Arthritis takes different forms
DEAR DR. ROACH: You published an article in April discussing the differences between osteoarthritis and rheumatoid arthritis. How does "degenerative arthritis" differ from the other two? -- R.L.
ANSWER: Degenerative arthritis is osteoarthritis; it's an old term that dates from a time when arthritis was thought to be caused by normal aging processes and from "wear and tear" caused by exercise. That is no longer accepted. For example, runners are at no greater risk for osteoarthritis of the knee than non-runners. Furthermore, exercise is a valuable therapy for osteoarthritis, and stopping an exercise program leads to more pain and disability. However, injuries clearly do contribute to the development of osteoarthritis.
Being overweight is the most important modifiable factor for the development of osteoarthritis.
DEAR DR. ROACH: I have a good friend who has arthritis in his hands and lower back. His physician has never suggested cold laser treatments to him. From what I have read on the Internet, they seem to be an effective, low-risk treatment option. What's your assessment of them? -- R.H.
ANSWER: Whether laser treatment is effective depends on what kind of arthritis your friend has. I discussed osteoarthritis briefly in the previous question, but it is much more common than rheumatoid arthritis, an autoimmune disease in which the immune system attacks the joints (and sometimes other important organs). Osteoarthritis is more likely to affect the back.
Low-level laser therapy, also called cold laser, has been studied in both rheumatoid arthritis and osteoarthritis. In people with rheumatoid arthritis of the hand, the laser treatment reduced pain and morning stiffness, and improved flexibility. In osteoarthritis, the jury is still out; some studies showed benefit, and others showed none. It does seem to be a safe treatment.
DEAR DR. ROACH: I am writing about my 16-year-old grandson. He was taken to the hospital with chest pain, and was diagnosed with a viral infection of the lining of the heart. He is now OK. He later had an MRI, and the doctor said the virus had damaged the outside of his heart and that he would need to be seen again in a year.
I would like to know how serious this is. I have never heard of anything like it. -- M.A.W.
ANSWER: It sounds as though your grandson had acute pericarditis ("acute" simply means "recent onset"; pericarditis is inflammation of the pericardium, the nonmuscular fibrous sac that goes around the heart). Acute pericarditis is most commonly caused by viruses, although this is seldom proved to be the case in individual patients. The most prevalent symptom is chest pain, which often feels better when the patient sits up and leans forward. An EKG is usually done to help diagnose it, and an echocardiogram usually is performed as well.
The standard treatment is anti-inflammatory medication, such as ibuprofen or indomethacin. For the most part, people improve within two weeks. Sometimes the inflammation of the lining of the heart includes inflammation of part of the heart itself, called myopericarditis. I wonder if that is what the doctor meant. This is diagnosed by echocardiogram or MRI and blood tests for muscle enzymes. Fortunately, even myopericarditis usually gets completely better, and is treated the same way.
In general, when a doctor wants to see you back in a year, that means things are going pretty well.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.
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