Patients Visit Doctors Most For Aches & Pains

DANBURY — Not cancer or heart trouble or infection or injury, but aches and pains are what send people to the doctor most often.

“Arthritis is the first or second most common complaint,” said Kenneth Miller, MD, Danbury Hospital Department of Medicine, Section of Rheumatology. Arthritis encompasses dozens of diseases and conditions that cause pain and stiffness, he added.

Dr Miller spoke to the community about “What’s New in the Treatment of Arthritis and Systemic Lupus” at a recent Medical Town Meeting sponsored by Danbury Hospital. Also speaking was Alla Rudinskaya, MD, Department of Medicine, Section of Rheumatology.

The doctors discussed the two main types of arthritis, rheumatoid and osteoarthritis, along with related conditions such as tendonitis, bursitis, fibromyalgia, and lupus.

Osteoarthritis is so common that everyone over the age of 70 has some level of joint pain and stiffness, according to Dr Miller. It is a degenerative disease that occurs from wear and tear of joint cartilage that comes from aging. Osteoarthritis can also occur after an injury.

It affects women and men equally, and can run in families. Features of osteoarthritis include morning stiffness, joint pain, boney swellings, functional impairment, deformities, joint space narrowing, cysts, bone spurs, and other problems.

Osteoarthritis is best treated with analgesics, low-dose nonsteroidal anti-inflammatory drugs (NSAIDs), and glucosamine and chondroitin. Local steroid injections are also helpful into an affected joint.

Exercise and weight reduction are also recommended. “A ten percent reduction in weight translates into a 20 percent improvement in how one feels,” said Dr Miller. As a last resort, joint replacement surgery is also helpful, especially for the knee or hip.

For the future, Dr Miller said that research is under way to find safer NSAIDs and treatments that help preserve and protect joint cartilage.

Rheumatoid arthritis (RA) is another form of arthritis. It is an autoimmune disease characterized by inflammation and is not a disease of the elderly. It affects one percent of the population, mostly women. It is characterized by swelling and deformity of a joint, especially the hands, and the presence of nodules. The best type of treatment works to prevent deformity, according to Dr Miller, and many new drugs and therapies are revolutionizing treatment of RA.

Dr Rudinskaya discussed systemic lupus erythematoses (SLE) or lupus, a disease that affects joints, skin, kidneys, and other parts of the body. Not nearly as common as osteoarthritis, SLE affects about one percent of the population, 90 percent of whom are women. While doctors think there is a genetic predisposition to lupus, environmental factors are also thought to trigger the disease, such as ultraviolet light, infections, viruses, medications, and more.

Symptoms include a butterfly rash; scaly, patchy rash; sensitivity to light; sores in the mouth and nose; arthritis; Raynaud’s syndrome; pleurisy; kidney problems; blood problems; weakness; fever; fatigue; weight-loss; hair loss; dry mouth; blood clots; and fibromyalgia.

It is treated with a variety of medications customized for each patient, including NSAIDs, Plaquenil, DHEA, prednisone and immunosuppressive drugs.