumed. Regular weight bearing and muscle strengthening exercises are important to maintain good bone density. Good activities include walking, swimming and weights. Lying in bed and sitting too much will reduce the bone density. Daily calcium intake from food and supplements should range between 1000 and 1500 mg per day. Vitamin D intake should be 400 to 800 I.U. per day. Try to get 15 minutes of sunshine per day. You may have to check with a dietician that you are eating the right amount of calcium and vitamin D and that you are not eating too much of something that may interfere with them. Your bone mineral density should be followed to make sure that therapeutic changes are making a difference. Your hormone therapy should be reviewed to make sure that you are getting enough estrogens and that there are no risk factors for taking estrogens. Didrocal may not be helping you enough. You may benefit from switching to another drug like it ( the bisphosphonates) e.g. alendronate, risendronate, pamidronate. Calcitonin taken by nasal spray or injection is another drug that could help if the bisphosphonates do not pan out. However, a new therapy, parathyroid hormone, may soon become available. It could become one of the most effective treatments for osteoporosis. Contact the Osteoporosis Society of Canada for more information and ongoing developments. Ask for the book, "The Osteoporosis Book". Phone number is 1-800-463-6842. Web site is www.osteoporosis.ca.
	Answered on: May 26, 2003

	I have been diagnosed with 'lichen planus' and was told it is related to arthritis. Do you have insights into the disease and its relationship with arthritis?
	Lichen planus is a skin condition of unknown cause. It can involve the skin including the vulva and penis, nails and mucus membranes of the mouth. It consists of raised bumps or plaques that may be itchy or painful. It may be associated with liver diseases such as hepatitis C. It is generally not associated with arthritis but can be induced by several drugs used to treat arthritis e.g. nonsteroidal anti-inflammatories, gold, antimalarials like hydroxychloroquine and d-penicillamine. In such cases, it is frequently located in the mouth on the inner cheeks.
	Answered on: May 20, 2003

	I was thinking about purchasing an infrared thermal sauna system, which is a sauna-like booth with infrared heat. Do you think this is safe? Will the infrared heat help my arthritis?
	All forms of heat can reduce pain and stiffness from sprains, strains, fibromyalgia, muscle spasm, back and neck aches, sore non-inflamed joints, tendonitis and bursitis. Heat only relieves these symptoms temporarily without any curative effect on the condition being treated. Heat may also reduce tension caused by stress. Heat should not be used for very inflamed joints or acutely swollen areas as it can aggravate the inflammation and swelling. Heat should also be avoided in the presence of fever, poor circulation such as peripheral vascular disease and impaired skin sensation. Generalized heating of the body should be avoided in bleeders as the heat dilates the blood vessels prolonging bleeding; in pregnancy; in persons taking drugs that lower blood pressure as the heat may lower the pressure further causing fainting; and in individuals with neurological conditions that impair the body's ability to control temperature. Deep heat should be avoided in areas of enclosed infection and areas of metal implants. Superficial heat can be applied using hot packs, heating pads, hot towels (put towel in microwave for 1 minute), hot water bottles, hot baths, pools and showers, paraffin wax, mud packs and baths, hot springs, saunas and whirlpool. Deep heat can be applied using infrared light, ultrasound, short wave and microwave diathermy. An infrared thermal sauna is easier to breath in and uses less electricity than a regular sauna. There is no evidence that it results in greater medical benefits than any other form of heat. A physiotherapist experienced in treating arthritis should design a treatment program for you before you purchase this sauna system. Furthermore, you should demo the infrared thermal sauna system for a few treatments before buying it.
	Answered on: May 13, 2003

	I have had massive amount of swelling and pain in my feet, knees and hands for two months. No one has been able to identify it. Can you get arthritis when you are 20 years old? I play university soccer. Would I still be able to play?
	There are many different types of arthritis and some of them can occur even in babies, let alone in someone 20 years old. Some types of arthritis that might occur at your age and as per your description include rheumatoid arthritis, reactive arthritis, psoriatic arthritis, sarcoidosis, scleroderma, eosinophilic fasciitis, lupus and hypertrophic osteoarthropathy. However, a firm diagnosis must be made first before anyone could predict your soccer future. Some types of arthritis can disappear spontaneously and some can respond very well to treatment. You must see a rheumatologist as soon as possible to determine if your symptoms are due to a form of arthritis and if so, which type is it and what treatment is needed.
	Answered on: May 05, 2003

	I am 35 years old. I am in constant pain. It is excruciating and debilitating. My children have to tie my shoes for me. I had an x-ray done recently and it revealed I have almost non-existent cartilage between two discs in my back. I am taking chondroitin, something called Saturn (with MSM) and Advil. Sneezing is a frightening experience. I am terrified that my back will go completely. I have not slept through the night in almost a year. When I am menstruating, I am brought to tears. Everything I do is too painful. I have gone to my family doctor who does not see the need to refer me to anyone. I have seen several chiropractors. They all tell me to come to them three times a week and that it will take years apparently to gain back some of my previous verve for life. What will I be like when I am 45? 55? Will I still be walking? Any input would be appreciated.
	I assume you mean that the X-ray showed no cartilage or disc between two vertebrae in your back.Your pain may very well be due to the disc disease. The disc may have herniated or protruded. There may be instability of the vertebrae causing abnormal painful movement and accelerated disc damage. Such instability could be due to spondylolisthesis or stress fracture of the posterior parts of one of the vertebra at this level. Low grade infection of the disc is uncommon but should be ruled out with such persistent severe pain and advanced disc damage at one level on the X-ray. A blood test to measure the white blood cell count, hemoglobin and sed rate should be done regarding the possibility of infection. A CT scan or MRI should be done to look for evidence of instability/stress fracture etc. and for any mass or infection around the disc. You should be seen by a back specialist for further investigation and treatment. Without a specific diagnosis, it is impossible to predict how you would be when you are older. You should certainly be walking as any sign of neurological involvement would be treated promptly by a back surgeon.
	Answered on: April 28, 2003

	I am 53 years old. I have had rheumatoid arthritis since 1993 and diabetes since 1970. I am taking 25 mgs of methotrexate every Monday and 7 mgs of prednisone every day. I recently went for a yearly eye exam and the optometrist set up an appointment for me to see an eye specialist for further study on the inside of my eyes. The optometrist did not explain anything to me. Is it possible that I have corneal melting? If so, what happens next?
	Both rheumatoid arthritis and diabetes can affect the eyes in several different ways. Corneal melting is a rare complication of rheumatoid arthritis. See the answers to questions dated July 30, 2001 (re:corneal melting) and January 15, 2003 (re: eye complications of rheumatoid arthritis). It affects the cornea, located at the front of the eye covering the pupil and is not "inside of my eyes". Cataracts are much more common especially with diabetes and the use of prednisone. And of course, involvement of the retina is very common with diabetes especially after 33 years. This complication is referred to as diabetic retinopathy and causes no symptoms in the early stages. It is more likely that you are seeing an ophthalmologist because of cataracts and /or diabetic retinopathy.
	Answered on: April 22, 2003

	I am a 49-year-old female with osteoarthritis of the total spine. I have had neck fusion and a herniated disc of the lower spine for which I'm told there is no surgery. I also have psoriatic arthritis and fibromyalgia. And lastly, I have type II diabetes. As a result of the psoriatic arthritis, my right index finger and part of my hand had to be amputated. I know that amputations can sometimes be associated with diabetes. But arthritis? I was shocked by my turn of events. Have you heard of such a thing? How common is this?
	This is indeed unusual. Was the reason for the amputation a lack of blood supply due to diseased arteries or infection (both associated with diabetes)? Amputation because of arthritis, or deformity alone is very uncommon. Rarely it might be done for a severe fixed deformity of a finger that interferes with the use of the hand like putting the hand in a pocket or holding something in the palm. Ask your physician exactly why it was done--there may be a good reason.
	Answered on: April 07, 2003

	I am a 47-year-old woman, a full-time student in a Master's Program, very recently diagnosed with severe osteo-arthritis of the knees. I just had my first visit to the specialist and was overwhelmed by the experience. While I was lying on the exam table, the doctor manipulated my legs, bending my knees etc., very quickly and roughly, ignoring my questions and hurting me physically very much. He told me he was going to give me a shot, and just jabbed it deep into my knee, moving the needle vigourously. The pain was excruciating. When I asked if it was cortisone, he impatiently told me it was, but that there were no side effects. When I asked him about nutritional supplements and possible dietary changes, he said it was all hocus-pocus. When I asked about web sites for learning to manage it, he said he didn't have any. After x-rays, I was told to re-join him in his office. As I walked in, he was dictating my diagnosis, including the fact that I require surgery on both knees, into a recording machine - this was how he broke the news to me. I found some web sites on my own, but my question is, do doctors usually give a local anaesthetic before a cortisone shot into a painful area? I left the appointment feeling like I was hit by a truck, and I want to know if this is typical - in other words, is it inappropriate to ask questions of the specialist? Do they confine practice to surgery and medications, hoping that patients research all other helpful information on their own? I am a happy, strong, confident woman with a full life, but this was a degrading, overwhelming and isolating experience. The arthritis has immobilized me to a great degree, and I had held out hope that the visit would give me some hope in terms of coping, but I was devastated. I have no wish to confront the doctor or complain about him - I simply wonder if I should start over.
	Education is a very important part of managing arthritis. Your questions should be answered. The physician should explain things to you. You should have been referred to an arthritis management program e.g. a local branch of The Arthritis Society in Canada. Pamphlets, books and websites are very informative. This Arthritis Society website has a lot of information about osteoarthritis. Two books to consider for further education about osteoarthritis are: The Arthritis Foundation's Guide to Good Living with Osteoarthritis. Atlanta: Arthritis Foundation, 2000. Living Well with Arthritis. A sourcebook for understanding and managing your arthritis. By Dianne Mosher, Howard Stein, Gunnar Kraag. Viking Canada (Penguin Group, Toronto), 2002. They will discuss medications, physical therapy, injections, diet, nutrition, complementary treatments, surgery, exercise and pain management. Cortisone injections to a joint are very safe but rare complications include joint infection, bleeding and bruising, transient flare-up of joint inflammation and flushes, sweats and fainting. Local anesthetic is often given, but use of a small gauge needle, muscle relaxation, gentleness and very careful positioning of the needle are the main ways to make the injection almost painless. After all, the local anesthetic is given by needle and takes a few moments to work and may cause some stinging. It seems that you got the rough, painful approach. Here is also a reply to your question from Cheryl Koehn, patient advocate: "The experience you describe was certainly far from ideal, both from a patient and specialist perspective. For treatment to be successful�whether it be an examination procedure, a medication prescription, or an injection such as you describe�it is imperative that the person being treated fully understand the reasoning behind the specialist�s recommendation to be physically and psychologically prepared to receive the treatment. One does this by asking questions before hand (as you did) to determine their willingness to assess whether the benefit of the treatment outweighs any risks it may pose to their health. If a physician, be they a specialist or a general practitioner, is unwilling to take the time to ensure that the person seeking their help is at ease and a willing participant of the advice and treatment being dispensed, you should ask for a referral to another physician rather than possibly subjecting yourself to this type of situation again."
	Answered on: April 01, 2003

	My mother who is 80 suffers severely from arthritis. She takes a blood thinner and we are being told the only thing she can take for pain is Tylenol. Is there is anything else she can take. She is now in a full blown attack and can barely move. It is hard to watch, knowing that her vitals are good, but she has no quality of life due to her pain. To me it does not make sense as the pain has now put her in bed, when she wants to be able to get up and move.
	Physical therapy such as ice, heat, transcutaneous electrical nerve stimulation (TENS), splinting etc. may reduce the pain. A physiotherapist could help with such recommendations. Stronger analgesics (pain killers) could be used such as codeine (e.g. Tylenol #3), oxycodone and morphine during these attacks. Conventional nonsteroidal anti-inflammatory drugs (NSAID's) like aspirin, ibuprofen and naproxen may interfere with the blood thinner, alter the platelets to prolong bleeding even further and cause peptic ulcers that could bleed more than usual because of the blood thinners. However, the new COX-2 anti-inflammatory drugs like celebrex and rofecoxib do not affect the platelets and are less likely to cause bleeding peptic ulcers. They usually do not interfere with the blood thinner, but the INR (blood test used to monitor the dose of the blood thinner) should be checked more often when first starting them to make sure no adjustments have to be made to the dose of the blood thinner. You should also be aware that if too much acetaminophen (about 3500 mg per day or more) is taken, it too can interfere with the blood thinner so that bleeding is more likely.
	Answered on: March 26, 2003

	I am a 27 year old female. For the past ten years my knees have made this horrific cracking noise every time I would bend down. Now, it is at the point of popping noises and the pain in my knees is constant (every day as opposed to 2 - 3 times a week). I went to my doctor last year who told me I had the beginnings of Arthritis. The problem is he never told me what kind it is or what to do except to take it easy on the knees. He is my only doctor although he is near retirement. I have been having some trouble finding a new doctor, especially now with this arthritis. My question is how many different cracks can my knees make and is this an indication of a specific type of arthritis.
	There are many different types of joint cracking. The crunching or catching of folds of synovium (membrane lining joints) can occur due the thickening of the synovium in inflammatory arthritis (synovitis) or to the catching of folds of normal synovium between bones and/or tendons in mechanical joint abnormalities. The loss of the cartilage in a joint as occurs in osteoarthritis can lead to coarse grinding. Sometimes irregularities on the cartilage surface can lead to cracking sounds as can loose bodies (like a torn cartilage). Mild subluxations of joints, e.g. minor dislocations of the kneecap, can also cause popping noises. Tendons snapping quickly over bone or joints can cause popping sounds. Irregularities or abrasions or inflammation of tendons can also lead to noises during movements. Sudden change in the volume of a joint space can cause cracking too as when one cracks their knuckles. If there are other symptoms in addition to the cracking such as pain and swelling, then a more significant problem is present. In a young female with symptoms such as yours, the commonest problem would be patellofemoral syndrome. The pain and cracking are coming from the joint between the kneecap (patella) and the end of the thighbone (femur). See the question answered on "Ask the Expert" on December 10, 2002 re: patellofemoral syndrome. In an older person, osteoarthritis would cause similar symptoms. It would be helpful to be seen by a rheumatologist or orthopedic surgeon to clarify the problem.
	Answered on: March 13, 2003

	I use Celebrex for my osteoarthritis. Is this medication safe to be used for long periods?
	Celebrex has been on the market for about 4 years now and has been used by thousands of people. There have not been any unexpected side-effects so far. However, one cannot be absolutely certain that an unexpected problem might not show up later with more surveillance. The side-effects of Celebrex are similar to those of the currently available non-steroidal anti-inflammatory drugs (NSAID's) like naproxen and diclofenac except that it causes less stomach side-effects. The incidence of symptomatic and complicated (e.g. bleeding) peptic ulcers appears to be less. In addition, it does not interfere with the function of the platelets so that bleeding is not prolonged. One still has to be monitored for high blood pressure, abnormalities of the kidneys, fluid retention, bleeding from the stomach and bowel, rashes and allergies etc. just like the other NSAID's. In conclusion, Celebrex can be used for long periods. It appears to produce less problems with peptic ulcers and platelets than conventional NSAID's, but it should still be monitored carefully for side-effects as regular NSAID's are.
	Answered on: March 06, 2003

	I had a total hip replacement (right hip) in January 1994 when I was 52 years old. It was a non-cemented replacement, which my surgeon described as a procedure in which bone would grow around the prothsesis, ensuring a more secure and durable joint. Since then, I have not had any problems whatsoever -- I exercise seven days a week with weights and on a treadmill, bike and essentially enjoy all activities -- except running which I previously enjoyed doing very much. How long can I expect my hip replacement to last? If I have problems, what will be the symptons? Will a new hip replacement be a problem? Are there any age limits to having a hip replacement, particularly with respect to age-related health concerns and limited resources in the health care system?
	It is very difficult to predict how long one's hip replacement will last--perhaps 10 to 15 years. It depends on many factors including the amount of stress put on the joint by activities and weight, the strength of the underlying bone, any deviations in positioning of the implants at surgery etc. etc. There are 2 problems that may occur that do not have symptoms at first: wearing away of the plastic socket liner and resorption of bone from around the implants. These changes are detectable by X-rays. Therefore it is important to be followed on a regular basis by the surgeon. Otherwise, the commonest symptom of a problem is pain. Usually the pain is in the groin with a socket problem and in the thigh with a stem problem. The pain is worse with bearing weight on the leg. The problems include loosening of the implants, bone resorption, wearing of the socket liner with varying degrees of dislocation and infection. With significant wearing of the socket liner, pain, clunking and buckling may occur on getting up to walk and then improve as walking continues. Although revisions of hip replacements may not be as good as the original hip implants, considerable progress has been made. Sometimes it may be difficult to remove the stem from the femur. If there has been too much bone loss, then the revision will be more difficult. There are no upper age limits for having a hip replacement. However, the presence of other medical illnesses and the frailty of the patient are important factors in limiting surgery. Hopefully limited resources in the health care system will never be a limitation to hip replacements particularly since this procedure is so dramatically effective in reducing pain, restoring function and improving quality of life.
	Answered on: March 03, 2003

	Are you aware of any organization or professional society in the world which supports supplying artificial knee joints to needy people?
	I am not aware of any. You might want to contact the companies that manufacture artificial knees e.g. Zimmer Inc., DePuy Orthopaedics Inc., Smith and Nephew, Stryker Howmedica Osteonics etc. The Shriners Hospitals do charitable orthopaedic surgery for children. You may want to call them to see if they know of any comparable organization for adults.
	Answered on: February 25, 2003

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