All posts filed under: side2

Diagnosing rheumatoid arthritis

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Once a person has at least one joint that is painful and inflamed, a rheumatologist can use a ten point check to help diagnose rheumatoid arthritis (RA). The assessment covers four areas: joint involvement, serology, acute phase reactants plus duration of symptoms. There is a total of ten points. A score of six confirms a diagnosis of rheumatoid arthritis. Here is how it breaks down. Choose one from each group and total.. A. Joint involvementOne large joint 0 points2-10 large joints 1 point1-3 small joints 2 points4-10 small joints 3 pointsGreater than 10 joints including at least one small joint 5 points B. Serology (blood tests)Negative RF and negative ACPA 0Low positive RF or low positive ACPA 2High positive RF or high positive ACPA 3 C. Acute phase reactants(inflammation blood tests)Normal CRP and normal ESR 0Abnormal CRP or abnormal ERS 1 D. Duration of symptoms< 6 weeks 0 6 weeks 1 My choices are a total of 7. Note I am seronegative, and it took a lot of joint involvement to get a positive diagnosis. …

RA treatment in the 1920s

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In the early days of the twentieth century very little was known about rheumatoid arthritis.  It might have been called chronic infectious arthritis, proliferative arthritis or atrophic arthritis. Rheumatology was not a specialty. There were no rheumatologists. It was not a good time to have RA. Arthritis treatment at the Mayo Clinic  included bed rest. Patients were admitted to the hospital and put on bed rest for several weeks. They were given a balanced diet. Physical therapy was an important therapy. It improved range of motion, strengthened muscles and prevented deformities. Heat and massage were used  to improve circulation and to remove toxins. Bracing and casting were used to support joints and reduce contractions. Canes were prescribed. Shoe corrections were prescribed. Vaccine therapy, fever therapy and sympathectomy were popular treatments at the Mayo Clinic based on the theories of the time. As medical knowledge grew these therapies fell out of favor. Salicylates were drugs of choice. Remember this was before sulfa, penicillin and cortisone. It a was long time before ibuprofen would be formulated. Any …

Purging, Bloodletting and Algorithms

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At the beginning of the twentieth century, the old remedies of purging and bloodletting were left behind. Lister’s concepts of cleanliness had finally become widely accepted. Human anatomy was documented. The culprits of bacteria were identified. Medical knowledge base was growing beyond imagination. Yet doctors were stuck. There was no cure for a bacterial infection. There was no cure for a strep infection. If you were stricken with a strep throat, there was a good chance that you would die. Doctors had no solutions and people of all ages died from pneumonia, wound infections, meningitis, and more. Infection was feared. Today all this is unimaginable. But then, Ehrlich’s ‘magic bullet’ was yet to be discovered. The world changed forever with the discoveries of sulfa in 1936. Penicillin was refined and put into production in the 1940s. There were many more ‘magic bullets’ to follow. Doctors finally had new tools for their toolbox. It became the age of knowledge plus tools. Life became much better. Lifespans became longer. Today, in the twenty-first century, our doctors have …

Renoir and RA

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Bal du Moulin de la Galette sold in 1990 at Sotheby’s for $79 million. Renoir painted this scene of popular Parisian life in 1876.   It was a typical Sunday afternoon at Moulin de la Galette in the district of Montmartre in Paris.  An impressionistic image. Vivacious and joyful in nature.   In fact, he painted not one but two of the same scene. One large and one small. Almost identical with minor differences in style. The larger of the two paintings hangs in Musee d’Orsay, which houses the largest collection of impressionist masterpieces in the world. The smaller of the two, the one sold for $79 million, is in a private collection. Pierre-Auguste Renoir loved painting. He started his career at the young age of 13 working in a porcelain factory. He frequently visited the Louvre to study the French masters.  He spent his lifetime studying and admiring the paintings of  the master painters. With his factory earnings, he joined Alfred Sisley, Frederic Bazille and Claude Monet for classes at Charles Gleyre’s studio.     Renoir along with Pissarro, Monet, …

Did the Dinosaurs have RA?

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They did not. They were a healthy species.  However, there were some who had holes in their bones similar to those humans who have Gout. The earliest findings of RA in humans was actually in North America in an area know today as Tennessee. Bones found to belong to Native Americans who lived about 6500 years ago or in 4500 BC were authenticated to have RA.  Today Native Americans have the highest incidence of RA in any ethnic group.  Some argue that RA is a new disease but it seems they are ignoring all the evidence compiled by researchers. RA was also found to be present in Egyptian mummies. We can feel fortunate that we have our RA in the present.  Even  in the 20th century it was a tough disease to have.  Aspirin was consumed in large doses as was Prednisone in the latter part of the century.  Prednisone was considered a miracle drug and was used in high doses.  Today it is helpful tool in our war chest but in much lower doses. …