Dr. Thomas Olenginski, M.D.

Thank you for the question and I hope your daughter does well In some patients with juvenile arthritis, we can see leg length discrepancy or joint contracture Additionally, we may also see the development of micrognathia, or under growth of the lower jaw Today, we feel that if juvenile inflammatory arthritis is effectively controlled then we should not see the complications of Bone development that you asked about Again, I think the best solution is that everyone has access to pediatric rheumatology for accurate diagnosis and defective therapies and long-term follow up Thomas P. Olenginski, M.D., FACP Staff Attending Physician - Geisinger Medical Center, Danville PA Department Rheumatology HiROC FLS Physician Champion BMD Committee Chairperson 570-271-6416 Fax: 570-214-2924

thank you for the question Children can develop inflammatory arthritis, much of which is termed juvenile inflammatory arthritis or JIA and with in the subtypes of inflammatory arthritis is a psoriatic arthritis or spondyloarthritis category It is also important to know that if someone has a definite diagnosis of psoriasis that perhaps 25 percent of them over their lifetime will develop psoriatic arthritis Psoriatic arthritis has subtypes: There is a subtype that involves 4 or fewer joints and we call that pauci articular; there is a polyarticular form that for all intents and purposes can be considered to be juvenile inflammatory arthritis or RA like; there is a form that is extremely unusual and that is fortunate because it is a very active and destructive arthritis that is called mutilans; there is a form that can cause inflammation in the sacroiliac joints and this can mimic a condition called ankylosing spondylitis; and there is a form that can involve the end knuckle what we call the D IP or end knuckle joint Patients with psoriasis can have abnormal fingernails and abnormal toenails There symptoms will typically include pain, stiffness, particularly morning stiffness, and inflammatory swelling of the joints and or marked stiffness of the low back Pediatric rheumatologists are incredibly skilled at trying to determine the cause of musculoskeletal symptoms in children Again thank you for the question Thomas P. Olenginski, M.D., FACP Staff Attending Physician - Geisinger Medical Center, Danville PA Department Rheumatology HiROC FLS Physician Champion BMD Committee Chairperson 570-271-6416 Fax: 570-214-2924

Rheumatoid Arthritis is a condition that tends to cause a symmetric polyarthritis - typically that means what happens on 1 side happens on the other and polyarthritis means many joints that are involved Morning stiffness is a characteristic symptom of rheumatoid arthritis were it may take a patient 1 or 2 hours to limber up in the morning and be able to get on with their day. Also squeeze tenderness of the knuckles of the hands and the metatarsal regions of the feet is common When we evaluate someone who has pain swelling and or stiffness of many joints we consider rheumatoid arthritis, psoriatic arthritis, or conditions termed spondyloarthropathy Characteristic lab abnormalities in rheumatoid will include an elevation of the sedimentation rate and C-reactive protein, which are inflammation indicators. About (3/4) patients with rheumatoid arthritis produce a rheumatoid factor antibody and there is a newer more specific antibody called an anti CCP that can assist in the diagnosis My advice would be to get your symptoms checked so that a diagnosis and treatment plan can be initiated Thomas P. Olenginski, M.D., FACP Staff Attending Physician - Geisinger Medical Center, Danville PA Department Rheumatology HiROC FLS Physician Champion BMD Committee Chairperson 570-271-6416 Fax: 570-214-2924

I am sorry to hear that your father is having this difficulty Yes, it is permissible to massage if the correct technique is used If someone nor to have acute swelling and pain, then I might consider using ice as an adjunctive therapy Heat tends to be more effective for chronic pain There are topical anti-inflammatory medications that can be applied to the skin such as diclofenac gel Acetaminophen taken on a regular basis can also be effective In general, we avoid using nonsteroidal anti-inflammatory drugs in elderly patients with knee arthritis because of the risks of side effects At times, cortisone injections can be helpful I hope this is of some benefit to you and I hope your father is feeling better

The most important thing in giving treatment recommendations for arthritis is to know what specific form of arthritis we are dealing with The most common arthritis that affects the knees is osteoarthritis That is a condition where the cartilage which cushions the joint space slowly wears down And in doing so, the joint space narrows, and patients experience pain and difficulty walking etcetera The treatment of arthritis suffers from lack of understanding of some of the reasons and mechanisms behind arthritis, whether it is osteoarthritis or rheumatoid arthritis or psoriatic arthritis etcetera I am not aware of any clear study that shows that a medical food or specific diet and or dietary changes clearly effects the progression of a patient's arthritis The most important thing in osteoarthritis is weight management and weight loss if necessary as well as an exercise program I have many patients who follow an anti inflammatory diet and they seem to be helped by this There was no good evidence however to show that 1 diet is better than another in a rigorous scientific way So my patients that they can follow choose or learn about an anti-inflammatory diet Patients who have gout, they develop problems because of the accumulation of excess amounts of uric acid Patient is can follow a low purine diet and help lower being of your to some degree, although in almost all patients with recurrent gout, a uric acid lowering medicine is necessary Again I would advise anyone with questions about arthritis to be sure that they know exactly what type of arthritis they have I hope your pain improves and I hope you have a good day.

Thank you for your question The most important thing in determining what the best treatment rests on determining what specific form of arthritis you have Patients with rheumatoid arthritis or psoriatic arthritis can be treated with very specific disease-modifying medications and or water-termed biological medications Alternatively if you have osteoarthritis, which is the most common arthritis in the world, then our treatments become symptom-based treatments would include acetaminophen/Tylenol; Advil or Aleve, 2 over-the-counter nonsteroid anti-inflammatory drugs; prescription anti-inflammatory medications such as naproxen, Voltaren, Celebrex, meloxicam, etcetera; we typically, we do not use strong pain relievers for arthritis pain. That is because of the risks of side effects, including lightheadedness, dizziness, sedation, and dependence. A topical anti-inflammatory cream such as diclofenac or Voltaren gel can be considered Sometimes physical therapy and or occupational therapy or a hand therapy evaluation can be helpful Finally, pain modulators such as duloxetine can be considered Again, the best treatment plan is based on a specific diagnosis Best wishes and good luck.

I am going to answer question really addressing how we evaluate a patient with Raynaud's Raynaud's can be primary, where a patient starts to have signs and symptoms of Raynaud's at a relatively young age We will say primary when we see no signs or symptoms of any other condition Secondary Raynaud's is a condition linked to an underlying autoimmune or immunologic condition The most common condition associated with secondary Raynaud's is scleroderma and there are different forms of scleroderma, the most common form being what we call limited scleroderma and the other form being called diffuse scleroderma Additionally, we can see Raynaud's in patients with lupus or a condition we call mixed connective tissue disease or an overlap condition, really meeting that we see signs and symptoms of more than 1 condition but we can not diagnose the patient as lupus or scleroderma or Sjogren's Finally, patients with an inflammatory muscle condition called dermatomyositis can also have Raynaud's From a clinical standpoint, if I do not see any signs or symptoms of Raynaud's that is very reassuring Typically, when we do laboratory tests to evaluate the most important test is the antinuclear antibody The ANA test is a test that can be performed by different methods and there are more specific methods that can be used Nonetheless, when there is an apparent abnormality in the ANA screening test, we do more specific autoantibodies to better define the ANA Those antibodies are typically anti DNA, anti SSA SSB, anti-SM/RNP The ANA test will often return with a titer, example 1 to 160, and with a pattern, example homogeneous or speckled When the ANA pattern is centromere, that indicates that there is a centromere antibody in the patient's system and that antibody is most typically seen in patients with limited scleroderma An antibody called anti Scl 70 can be detected in patients with diffuse scleroderma So, from what I think I understand in your situation, the additional testing and the interpretation of that will be very important I wish you well and thank you for your question

The first question I would want to know is what was the reason for the test. One could order IgG subclasses in the evaluation of a suspected immune deficiency state. The most common thing for rheumatologists to order this test would be in the evaluation of suspected IgG for related disease. It is important to know that a small percentage of the otherwise normal population will have an elevated test. Additionally, this test can be elevated in many inflammatory and infectious and allergic disorders. So again, I would want to know why your doctor ordered this test. And then based on the test results and his or her suspicions, further testing may be necessary. The most important point is that many conditions can cause an elevation of this specific test Best wishes

I am sorry that you are having difficulties I presume that the prednisone and methotrexate have been used to treat polymyalgia rheumatica or what we call PMR This is an inflammatory syndrome of the elderly that is very responsive to prednisone, usually On occasions, we will encounter patients who have difficulty getting to lower doses of prednisone The big concern with chronic prednisone therapy, even at low dose, our side effects including osteoporosis, muscle weakness, bruising of the skin, cataracts, etcetera There is a new medication that is recently approved for the treatment of polymyalgia rheumatica when the patient has trouble tapering off or to lower doses of prednisone That medication is Kevzara or Sarilumab This is a medication in the category of Biologic and it is similar to a medication called Actemra, which is used to treat rheumatoid arthritis and giant cell arteritis In general, medications such as methotrexate and Plaquenil are not as reliably effective in trying to bring the dose of prednisone down in somebody with PMR From what I see here, you may very well be a candidate for Kevzara and I would encourage you to talk to your rheumatologist about that Best wishes to you

Pain, swelling, stiffness, deformity, or difficulty using your joints are all potential signs of arthritis. Having said that, there are many different forms of arthritis and it is very important to know what type of arthritis affects you so that the best treatment can be recommended. Best wishes to you and I hope you feel better

This symptom could potentially be the start of arthritis. However, I would look at the symptoms as a reason to be evaluated to know specifically what is going on. Arthritis of the wrist is not as common as arthritis of the hips or knees or back or some other joints. Wrist pain can be the sign of what we will term an overuse injury, perhaps a tendonitis, perhaps a prior injury that may lead to a post traumatic arthritis. While numbness in the 1st 3 fingers is often related to carpal tunnel syndrome, wrist pain can be a sign as well. Additionally, chronic infections can present as wrist pain and wrist arthritis and wrist arthritis can be a consequence of an earlier inflammatory condition such as juvenile arthritis or Still's disease. Again, I would recommend evaluation so that you will have peace of mind and a treatment plan

It sounds to me like you had a cramp or other muscular pain There are many potential causes for calf pain Should this continue and/or worsen, then I would get checked by your primary care doctor Best wishes

Thank you for this question I appreciate the question and from what I read you indicate that your mother has very severe knee arthritis, most likely osteoarthritis Osteoarthritis is a condition where the cartilage breaks down and over a long period of time there can be the development of joint deformity and or severe pain and or difficulty walking We indicate that treatment for osteoarthritis is symptom based, meaning that we unfortunately do not have a way to stop the arthritis Traditional recommendations include acetaminophen, physical therapy, topical diclofenac which can be rubbed into the knee regions 3 times daily, steroid injections, and possibly water called intra-articular hyaluronic acid injections Anything applied locally to a painful region may be of benefit, whether hot or cold Hot oil massage is a treatment that does not have any clear-cut scientific evidence From my standpoint, massage may be helpful to the muscles above the knee as these muscles are very important to getting up and down, especially in someone with knee arthritis I hope this helps and I wish your mother well Dr O

This is a very common question that we get, but unfortunately I can not say that there is strong evidence supporting any specific diet However, if one suffers from gout we recommend a diet low in purines My colleagues and I typically recommend a Mediterranean diet to someone who is motivated to try to help themselves Probably the best dietary advice for anyone with arthritis is to maintain an ideal body weight as patients with obesity commonly have low back and knee pain Best wishes to you

One of the most underrated aspects of what a rheumatologist does is to take a history, and to do physical examination. The rheumatologist will thoughtfully listen to your signs and symptoms and concerns, and will ask additional questions to help get to the bottom of the matter. likewise, the rheumatologist will skillfullyand carefully order tests that will help determine the cause of your signs and symptoms in an error where medical care is being pressured to be too fast and too quick, trust your rheumatologist to take his or her time to help you Get Outlook for iOS<https://aka.ms/o0ukef>

if a family, member or friend asked me this question, I would say that you should see a rheumatologist, orthopedic surgeon, or sports medicine, physician. Get Outlook for iOS<https://aka.ms/o0ukef>

Thank you for submitting an excellent question. First and foremost, I would discuss with your physicians whether any type of vaccine or medication for such things as traveler's diarrhea are necessary. Additionally, I would at least discuss with your employer the availability of medical care where you are traveling to, just in case of an emergency or a medical question. I would make sure that you have an adequate supply of your medications and I would make sure that any type of laboratory monitoring be done prior to your travel. On your trip, I would be careful that you get adequate sleep, that you eat regularly an nutritiously and that you get regular exercise. If you have the ability to send a protected e-mail to your doctors, that would be very useful because you could consult with them if you have any questions while you are way. Likewise in the event of an illness they could give you advice and hopefully you would then be able to apply that advise and be seen locally in the country that you are visiting. Finally, if you are on injectable medications with needles and or syringes, it would be important that you have a letter that you could show to the appropriate people at the airport and or security. I hope that helps and I wish you a safe and successful trip

This is a common circumstance for some patients with arthritis; the most important thing to do is make sure that we have a correct diagnosis so that appropriate treatment recommendations can be given

From what I read, you were indicating low back pain that may be radiating to the right buttock. There are many causes of back pain. The most important way to get to the root cause is to get a thorough history of signs and symptoms from the patient. this is followed by inappropriate physical examination, and the use of imaging modalities, if indicated. Many would suggest the initiation of physical therapy for your particular problem. The problem may very well be what we call a radiculopathy, whereby the exiting spinal nerve roots maybe Irritated by herniated disc material. Based on your response to physical therapy, and perhaps the use of anti-inflammatory medications, this would help your doctor determine whether or not to consider an MRI scan. In summary, the best treatment really rests on getting to the root of the problem Get Outlook for iOS<https://aka.ms/o0ukef>

Find a good doctor and work with that office to help you with your pain