Q&A: Joint and muscular pain

Q: Good afternoon,

I’m having severe joint and muscular pain everywhere, I have crohns that is in remission with humira and also have Graves’ disease which is currently under control, and my question is could it still be arthritis even though I’m on humira, that pain is so bad it wakes me at night and I’m so fatigued and feel like I can’t think, I’m not sure what is going on with my joint and muscles. My email is meljanx@gmail.com

A: You can still have active an crohn’s inflammatory arthritis even if your crohn’s is stable on humira. You might also have a secondary arthritis such as osteoarthritis in addition to the Crohn’s arthritis. You should followup with a Rheumatology for further evaluation.
– Dr.Amal Mehta

Q&A: Psoriatic Arthritis

Q: Do any of the doctors treat Psoriatic arthritis as caused by a microbial infection?
A: All of our doctors treat Psoriatic Arthritis. The exact etiology of Psoriatic Arthritis is unclear however there is data to suggest that microbial infections can cause Psoriatic Arthritis. We do not use antibiotics to treat Psoriatic Arthritis. We typically use medications such as methotrexate and anti-tumor necrosis factor drugs.
-Dr.Amal Mehta

Q&A: Osteoporosis

Q: Hi, I have a diagnosis of osteopenia of my right hip. I am 53 y.o., female, lacto-intolerant, never bore a child, have never used drugs, never excessively drank alcohol. Is it true my number one defense is to exercise using weights. I understand some controversy of the benefit of use of calcium supplements?
A: Weight bearing exercise does improve bone density. There is some controversy regarding calcium supplements. The United States Preventative Services Task Force recommended that post-menopausal women do not need to take supplemental calcium or vit D, however this recommendation does not apply to people with Osteoporosis or Low vit D.
-Dr.Amal Mehta

Back pain – Sciatica?

Q: Without being able to pinpoint when I actually “hurt” my back, I now have pain and spasms from my buttocks all the way down both legs as far as the back of my calves. I have tried ice and stretching exercise on the floor. I will go for a few hours with relief (also use Advil) but then my legs for no given reason will just spasm and “lock” up.
A: There are several possibilities for your pain. Pain that originates from the lower back and radiates down the leg can be secondary to lower back spasms or could be directly from the spine. Spinal pain in this situation can be divided into broad categories, “wear and tear” such as Osteoarthritis, spinal stenosis which is narrowing of the spinal cord, disc herniation, traumatic arthritis, rarely infectious arthritis and inflammatory arthritis. You need to see a doctor for a thorough history, physical exam, imaging tests and possibly blood tests. Treatment will depend on the underlying etiology of your back pain and could include medication for nerve pain such as gabapentin, lyrica, norepinephrine/serotonin reuptake inhibitors such as cymbalta, oral/topical anti-inflammatory medications, steroid injections, stretching exercises and surgery in severe cases.
-Dr.Amal Mehta


Shoulder pain, Osteopenia?

Q: After three months of both severe shoulder pain, after two falls, I requested an x-ray. The results were that I have Oesteopenia. The pain is severe and wakes me up in the middle of the night. What should my next step be in order to lessen the pain?
A: Osteopenia is a mild thinning of the bones and can be suggested by an x-ray but needs to be diagnosed by a tested called a bone density scan (T score between -1 and -2.4). Osteopenia does not cause pain and is not related to your shoulder pain. If the X-ray did not show arthritis in your shoulder and if your primary care physician can not determine the etiology of your shoulder pain, you should see a Rheumatologist or an Orthopedic surgeon. Possibilities for your shoulder pain include arthritis in the shoulder joint, bursitis, inflammation of the biceps tendon as it inserts into the humerus, rotator cuff tear or pain radiating from the neck if you have cervical spine arthritis. You might need an MRI. Treatment will depend on the underlying etiology of your pain and options may include steroid injections, anti-inflammatory medications, exercises, nerve blocking or narcotic pain medication and surgery.
-Dr.Amal Mehta

Raynauds – Cold fingers and Toes

Q: Do you treat people with Raynaud’s Phenomenon?
A: Yes, we treat people with Raynaud’s Phenomenon. Raynaud’s is a condition that results in poor blood flow, typically to the hands and feet. The decreased blood flow is exacerbated by cold temperatures and can cause color changes and pain in the digits. As Raynauds progresses, it can cause gangrene to the affected digits. When evaluating someone for Raynauds, it’s important to determine if they have primary Raynauds or Raynauds secondary to a connective tissue disease such as lupus or scleroderma. The treatment for Raynauds is to improve blood flow to the affected extremity by keeping the hands and feet warm and we typically use oral or topical medications as well. The medications work by dilating the blood vessels so your blood pressure needs to be monitored because a common side effect of medications used to treat Raynauds is low blood pressure.
-Dr.Amal Mehta