At my Rheumatology Clinic today, I saw a young Pakistani young girl accompanied by her father who had come all the way to India because she was concerned that she had a lethal disease. Both father-daughter were concerned as she was being treated for already diagnosed  SLE (Systemic lupus erythematosus) with Hydroxychloroquine and Azoran for the last two years and was planned for addition of steroids just to bring down the level of DsDNA  which was detected to be positive in an asympotomatic patient, ANA being negative .

Actually, two years ago, she had developed cervical and axillary lymphadenopathy (enlarged lymph nodes in neck region) without any history of fever. Tissue taken on biopsy from lymphnode revealed reactive lymphadenopathy, however the fever subsided within a span of two weeks without any treatment but anti DsDNA was found positive by ELISA and ANA was negative. Treatment of SLE was started just on the basis of a single positive test without meeting the four criteria required to confirm the diagnosis of SLE.

So what did I do? I cancelled the diagnosis of SLE as DsDNA positivity was an incidental finding and this can be found positive in around 5% of normal individuals, hence should be ignored if the patient is otherwise healthy. I immediately advised her to stop all the medications for SLE as unnecessary chemicals in your body will only harm you.

I can’t even imagine how she would have suffered, had she been taking those medicines.

So the moral of the story is, we diagnose rheumatic diseases based on the symptoms not on the basis of the Investigations. Investigations are performed to confirm the diagnosis and for prognostification and not the other way around. So, if you are asymptomatic, do not run around to get yourself treated for any incidentally detected abnormal investigation.

By the way, the patient concerned was a final year, MBBS student.

So far we do not know what causes Rheumatoid Arthritis (RA). However, there are many theories such as molecular mimicry and development of mutated proteins behaving like auto-antigens. Molecular mimicry occurs after some infection and mutated proteins such as citrulination of vimentin and other peptides. Conversion of self antigens into autoantigens most likely results due to hypoxic stress of cartilage. These molecules are liberated in the joints and thereby reacting with synovial tissue which tries to remove these antigens from the system.

I have been in clinical practice of rheumatology for more than a decade and during this long span I have seen many examples where RA resulting after an excessive traumatic stress perhaps, resulting in liberation of damaged cartilage in the joint cavity. Cartilage is the tissue which generally does not come in contact of the immune system as it is an avascular structure but when it comes in contact with immune system because of the damage after physical stress, after so many years, it does not recognise it as self. Hence, it starts reacting to it as foreign substance and continues to do the same till all the cartilage tissue is eaten up. There are animal models to the same concept.

As you can see in the picture, the tyre which can be compared to our joints has given up under the weight of the debris. So my advice is to prevent the development of RA by optimising our physical stress and also not stressing our immune system too much by maintaining a healthy weight. We can perhaps also prevent the development of RA through clean habits and avoiding various infections mainly those which effect our Gastrointestinal & urinary tract. 

For years now, in my medical practice, I’ve believed that Fibromyalgia results from recurrent micro-sprains and strains of myofacial junctions in patients with weak biomechanics and hyper mobility associated with obesity or being overweight. And whoever put into practice, my advice to reduce their weight, their symptoms of fibromyalgia significantly resolved. Please read on the abstract of a yet to be published study, which now confirms my deep rooted belief (by experience, of course).

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We all more or less know what's healthy and what's not, thanks to health magazines and shows. But some of us, combine the wrong food together, some mess up when they shop, some don't cook healthy and most of us fall prey to greed when we eat.

Print it. Paste it in your kitchen. And most importantly, follow it patiently. You'll see the extras disappearing overtime.

One of the queries on my facebook page asked me for my opinion about AP therapy by Dr. McPherson Brown. Explaining everything in detail is quite a task on the post so I thought, I’d include this in my blog for the benefit of other patients.

First, let me give you a background of AP therapy. It is an antibiotic protocol therapy propagated on the premise that rheumatic diseases including Rheumatoid Arthritis (RA) results from mycoplasma infections and prolonged antibiotics can resolve the arthritis¹.

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The April issue of Arthritis & Rheumatism brings with it good news, which I would like to share with all the readers. I’m excited to know that even in the case of a degenerative arthritis called Osteoarthritis, lot of new researches are happening and the latest evidence has shown the presence of CPC ie, chondrogenic progenitor cells even in the late stages of Osteoarthritis and cartilage tissues had receptor for estrogen and androgen.  Local placement of these hormones may prove beneficial in future studies. I’m eagerly awaiting results. If you want to read the full article please see below,

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More often than not, people who suffer from obesity are heard complaining about joint pains much earlier in life as compared to people who maintain their optimum weight. As a doctor, it is easy to ask my patients to reduce their weight, however that is easier said than done. The larger problem at hand is motivating my patients to follow a healthy lifestyle and encourage them to actually lose the excess weight.

In my experience, there is a holistic improvement in the patients health after reducing their weight. I have treated such patients with a lot of patience and understanding as weight issues can be very sensitive, especially with women. So, I thought I’ll share some of my experiences with you.

If you know someone who is obese and is suffering from joint pains or arthritis and want to help them, the most important thing to do is, spare some time and understand why they are gaining weight. Take them to a doctor who would not only give them medicines to reduce the pain but wants to help them in the long run and tries to understand why he/she has gained weight & what increased weight is doing to his/her body systems?

What I do is, I show my patients a real vivid picture of their personality. It’s like showing them a mirror. It might sound a little insensitive to some but that’s what a well wisher will do. And it’s very important to have a doctor who you can trust to be brutally honest with you and show you the right path. Majority of the times, I have been successful in motivating my patients to reduce their excess weight and have seen arthritis symptoms ameliorate & even co-morbidities subside significantly. I motivate people on the following lines, I tell them in all sincerity that,

When you are obese, what you project to the world & tell the world about yourself is this: 

 

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