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Ankylosing Spondylitis

Ankylosing Spondylitis, or “AS”, is an inflammatory disease characterized by back pain and a progressive stiffness of the spine. A form of Spondyloarthritis (SpA), AS typically affects adults between 20 and 30 years of age. Although AS is regarded as a spinal disease, transient acute arthritis of peripheral joints occurs in as many as 50 percent of patients. Other organs such eyes, lungs, heart, and kidneys can also be affected.

Arthritis

There are two main types of arthritis: inflammatory and noninflammatory. Examples of inflammatory arthritis include infectious arthritis, rheumatoid arthritis, and gout. An example of noninflammatory arthritis is osteoarthritis, the most common type of arthritis. The location, timing, and pattern of joint pain, as well as the presence of swelling and symptoms outside the joint (such as rash), can help to distinguish between inflammatory and noninflammatory arthritis.

Inflammatory Arthritis — Inflammatory arthritis usually causes joint stiffness with rest, especially morning stiffness. Certain types of inflammatory arthritis, such as rheumatoid arthritis and the arthritis of systemic lupus erythematosus (SLE), affect joints symmetrically (ie, affect the same joints on both sides of the body).

Noninflammatory Arthritis — Noninflammatory arthritis usually causes pain that is aggravated by movement and weight-bearing and is relieved by rest. Joints on one or both sides of the body may be affected

Behcet’s Disease

Behcet’s Disease is an autoimmune disease that results in recurrent ulceration, and potentially in numerous other systemic symptoms. It is considered rare in the United States, where more women are affected than men. In the Middle East and in many Asian countries, the disease affects more men than women. Most symptoms of Behcet’s Disease are caused by vasculitis (inflammation of the blood vessels). Many clinical professionals think that the vasculitis is caused by an autoimmune reaction; in an autoimmune reaction, the immune system mistakenly attacks and harms the body’s own tissues. The most common symptoms of Behcet’s Disease are mouth sores, genital sores, inflammation of the eye, and skin problems. Particularly, inflammation of the eye occurs in more than half of all cases of Behcet’s Disease, and may cause blurred vision, ocular pain and ocular redness. Other symptoms may include blood clots, arthritis, inflammation in the central nervous system, and inflammation of certain digestive organs.

Bursitis

Bursitis is the inflammation of one or more small “cushions” called Bursae. Bursae are fluid-filled sacs or discs, found around most of the major joints in the body, that provide a cushion between bones and tendons and/or muscles around a joint to reduce friction between the bones and allow free movement. When a bursa is inflamed, movement of the inflamed area becomes difficult and painful. Movement of tendons and muscles over the inflamed bursa also aggravates this inflammation, creating a chronic condition. Repetitive movement, excessive or prolonged contact pressure, trauma, auto-immune disorders, and infections can all cause bursitis.

Connective Tissue Disease

A connective tissue disease is a family of illnesses that has the connective tissues of the body as a target of its pathology. These tissues form a framework for the body, and are composed of collagen and elastin. In patients with connective tissue disease, it is common for collagen and elastin to become injured by inflammation. Many connective tissue diseases feature abnormal immune system activity with inflammation in tissues as a result of an immune system that is directed against one’s own body tissues (autoimmunity). Diseases in which inflammation or weakness of collagen tends to occur are also referred to as collagen diseases. Collagen vascular diseases can be (but are not necessarily) associated with collagen and blood vessel abnormalities and that are autoimmune in nature. Connective tissue diseases can have strong or weak inheritance risks, and can also be caused by environmental factors.

Dermatomyositis

Dermatomyositis is a connective tissue disease characterized by inflammation of the muscles and the skin. While DM most frequently affects the skin and muscles, it is a systemic disorder that may also affect the joints, the esophagus, the lungs, and, less commonly, the heart. The cause is unknown, but it may result from an initial viral or bacterial infection (even after treatment or cure of the infection). In cases that follow closely after pregnancy, some research suggests an immune response to lingering fetal cells still circulating in the mother becoming an immune response against the parent, resulting in chronic autoimmune activity. Gottron’s papules, scaly erythematous eruptions or red patches overlying the knuckles, elbows, and knees are a characteristic feature of Dermatomyositis, though not seen in every patient.

Fibromyalgia

Fibromyalgia is characterised by chronic widespread pain and a heightened and painful response to pressure. Fibromyalgia symptoms are not restricted to pain; Other symptoms include debilitating fatigue, sleep disturbance, and joint stiffness. Some people also report difficulty with swallowing, bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction. Fibromyalgia is frequently associated with psychiatric conditions such as depression and anxiety and stress-related disorders such as post-traumatic stress disorder.

Gout

Gout can present in a number of ways, although the most usual is a recurrent attack of acute inflammatory arthritis (a red, tender, hot, swollen joint). The metatarsal-phalangeal joint at the base of the big toe is affected most often, accounting for half of cases. Other joints, such as the heels, knees, wrists, and fingers, may also be affected. Joint pain usually begins over 2–4 hours and during the night. The reason for onset at night is due to the lower body temperature then. Other symptoms may rarely occur along with the joint pain, including fatigue and a high fever. Long-standing elevated uric acid levels (hyperuricemia) may result in other symptoms, including hard, painless deposits of uric acid crystals known as tophi. Extensive tophi may lead to chronic arthritis due to bone erosion. Elevated levels of uric acid may also lead to crystals precipitating in the kidneys, resulting in stone formation and subsequent urate nephropathy.

Polyarthritis

Polyarthritis is any type of arthritis which involves 5 or more joints simultaneously. It is usually associated with autoimmune conditions. Polyarthritis may be experienced at any age and is not gender specific. It is most often caused by an auto-immune disorder such as rheumatoid arthritis, amyloidosis, psoriatic arthritis, and lupus erythematosus, but can also be caused by infection with an alphavirus such as the chikungunya virus and Ross River virus. This condition is termed alphavirus polyarthritis syndrome. Sindbis virus, which is endemic in Northern Europe, Africa, the Middle East, and Australia, is the most widely distributed of the alphaviruses causing polyarthritis, though infection is usually mild or asymptomatic.

Joint Pain

Arthralgia (literally, “joint pain”) it is a symptom of injury, infection, illnesses (in particular arthritis) or an allergic reaction to medication. The term “arthralgia” should only be used when the condition is non-inflammatory; the term “arthritis” should be used when the condition is inflammatory. The causes of arthralgia are varied, and range from degenerative and destructive processes such as osteoarthritis and sports injuries to inflammation of tissues surrounding the joints, such as bursitis. These, in turn, might be triggered by other things, such as infections or vaccinations.

Osteoarthritis

Osteoarthritis (OA) also known as degenerative arthritis or degenerative joint disease or osteoarthrosis, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. A variety of causes — hereditary, developmental, metabolic, and mechanical deficits — may initiate processes leading to loss of cartilage. When bone surfaces become less well protected by cartilage, bone may be exposed and damaged. As a result of decreased movement secondary to pain, regional muscles may atrophy, and ligaments may become more lax. Treatment generally involves a combination of exercise, lifestyle modification, and analgesics. If pain becomes debilitating, joint replacement surgery may be used to improve the quality of life.

Osteoporosis

Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass and density which can lead to an increased risk of fracture. In osteoporosis, the bone mineral density is reduced, bone microarchitecture deteriorates, and the amount and variety of proteins in bone are altered. In and of itself, Osteoporosis has no symptoms; its main consequence is the increased risk of bone fractures. Osteoporotic fractures occur in situations where healthy people would not normally break a bone; they are therefore regarded as fragility fractures. Typical fragility fractures occur in the vertebral column, rib, hip and wrist.

Paget’s Disease

Paget’s Disease is a chronic disorder that can result in enlarged and misshapen bones. Paget’s is caused by the excessive breakdown and formation of bone, followed by disorganized bone remodelling. This causes affected bone to weaken, resulting in pain, misshapen bones, fractures and arthritis in the joints near the affected bones. Rarely, it can develop into a primary bone cancer known as Paget’s sarcoma. Often Paget’s disease is localized to only a few bones in the body. The pelvis, femur, and lower lumbar vertebrae are the most commonly affected bones.

Polymyalgia Rheumatica

Polymyalgia Rheumatica, abbreviated as PMR, is a syndrome with pain or stiffness, usually in the neck, shoulders, and hips. The pain can be very sudden, or can occur gradually over a period. It may be caused by an inflammatory condition of blood vessels such as temporal arteritis. Most PMR sufferers wake up in the morning with pain in their muscles; however, there have been cases in which the patient has developed the pain during the evenings. Patients who have polymyalgia rheumatica may also have temporal arteritis, an inflammation of blood vessels in the face which can cause blindness if not treated quickly. PMR is usually treated with courses of oral corticosteroids. Most people need to continue the corticosteroid treatment for two to three years. PMR usually goes away on its own in a year or two, but medications and self-care measures can improve the rate of recovery.

Polymyositis

Polymyositis is a type of chronic inflammation of the muscles related to dermatomyositis. Symptoms include pain, with marked weakness and/or loss of muscle mass in the muscles of the head, neck, torso and upper arms and legs. The hip extensors are often severely affected, leading to particular difficulty in ascending stairs and rising from a seated position. Difficulty swallowing, or other problems with esophageal motility, occur in as many as 1/3 of patients. Low grade fever and peripheral adenopathy may be present. Foot drop in one or both feet can be a symptom of advanced polymyositis and inclusion body myositis. Polymyositis is also associated with interstitial lung disease. Polymyositis may represent a modest increased risk for non-Hodgkin lymphoma and lung and bladder cancers.

Psoriatic Arthritis

Psoriatic arthritis is a type of inflammatory arthritis that will develop in up to 30 percent of people who have the chronic skin condition psoriasis. The exact causes are not yet known, but a number of genetic associations have been identified in a study of psoriasis and psoriatic arthritis. No cure for psoriatic arthritis exists, so the focus is on controlling symptoms and preventing damage to your joints. Without treatment, psoriatic arthritis may be disabling. The symptoms of psoriatic arthritis often resemble those of rheumatoid arthritis, but patients also can present with swollen fingers and toes, foot pain, and lower back pain. Some people develop a condition called spondylitis as a result of psoriatic arthritis.

CPPD (Pseudogout)

CPPD is a type of arthritis that, as its old name “Pseudogout” suggests, can cause symptoms similar to gout. Yet in CPPD, a different type of crystal deposit triggers the reaction. CPPD can cause bouts of severe pain and swelling in one or more joints, which can limit activity for days or weeks. It also can cause a more lasting arthritis that mimics osteoarthritis or rheumatoid arthritis. The condition most often involves the knees, but can affect wrists, shoulders, ankles, elbows, hands or other joints. CPPD develops when calcium pyrophosphate crystals build up in a joint. Crystals deposit first in the cartilage (the tissue that cushions inside joints) and can damage the cartilage. The crystals also can cause inflammation that leads to joint pain, warmth and swelling. In most cases, it is not clear why the crystals form, although crystal deposits clearly increase with age. Because the condition sometimes runs in families, genes likely play a role.

Raynaud’s Phenomenon

Raynaud’s Phenomenon is excessively reduced blood flow in response to cold or emotional stress, causing discoloration of the fingers, toes, and occasionally other areas. It is a hyperactivation of the sympathetic nervous system, causing extreme constriction of the peripheral blood vessels, leading to tissue hypoxia. Chronic, recurrent cases of Raynaud’s Phenomenon can result in atrophy of the skin, subcutaneous tissues, and muscle. In rare cases, it can cause ulceration and gangrene. This condition may also cause nails to become brittle with longitudinal ridges. Named after French physician Maurice Raynaud (1834–1881), the phenomenon is believed to be the result of spasms of the veins, which decreases blood supply to the respective regions. Raynaud’s Phenomenon, by itself, is just a sign accompanied by a symptom (discomfort). When linked to pathogenesis, it can be part of Raynaud’s Disease, where the cause is unknown, or part of Raynaud’s Syndrome (secondary Raynaud’s phenomenon), which is a syndrome caused by a known primary disease, most commonly connective tissue disorders such as systemic lupus erythematosus. Measurement of hand-temperature gradients is one tool used to distinguish between the primary and secondary forms.

Reactive Arthritis

Reactive arthritis is a painful type of inflammatory arthritis. It occurs as a reaction to an infection by certain bacteria. Most often, these bacteria are in the genitals (Chlamydia trachomatis) or the bowel (Campylobacter, Salmonella, Shigella and Yersinia). The bacteria induce (cause) arthritis by distorting your body’s defense against infections, as well as your genetic environment. It often has no symptoms, but can cause a pus-like or watery discharge from the genitals. The bowel bacteria can cause diarrhea. Reactive arthritis can result in pain and swelling of certain joints, often the knees and/or ankles; swelling and pain at the heels; extensive swelling of the toes or fingers; persistent low back pain, which tends to be worse at night or in the morning. Some patients with this type of arthritis also have eye redness and irritation. Still other signs and symptoms include burning with urination and a rash on the palms or the soles of the feet. How exactly each of these factors plays a role in the disease likely varies from patient to patient.

Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks flexible (synovial) joints. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility if not adequately treated. The process involves an inflammatory response of the capsule around the joints secondary to swelling of synovial cells, excess synovial fluid, and the development of fibrous tissue in the synovium. The pathology of the disease process often leads to the destruction of articular cartilage and ankylosis (fusion) of the joints. RA can also produce diffuse inflammation in the lungs, the membrane around the heart, the membranes of the lung, and white of the eye, and also nodular lesions, most common in subcutaneous tissue. Although the cause of RA is unknown, autoimmunity plays a big part, and RA is considered a systemic autoimmune disease. Clinical diagnosis is made on the basis of symptoms, physical exam, radiographs (X-rays) and lab tests.

Scleroderma

Scleroderma is a chronic systemic autoimmune disease characterised by hardening of the skin. In its most severe form, it also affects internal organs. Limited scleroderma involves cutaneous manifestations that mainly affect the hands, arms and face. It was previously called CREST Syndrome. Diffuse scleroderma progresses rapidly and affects a large area of the skin and one or more internal organs, frequently the kidneys, esophagus, heart and/or lungs. This form of scleroderma can be quite disabling. There are no treatments for scleroderma itself, but individual organ system complications are treated. The prognosis is generally good for limited scleroderma patients who escape pulmonary complications, but is worse for those with the diffuse form, particularly in older age and for males. Death occurs most often from pulmonary, heart and kidney complications. In diffuse scleroderma, five-year survival is 70% and 10-year survival is 55%. The cause of scleroderma is unknown. It is an autoimmune condition, in which the body’s immune system attacks healthy tissues. Strong environmental influences have also been implicated in the etiology of scleroderma.

Sjogren’s Syndrome

Sjogren’s Syndrome is a chronic autoimmune disease in which the body’s white blood cells destroy the glands that produce saliva and tears. The immune-mediated attack on the salivary and lacrimal glands leads to the development of xerostomia (dry mouth) and keratoconjunctivitis sicca (dry eyes), which takes place in association with lymphocytic infiltration of the glands. That inflammatory process eventually severely damages or destroys the glands. Sjogren’s is usually classified as either Primary or Secondary. Primary Sjogren’s occurs by itself, whereas Secondary Sjogren’s occurs when another connective tissue disease is present. Primary Sjogren’s and Secondary Sjogren’s patients can all experience the same level of discomfort, complications and seriousness of their disease.

Systemic Lupus Erythematosus

Systemic Lupus Erythematosus (SLE) is an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs. The underlying cause of autoimmune diseases is not fully known. SLE may be caused by certain drugs. SLE is much more common in women than men. It may occur at any age, but appears most often in people between the ages of 10 and 50. African Americans and Asians are affected more often than people from other races. Symptoms vary from person to person, and may come and go. Almost everyone with SLE has joint pain and swelling. Some develop arthritis. The joints of the fingers, hands, wrists, and knees are often affected. Other common symptoms include chest pain when taking a deep breath, fatigue, fever with no other cause, general malaise, hair loss, mouth sores, sensitivity to sunlight, and a unique skin rash (a “butterfly” rash) in about half people with SLE. The rash is most often seen over the cheeks and bridge of the nose, but can be widespread. It gets worse in sunlight. Some people have only skin symptoms. This is called discoid lupus.

Temporal Arteritis

Temporal Arteritis is a condition in which the temporal arteries, which supply blood to the head and brain, become inflamed or damaged. It is also known as Cranial Arteritis or Giant Cell Arteritis. Although this condition usually occurs in the temporal arteries, temporal arteritis can occur in almost any medium to large artery in the body. Although the exact cause of the condition is unknown, there may be a link with the body’s autoimmune response. In addition, excessive doses of antibiotics and certain severe infections have been linked to Temporal Arteritis. There is no known cure for the condition. However, once diagnosed, temporal arteritis can be treated to minimize complications. Symptoms of temporal arteritis can include excessive sweating, disturbances in vision, the sudden, permanent loss of vision in one eye, throbbing headache, fatigue and weakness, loss of appetite, muscle aches, transient jaw pain (sometimes, but not always, when chewing), fever, unintentional weight loss, bleeding gums, facial pain, hearing loss, mouth sores, drooping eyelid, joint pain and stiffness, depression, and tenderness in the scalp and temple areas.

Tendinitis

Tendinitis (also tendonitis), meaning inflammation of a tendon, is a type of tendinopathy often confused with the more common tendinosis, which has similar symptoms but requires different treatment. (The suffix -itis denotes diseases characterized by inflammation.) The term tendinitis is reserved for tendon injuries that involve larger-scale acute injuries accompanied by inflammation. Tendinitis injuries are common in the upper and lower limbs (including the rotator cuff attachments), and are less common in the hips and torso. Individual variation in frequency and severity of tendinitis will vary depending on the type, frequency and severity of exercise or use; for example, rock climbers tend to develop tendinitis in their fingers or elbows, swimmers in their shoulders. Achilles tendinitis is a common injury, particularly in sports that involve lunging and jumping, while Patellar tendinitis is a common among basketball and volleyball players. Symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding the joint. Pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms.

Vasculitis

Vasculitis is a condition that involves inflammation in the blood vessels. The condition occurs when the immune system attacks blood vessels by mistake. This may happen as the result of an infection, a medicine, or another disease or condition. Vasculitis can affect any of the body’s blood vessels, including arteries, veins, and capillaries. If a blood vessel is inflamed, it can narrow or close off. This limits or prevents blood flow through the vessel. Rarely, the blood vessel will stretch and weaken, causing an aneurysm. An enormous number of vasculitis symptoms are possible because any organ system may be involved. If the skin is involved, there may be a rash. If nerves suffer loss of blood supply, there may initially be an abnormal sensation followed by a loss of sensation or muscle weakness. Vasculitis in the brain may cause a stroke, or in the heart, may result in a heart attack. Inflammation in the kidney could result in abnormalities noted on urine tests and can lead to progressive kidney failure. Sometimes the symptoms may be as general as fever, loss of appetite, weight loss, and loss of energy.