Other forms of Arthritis

Inflammatory Immune Arthritis eg Psoriatic Arthritis

The treatment of the other common inflammatory immune diseases follows the model for RA with DMARDs, progressing to biologics as the mainstay and steroid injection or tablets as an aid to achieving control. Details differ, so for example steroids are less used in psoriasis, while methotrexate also treats the skin and may be useful on both fronts. often, however, the DMARDs are less effective in other conditions than they are in RA.

The newly released oral medication “Otezla” (Apremilast) offers new possibilities for the treatment of Psoriatic Arthritis and I am gaining early experience in it’s use.

Beyond these treatments Biologic therapies, usually TNF-alpha blockers are used

Osteoarthritis (OA)

There is no way currently to alter the natural history of Osteoarthritis. the treatment is the treatment of symptoms and function.  As well as injections of steroid and hyaluronans (joint lubricating Gells), advanced pain management techniques such as pulse RF of the nerves to joints such a hip and knee can be dramatically effective in treating the pain of OA (see interesting cases).

The image (from Kimberley Clarke) shows electrodes in position to treat the obturator and femoral nerve branches which supply pain sensation to the hip.

The image (from Kimberley Clarke) shows electrodes in position to treat the obturator and femoral nerve branches which supply pain sensation to the hip.

 

This siamge shows electrodes in position to treat the right knee with pulse RF pain modulation to the 3 main "Geniculate" nerves to the knee.

This image shows electrodes in position to treat the right knee with pulse RF pain modulation to the 3 main “Geniculate” nerves to the knee.

Gout

Gout results from the accumulation of uric acid most of which is produced by daily metabolism rather than from foodstuffs. Uric acid accumulates if there is an imbalance between production/ingestion and excretion throughout the kidneys. Most cases of Gout are straightforward and just need a clear management plan.  Where things have progressed to tophaceous gout with severe problems treatment has been difficult but even this can be rested in exceptional circumstances (see interesting cases: gout)