Physical Therapy in Lynn Haven and Panama City Beach for Viral Arthritis

Welcome to First Choice Physical Therapy’s patient resource about Viral Arthritis.

We know that some viruses cause joint pain and inflammation (swelling, redness, and heat). Researchers have wondered for a long time whether some kinds of arthritis with unexplained causes may be the result of a virus. So far no one knows, partly because the virus itself may be long gone before a patient ever develops the pain and inflammation of arthritis.

This guide will help you understand:

• how viral arthritis develops
• how doctors diagnose viral arthritis
• what can be done for the condition

Where does viral arthritis develop?

Most viral infections in the body cause a limited illness. Then the body’s immune system destroys the virus, and the symptoms of the illness go away.

In viral arthritis, the immune system’s response to the virus causes inflammation in the joints. Even after the virus is eliminated from the body, the changes in the joint can continue to cause pain and swelling. The joint may even become permanently damaged.

Which viruses cause viral arthritis?

Several viruses are known to cause problems with joint inflammation and pain. Some of the most common are listed below.

Parvovirus B-19

Parvovirus B-19 is a common virus. About 60 percent of adults have been infected with it at some point in their lives. Parvovirus B-19 causes the illness called fifth disease, which causes a rash on the face and body. People usually get fifth disease as children. About 15 percent of children with fifth disease have some kind of joint pain, which usually goes away quickly. Almost 80 percent of adults who get fifth disease report sore joints within three weeks of the infection. Any joint can be involved, but usually it affects the foot, hand, knee, wrist, and ankle joints on both sides of the body. Most of the time the joint pain clears up in about two weeks, but it has been known to come and go for as long as ten years.

Hepatitis B

Hepatitis B infection, which causes severe inflammation of the liver, can cause a severe and sudden form of arthritis that affects many joints on both sides of the body. The hands and knees are the most common sites, but the wrists, ankles, elbows, shoulders, and other large joints are also affected. The arthritis often starts before the jaundice (yellowness of the skin) of hepatitis, and it may last for several weeks after the jaundice is gone. For patients with chronic (meaning long-lasting) hepatitis, joint pain may come and go.

Rubella

Rubella, a mild but highly infectious viral disease, causes joint pain in many adults, especially women. Joint symptoms tend to appear within a week of the rash common with this disease. The joints are usually not inflamed, but they are stiff and painful. The hands, knees, wrists, ankles, and elbows are most commonly affected. The joint pain of rubella usually goes away within two weeks, but in some cases it can last for several years.

The rubella vaccine also causes joint pain in about 15 percent of people. Joint stiffness occurs about two weeks after the shot and lasts for about a week. The vaccine has been known to cause more severe joint stiffness in some people, however, which can last for more than a year.

HIV

Human immunodeficiency virus (HIV) is the virus that causes AIDS. It is connected to several different forms of arthritis. When people are newly infected with HIV, they often have flu-like symptoms and joint pain. About 10 percent of HIV patients have severe joint pain that comes and goes, mostly in the shoulders, elbows, and knees. Patients with HIV are much more likely to develop reactive arthritis, Reiter’s syndrome, and psoriatic arthritis. In these cases, doctors aren’t sure whether HIV actually causes these forms of arthritis, or whether the arthritis occurs separately. Up to 30 percent of HIV patients also suffer from fibromyalgia.

In some cases, viruses that cause arthritis type symptoms can be carried by insects. Alphaviruses, one such family of viruses, are carried by mosquitoes in Africa, Australia, Europe, and Latin America. All can cause arthritis symptoms.

How do doctors identify viral arthritis?

There is no specific test for any type of viral arthritis. Your doctor will make the diagnosis based on other symptoms. Usually blood work and X-rays don’t help. In many cases the diagnosis of viral arthritis is made after a search for other causes turns up negative and your symptoms or history suggest a virus as the cause.

What can be done for the condition?

In most cases, viral arthritis runs its course fairly quickly. Your doctor may recommend a medication to help with the discomfort. Most of the time this will be an over-the-counter pain reducer like acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen. Your doctor may also recommend use of hot or cold packs on the inflamed joints and rest.

Welcome to First Choice Physical Therapy’s patient resource about Arthritis.

Arthritis is the most common cause of chronic disability. There is no cure for most forms of arthritis. But with some effort, you don’t need to lose all the movement in your joints. Most doctors refer their patients to Physical Therapists or occupational therapists for rehabilitation.

At First Choice Physical Therapy we can develop a  personalized  program to help you maintain and even improve your strength and mobility. With some help from our Physical Therapists and special equipment, arthritis won’t always stop you from doing the things you enjoy or the things you need to do.

Our rehabilitation is a hands-on form of care and relies on your participation and effort. It involves exercising, learning how to care for sore and swollen joints, and figuring out ways to minimize the stress on your joints.

In the early stages of arthritis, our goal is to maintain or improve your joint range of motion and muscle strength. If your joint is severely damaged, our Physical Therapist will focus on managing your pain and finding special equipment to help you with necessary tasks. The rehabilitation experts at First Choice Physical Therapy are also experienced in helping people recover from joint surgery. Our rehab program will involve managing your symptoms, exercise, and lifestyle changes.

Rehabilitation requires patience. It takes time to strengthen your movements and learn how to do familiar tasks in new ways. The result can be a greatly improved quality of life.

In addition to Physical Therapy specialists, such as those at First Choice Physical Therapy, many other types of medical professionals are involved in caring for people with arthritis; rehabilitation nurses, vocational rehab counselors, recreational therapists, and sometimes even medical social workers, speech therapists, and psychologists. No matter what kinds of specialists you see, rehabilitation is a team effort – you, your doctor, and your therapists.

Your First Visit

What happens on the first visit to our office?

The first step in your rehabilitation is for our therapist to learn more about you and your joint problems.

History of the Problem

When you first visit First Choice Physical Therapy, we will ask questions about your disease history, your day-to-day activities, and what you have problems doing. Our Physical Therapist will ask you to rate your pain on a scale from one to ten. Your answers will help guide our examination. Below are some other questions out therapist might ask you.

• What makes your pain or symptoms better, and what makes them worse?
• How do your symptoms affect your daily activities?
• What treatments have been helpful for you?

After reviewing your answers, your First Choice Physical Therapy Physical Therapist will do an examination that may include some or all of the following checks.

Posture and Joint Alignment

By checking your overall posture and joint alignment, our Physical Therapist can see if you have swelling or other signs of inflammation. We will also look to see if you have any nodules or other changes around your joints, which may be present with various forms of arthritis.

Range of Motion (ROM)

Our Physical Therapist will check the ROM in your sore joints. This is a measurement of how far you can move the joint in different directions. Your ROM is written down and is used to compare how much improvement you are making with treatment.

Strength

Your strength is tested by having you hold against resistance applied by your Physical Therapist. Weakness and pain with these tests may be expected due to the presence of arthritis.

Manual examination

Carefully moving the joint in different positions can give our Physical Therapist an idea of the stiffness or laxity in your joints.

Palpation

Our therapist will feel the soft tissues around the sore areas. This is called palpation. Through palpation, we can check for changes in skin temperature and for swelling. Our Physical Therapist also pinpoints sore areas and looks for tender points or spasm in the muscles around the sore area. Palpation is important in helping your therapist decide which treatments to recommend.

Planning Your Care

What goes into a rehabilitation plan?

All the information you give our Physical Therapist, along with the results of the examination, will be used to create a First Choice Physical Therapy rehab program especially for you. We will put together a treatment plan that targets the goals you and our Physical Therapist have for the treatment. The plan will list the exercises and treatments that will be used, and it includes an estimate of how many visits you will need over what period of time. Our therapist will also let you know what results to expect from the program.

What kind of treatments and activities might the Physical Therapist recommend?

Controlling Your Symptoms

Rehabilitation therapy, combined with drugs and other treatments prescribed by your doctor, can help you manage the pain and swelling in your joints. Your Physical Therapist in First Choice Physical Therapy recommendations will depend on your specific symptoms and needs and may include one or more of the following treatment choices.

Rest

Knowing when to rest painful joints can help ease arthritis pain. Rest is especially important during flare-ups. As a common sense rule, if a certain activity or movement causes severe pain, avoid doing it. If you can’t avoid it, do it less or take frequent breaks to let your joints rest.

Our Physical Therapist may make you a special resting splint to support your sore joint when you’re not using it. A resting splint keeps the joint properly aligned, which limits pain and prevents joint deformity.

Heat

Heat makes blood vessels expand, which is called vasodilation. Vasodilation helps flush away chemicals that make your joints and muscles hurt. It also helps your muscles relax. Moist hot packs, heating pads, and warm showers or baths are the most effective forms of heat therapy. Heat treatments usually involve applying heat to the sore area for fifteen to twenty minutes. Paraffin baths or warm whirlpools can be especially helpful for joints of the hands or feet. You may find you have less pain and better mobility after applying heat.

Be cautious when using heat. While heat can be very helpful at times, heat can make serious inflammation and certain types of arthritis worse. Even if heat is the best treatment for your discomfort, hotter is not better. Your skin can overheat and even burn. Sleeping with an electric hot pad is a bad idea. The prolonged heat can actually burn your skin.

Electrical Stimulation

Gentle electrical currents through the skin can help ease pain and decrease swelling. Electrical stimulation eases pain by replacing pain impulses with the impulses of the electrical current. Once the pain lets up, the muscles begin to relax, making movement and activity easier.

Topical Creams

Certain creams rubbed on the skin can give temporary relief to sore joints. The rubbing is relaxing, and the creams create feelings of warmth or coolness that are soothing. Creams containing Capsaicin, a compound derived from the common pepper plant, have been shown to effectively relieve arthritis pain. With all creams, you need to wash your hands after using them. What feels good on your sore joint does not feel good in your eyes.

Therapeutic Exercise and Functional Training

Whether at work, home, or play, your capabilities depend on your physical health and function. Specialized treatments and exercises can help maximize your physical abilities, including movement, strength, and general fitness. Physical Therapists also use functional training when you need help doing specific activities with greater ease and safety.

Exercise is safe for arthritis patients. In fact, it’s necessary if you want to improve or maintain joint function. Avoiding exercise just makes your arthritis worse. The less a joint is used, the weaker and stiffer it becomes. This leads to even more pain. Even if you don’t have much range of motion in a joint, our Physical Therapists can help you find ways of stretching and moving that can help strengthen your joint. There are some specific types of exercises that our Physical Therapists recommend especially for people with arthritis.

Stretching

Gentle stretching lengthens muscles and helps the joint maintain its shape and mobility. Our therapists teach specific stretches for different types of joints.

Strengthening

Muscles themselves are not part of joints, but strong muscles around a joint help joints move with less pain. Toned muscles act as shock absorbers in protecting the joint.

Your Physical Therapist in First Choice Physical Therapy will teach you strengthening exercises that have been adapted especially for arthritic joints. Isometric exercises involve tightening muscles without moving joints. This allows you to keep the muscles strong without stressing your joints. Isometrics can often be done even during flare-ups.

Stabilizing

There are also specific stabilization exercises to help keep your joints aligned. When your joints are positioned correctly, there is less rubbing or overstretching, and therefore less pain. Correct alignment also helps prevent joint deformities.

Pool Therapy

When you exercise in a swimming pool, the water bears some of your weight. This puts less stress on the joints of your feet, ankles, knees, and hips. The water’s buoyancy lets you move more easily, and the water’s warmth can relax your muscles. You will probably start pool therapy in a group led by an instructor. If it is helpful, you may continue the exercises on your own. The warmth of the water can help relax muscles, improve circulation, and ease soreness.

Aerobic Exercise

Our Physical Therapist and your doctor will probably also recommend that you do some kind of aerobic exercise. Our therapists generally recommend thirty minutes of moderate activity, at least five days a week. People with arthritis can safely try exercises such as walking, swimming, stationary biking, and low-impact aerobics. We can suggest an exercise program based on your condition and your overall health. Keeping your body fit is important for your general health and can help keep your arthritis under control.

Aerobic exercise also helps you manage your weight. Weight control is especially important for people with arthritis in the hips, knees, feet, and spine. Keeping your weight down can do a lot to help you control your symptoms.

No matter what type of exercise you do, you should not feel extra pain in the joints while you exercise. Your joints may be sore after exercising, but the soreness should be mild and go away within a short period of time.

Lifestyle Management and Functional Training

It is important that you be very open with our therapist about the ways your disease affects your daily activities. We can then suggest ways to help you reduce the effort it takes to do difficult tasks.

Special Devices

There are many different kinds of equipment available to help you minimize the stress on your joints while you do daily tasks around the house or at work. What kind of equipment you need depends on which joints are affected. Canes and walkers help ease the stress on your weight-bearing joints. Raising the height of chairs and toilet seats can make it easier for you to sit down and stand up. Reachers or grabbers can help you pick up items from the floor without having to bend or stoop. There are devices to help with buttoning, putting on socks, or using zippers. A rolling cart is easier to haul around with arthritic fingers than a hand-held briefcase.

Our Physical Therapist may also suggest special splints or braces. A working splint keeps the joints aligned as you go about your daily activities. Splints are made for specific joints and specific activities.

Our Physical Therapist may also recommend simple changes in equipment. For example, a good pair of shoes can help reduce shock. If you walk or stand for long periods of time, you should try to do it on soft surfaces. As another example, women may choose a shoulder bag or a small backpack to take the place of a clutch purse or brief case if they have problems with the joints in their hands.

Ergonomics

When they hear the word ergonomics, most people think of the way their desk and computer are set up at work. The meaning is larger than that. Ergonomics considers the way you use your body when you take part in certain activities.

Rehabilitation Physical Therapists examine your workstation to help determine if you need to make changes. Our Physical Therapist will pay special attention to your posture, the repetitions involved in your work, rest times, the amount of weight you are working with, and which activities seem to cause you the most problems. We will look at the heights of your chair and desk, alignment of computer monitors, lighting, and any special equipment you use.

After evaluating your work site, our Physical Therapist will make recommendations. If changes are suggested, they are usually small and inexpensive, such as changing the height of your chair or standing in a different position. But even these minor changes can make big differences in your discomfort on the job.

The ideas behind ergonomics can also be applied to the tasks you do at home. If you have problems with specific jobs or hobbies, talk to our Physical Therapist. Together you may come up with a plan or some simple devices that can help.

Pacing Yourself

Plan to take breaks. Pace your activities so that you don’t get too tired or have to force your joint to function through pain.

Taking Care of Your Mind

Not all of your homework will be physical. Dealing with the pain and loss of function of arthritis can be emotionally draining. Make sure you take care of yourself mentally, and try to bolster your coping skills. Breathing exercises, naps, visual imagery, and meditation all can help you relax. Learning more about your condition can help you feel more in control of your disease. Many people find support groups helpful.

Home Program

At First Choice Physical Therapy, our goal is to help you figure out ways to keep your pain under control and improve your strength and range of motion. Once your rehabilitation is well under way, regular visits to our office will end. Although we will continue to be a resource for you, you will be in charge of your own ongoing rehabilitation program.

Physical Therapy in Lynn Haven and Panama City Beach for Rheumatoid Arthritis

Welcome to First Choice Physical Therapy’s guide to Rheumatoid arthritis (RA).

RA is a chronic, or long-term, inflammatory form of arthritis. RA is considered an autoimmune disease, in which your immune system attacks the tissues of your own body. In RA, the immune system mostly attacks tissues in the joints, but it can also affect other organs of your body. In some people, RA seems to run its course and does not gradually get worse. In others, RA gets progressively worse and leads to the destruction of joints. RA can greatly affect your ability to move and do normal tasks. RA can appear at any age, but most patients are between the ages of 30 and 50. About two million Americans have RA, and most of them are women. RA can affect children and when it does, it is termed Juvenile RA. Juvenile RA will not be discussed in this patient guide.

This guide will help you understand:

• how RA develops
• how your health care professional will diagnose the condition
• what can be done for RA
• what First Choice Physical Therapy’s approach to rehabilitation is

How does RA develop?

In RA, two processes are occurring in the joints. First, the immune system causes inflammation in the synovial membrane, called synovitis. The synovial membrane is the thin tissue that surrounds all joints. The synovitis is characterized by extra fluid, swelling, and warmth of the joint due to the increased blood flow.

The second process causing the problems in RA results from the ongoing or repetitive synovitis. The blood cells and the swollen membranes of the synovium release chemicals into the synovial fluid (the lubricating fluid of the joint) that can break down or damage the tissues of the joint. This breakdown can cause permanent damage to the cartilage, bones, ligaments, and tendons inside and around the joint. The structural damage usually happens in the first to third year of the disease. The synovitis can come and go, but the structural deterioration progresses and results in permanent damage. As a result, the joint becomes chronically painful and very difficult to move.

RA usually affects many joints on both sides of body (for example, both knees, both ankles, both wrists, and the same joints in both hands may be affected.) Research indicates that almost all the joints that will be affected long term show symptoms of RA in the first year of the disease. This means that each joint may continue to get worse, but you probably won’t have many more joints that will develop the symptoms of RA.

Most RA patients also have inflammation in the tendons around the joint. (Tendons connect muscle to bone.) Nodules, or bumps, may form on the tendons, or the tendon sheath (the membrane that surrounds the tendon.)

Most people think of RA as an inflammatory disease of just the joints and related tissue, but it is actually a systemic disease meaning that it affects the whole body. In general, inflammation causes symptoms of swelling, redness, heat, and pain.  RA can even show up in organs such as the heart, blood vessels, lungs, and eyes. Sometimes RA occurs in joints and other organs, and sometimes it occurs only in other organs. RA works somewhat differently outside the joints, but the underlying problem is still damage to the tissue and loss of function.

Rheumaotid factor (RF) is an antigen found in about 85 percent of RA patients. Not all patients with RA have RF in their blood. Some patients with RA do not have RF, and people with RF can have forms of arthritis that are not RA.  Being RF positive, however, increases your likelihood that your organs will also be affected by RA.

Why do I have this problem?

No one knows exactly what causes RA. There are probably different causes in different people. Many doctors and researchers think that a virus or bacteria might cause RA. So far studies have not proven this. Researchers do know, however, that bacteria can cause swelling in the synovial membrane.

Heredity, or your genes, play a part in RA. The disease tends to run in families. If a close relative has RA, you are 16 times more likely to develop the disease yourself.

What does RA feel like?

The primary symptom of RA is pain in symmetrical joints (i.e.: both elbows, both knees, and so on). In rare cases the pain is only in one joint. Most often the pain develops over several weeks but the pain can come on suddenly. As the pain spreads to other joints, it usually then becomes more symmetrical. The pain is directly related to the amount of swelling in the synovial membranes. When the swelling is at its worst, your joints themselves will feel warm and swollen. The pain can come and go with the swelling.

RA patients also describe severe morning stiffness that can last up to two hours. The stiffness can be so bad that it makes it hard to get dressed, make breakfast, or even get out of bed. This stiffness also corresponds to the synovitis. When the synovitis goes away for a time, so does the stiffness.
About half of RA patients have rheumatoid nodules. As described above, the nodules are hard knots, from the size of a pea to the size of a golf ball, that grow on the sheath of tendons or under the skin. They are usually found on the outside of the elbow, the Achilles tendon on your heel, the underside of your fingers, the lower abdomen, and certain toe joints. The nodules don’t usually hurt and over time they tend to shrink or disappear.

Due to RA being a systemic disease, most patients feel tired and weak during flare-ups. About 50 percent of RA patients have systemic inflammation during joint outbreaks of RA.
Conjunctivitis, or inflammation of the eye, is a common symptom of RA. It may be related to a disease of the eye called Sjogren’s syndrome, which often occurs along with RA. The main symptom is eye dryness, but patients often can’t even feel it.

When RA affects the lungs it can cause an inflammation of the membrane that surrounds the lungs (the pleura.) This inflammation is called pleurisy and results in pain, problems breathing deeply, and sometimes coughing.

RA commonly affects the nervous system, but the symptoms from damage to the nervous system can be hard to distinguish from other symptoms of RA. Damage to the joints in the cervical spine (the neck) can eventually lead to weakness and instability between the cervical vertebrae. This damage can cause problems with the spinal cord as it travels through the neck and in turn, spinal cord symptoms can result.

Common symptoms of affected areas include the following:

• Cervical spine (the neck): Symptoms include neck stiffness, weakness, and loss of motion. Ligaments are often inflamed, and there may be problems with the spinal cord or nervous system as explained above. Neck pain alone tends to get better, even when the joints are damaged. Damage to the nervous system, however, does not usually improve.
• Shoulders: The main symptom is loss of motion. Your body’s unconscious reaction to shoulder pain is simply to not use your shoulders. Since daily life doesn’t require large shoulder ranges of motion, frozen shoulder syndrome, in which the shoulder joint’s range or motion becomes severely limited, can set in quickly.
• Hands and wrists: Almost everyone with RA has affected wrists and the joints in the middle of your hand and the middle joints of your fingers. The knuckles at the ends of your fingers usually are not. RA can cause joint deformities that freeze your fingers in unusual positions. Rheumatoid nodules and tendon inflammation can make it hard to bend the fingers. Nodules can cause a locking and catching action as your fingers bend.
• Knees: Swelling in the knees is common and can be easily seen. A fluid-filled lump called a Baker’s cyst often appears behind the knee. It can burst and leak fluid into the calf.
• Feet and ankles: RA commonly affects the joints in the middle of the toes and the ankle joints. The deformities and pain in the toes can cause problems with walking. The sole of the foot can feel tingly or numb.

The progression of RA is hard to predict. The swelling of RA ‘flares up’ and dies down such that there may be times when there is not much pain at all. At other times, however, flare-ups cause significant pain.  Milder forms of the disease often don’t require much treatment. Even milder forms of RA may even go undiagnosed.

How do health care professionals diagnose RA?

Diagnosis in its earliest form begins with a complete history and physical examination. When you visit your Physical Therapist at First Choice Physical Therapy they will ask questions about when and how your pain began, what joints are involved, and what activities aggravate or relieve your pain. It is best if you can be very specific about where your pain is and when precisely it started. We may also ask about any previous injuries you may have had to your joints, as well as overall general health questions and questions about any family history of disease. The history is an extremely important part of any examination and may already lead your Physical Therapist to the suspicion of RA.

Next your Physical Therapist will do a physical examination of your joints.  First they will simply look and feel your joints for any signs of swelling which may include redness, increase in size, warmth, or possible abnormalities in the joint position or abnormalities such as nodules. We will always compare both sides of your body for differences or similarities and will often check many joints even if they do not feel painful to you.

Next your Physical Therapist will ask you to actively move your affected joints to assess your willingness and ability to move and also to determine if there is a range of motion deficit. Your Physical Therapist may also ask you to relax your muscles while they passively move your joints to further assess the range of motion. While your joints are moving we will also be assessing for crepitus, which is a high-pitched screech or grinding that you can feel or hear in the joint when bone rubs directly on bone.

This sound can indicate that inflammation in the joint has worn down the tissue inside such that the ends of the joints are rubbing on each other. Lastly, we will also check for any signs of damage or looseness in the joints by stressing the ligaments (the tissues that attach bone to bone.)

If your Physical Therapist deducts from the history and physical examination that your problem is potentially due to RA, we will refer you on to your doctor for further examination and investigations.

No single test can confirm a diagnosis of RA. Many findings over a period of time lead to the diagnosis. Early on, many characteristics of RA haven’t developed yet, such as the pattern of joints that are affected, X-ray findings, and blood test changes. RA in its early stages can look a lot like other orthopaedic problems or other forms of arthritis, such as lupus, psoriatic arthritis, and diseases of the spine or simple orthopaedic problems. Your doctor will need to consider each of these diagnoses and perhaps do tests to rule them out.

To confirm the presence of inflammation in the synovial membranes, which occurs in all patients with RA, your doctor can do a count of the white blood cells (WBC) in your synovial fluid. This test involves inserting a thin needle into your joint and drawing out a small amount of the fluid for testing. The fluid can also be tested for other things. The WBC alone, however, doesn’t prove that you have RA. Synovitis of the joints can occur even if you don’t have RA therefore your doctor will need to rule out other causes of synovitis.

Your doctor will also ask you to undergo a blood test. As mentioned previously, RF, or rheumatoid factor, is found in the blood of about 85 percent of RA patients. This test alone can’t confirm RA either. Some patients with RA do not have RF, and people with RF can have other forms of arthritis.
Another test your doctor can determine from your blood is the erythrocyte sedimentation rate (ESR, or sed rate), which measures how fast red blood cells settle in the test tube. Red blood cells that settle faster than normal indicate inflammation in the body. The ESR varies greatly between people. It is even possible for a patient with RA to have a normal ESR. The ESR may be more useful in monitoring the progress of RA than in diagnosing it. A higher ESR, however, usually means that the inflammation is more severe.

The C-reactive protein test can also monitor inflammation. It is a newer test that may be more accurate than the ESR. This test measures the amount of a certain protein that is produced by the body due to inflammation. When inflammation is very active the amount of C-reactive protein is high, and when inflammation is brought under control the level of protein decreases.
At some point your doctor will probably ask you to get X-rays of your affected joints and organs. X-rays and other imaging techniques can show damage to the cartilage and bone as well as swelling in the soft tissues of the joint.

If you have rheumatoid nodules your doctor may want to take a biopsy of them. During the biopsy a small amount of the nodule is removed and examined in a laboratory.

What can be done for the condition?

Doctors have learned a lot about RA in recent years, but they still don’t know much more about how to truly cure the disease. They do have many medical strategies for treating the symptoms of RA. This treatment includes both medication as well as physical rehabilitation. If you start treatment within a few months after your symptoms appear, you will probably do better in the long-term. Early detection and treatment can help avoid the worst joint damage. Sudden remission does occur, but it’s unclear how often, and it appears to be more likely within the first two years of the disease. Patients, who develop RA at a young age, are RF positive, have close relatives with RA, and have RA nodules tend to have a more difficult time managing the disease.

Medication

Your doctor will prescribe one or more medications.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can help decrease the pain and swelling.

Corticosteroids taken by mouth can also help with inflammation but should not be used long term if at all possible due to the other problems they can cause in your body. Corticosteroid injections into the affected joints can ease the swelling and give immediate, short-term relief. Due to eye inflammation being so common with RA and difficult to diagnose, your doctor may also prescribe eye medications, even if you have no eye symptoms. Prophylactic eye drops can help prevent symptoms from developing or becoming severe when they start.

Disease-modifying antirheumatic drugs (DMARDs) are important in treating RA. It is not certain exactly how DMARDs actually slow or prevent the structural damage from RA however, tests have shown all DMARDs to be effective.

Unfortunately, DMARDs can be very hard on the body and can interact with other drugs. Often more than one DMARD is taken at the same time and it is not always easy to find the best combination of drugs that work for each individual. Common DMARDs frequently prescribed are:
Hydroxychloroquine:  A relatively nontoxic drug that was made to treat malaria. It can be safely used with other DMARDs. It is most useful in early, mild RA. Regular eye check-ups should be conducted while taking this drug.

Sulfasalazine: Much like hydroxychloroquine. This drug requires regular blood monitoring.

Gold salts: Can cause short-term remissions. Over the long-term, however, the RA does progress.

Blood and urine monitoring is required.

Methotrexate: Can help manage RA, but it is unclear how much it actually changes the course of the disease. Methotrexate can be very useful over the long-term, but there are problems with flare-ups when patients stop taking it.

Azathioprine:  Used with moderate and severe RA.

Penicillamine: Only used in patients who have systemic disease that doesn’t respond well to other medications.

Cyclosporine: Expensive and hard on the kidneys, so it is most often used in severe RA.

Cyclophosphamide: Very effective but very toxic, so it is only used in specific cases.
Certain antibiotics are somewhat effective in mild cases.

Biologic response modifiers (BRMs) are among the newest drugs used to treat rheumatoid arthritis.

They are genetically engineered proteins derived from human genes and are designed to inhibit specific components of the immune system that play pivotal roles in fueling inflammation, which is a central feature of rheumatoid arthritis.These agents inhibit key factors responsible for inflammatory responses in the immune system. Common biologics frequently prescribed are abatacept (Orencia), etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), and anakinra (Kineret).
Abatacept inhibits T-cell activation. T-cells are types of white blood cells that cause swelling and joint damage in patients with RA.

Etanercept, infliximab and adalimumab are tumor necrosis factor (TNF) antagonists. TNF is responsible for both joint inflammation and other systemic inflammatory responses in RA patients
Anakinra inhibits interleukin-1 (IL-1). Interleukin-1 in RA amplifies and perpetuates the inflammatory process related to the lining of the joints. This  leads to the destruction of the cartilage and bones inside the joints.

Biologics are used to treat moderate to severe rheumatoid arthritis that has not responded adequately to other treatments. They differ significantly from traditional drugs used to treat rheumatoid arthritis in that they target specific components of the immune system instead of broadly affecting many areas of the immune system. Biologics may be used alone but are commonly given along with other rheumatoid arthritis medications. They have been shown to help slow progression of rheumatoid arthritis when all other treatments have failed to do so.

Abatacept (Orencia): Abatacept is given intravenously (IV) as an infusion over 30 minutes. During the first month, it is given every 2 weeks, then every 4 weeks thereafter. It may be used alone or with DMARDs.

Etanercept (Enbrel): Etanercept is taken as an injection once or twice a week. It may be used alone or with concomitant therapy such as methotrexate.

Infliximab (Remicade): Infliximab is given as a 2-hour intravenous infusion in a doctor’s office. Initially, 3 doses are given within a 6-week period; thereafter, a single dose is given every 8 weeks to maintain the drug’s effect. The interval between doses is shortened if the 8-week regimen fails to control symptoms. It is most often used with concomitant methotrexate.

Adalimumab (HUMIRA): Adalimumab is given as an injection every other week (or sometimes weekly). It is most often used with concomitant methotrexate.

Although there is no cure for RA, Physical Therapy can greatly assist with both the flare-ups as well as the potential long-term joint problems that can occur as a result of the disease. The main goals of our treatment at First Choice Physical Therapy for RA are to relieve symptoms, preserve the function of your joints, prevent structural damage or deformity, and to assist you with maintaining a normal lifestyle.

First Choice Physical Therapy provides services for Physical Therapy in Lynn Haven and Panama City Beach.

RA is a frustrating and complex disease. At First Choice Physical Therapy we believe that the more you understand about the disease, the more effective our treatment will be. For this reason, education is an important part of our treatment for RA. By understanding the disease, you will also be better able to assist us in treating your own symptoms and preventing or managing flare-ups.  Liaising with others who also have RA can be very insightful so we will assist in directing you to support groups or organizations that focus on living with RA.

As mentioned previously, the synovitis of the joints causes pain and over time can cause structural damage and deformities of the joints. During flare-ups the synovitis is actively occurring and is the source of pain.  Our treatment at First Choice Physical Therapy will therefore firstly focus on decreasing your pain.  Modalities such as heat or cold may be useful as well as other modalities such as transcutaneaous nerve stimulators (TENS.) These TENS machines assist with pain by delivering electrical currents through the painful area and work essentially to override the pain sensations. Your Physical Therapist may also suggest that you use hydrotherapy to ease the pain. During hydrotherapy your whole body, or just the affected joints, are immersed in warm water while gentle movements are performed. In many cases, this can significantly reduce the pain associated with an RA flare-up.  Massage can also be very helpful to assist with flare-ups although not all patients with RA enjoy their painful joints being massaged, and this will be entirely respected. Sometimes with RA the most effective treatment during a flare-up is simply to rest the joint. Each joint has a natural resting position where the least amount of stress is placed on the tissues of the joint and therefore causes the least amount of pain. Your Physical Therapist at First Choice Physical Therapy can advise you on the most effective resting position for any of your RA affected joints and can also advise you on when it is appropriate to begin exercise again after the rest period.

In addition to our Physical Therapy treatment the medication that your doctor has prescribed will be especially important during flare-ups. Your Physical Therapist at First Choice Physical Therapy may liaise closely with your doctor while treating you to ensure that all treatments are coinciding to most effectively relieve your pain. By limiting the length and intensity of the flare-ups, the synovitis has less time to cause structural damage to the joints and therefore less chance of causing a long-term deformity.

The next part of our treatment at First Choice Physical Therapy will focus on preventing any deficits or deterioration in range of motion of your affected joints. Your Physical Therapist may assist in stretching your muscles while at the clinic and, if necessary, may ‘mobilize’ the joint. This hands-on technique encourages joints to move gradually into their normal range of motion and may also assist with pain relief. We will also prescribe a series of stretching exercises that we will encourage you to do as part of a home exercise program. The daily stretches and range of motion exercises done at home are often the most important part of treating RA as they work to both prevent and stop the progression of long-term deformities in the joint. If your joints have already developed some deformity then we will be particularly specific in teaching you range of motion exercises that take into consideration the abnormal position of the joint. Standard stretching exercises may cause deformities to progress if not adjusted to this consideration. Your Physical Therapist at First Choice Physical Therapy will tailor a stretching program specifically for you.

Joints where deformity is likely to occur or that already show some deformation may require bracing or splinting to prevent further decline. Simple braces may be constructed by your Physical Therapist at First Choice Physical Therapy but for more complex braces we will refer you to an occupational therapist, orthotist, or chiropodist to ensure a proper individualized brace or orthotic is constructed. Occupational therapists can also provide you with assistive devices, if needed, which make using a joint affected by RA easier and less painful. This in turns prevents the deterioration of the joint.

The muscles surrounding the affected RA joints can lose strength. The strength loss occurs both due to decreased use of the joints when they are painful, and also as a result of the altered pulling on the muscles when there are joint deformities. Similarly to the range of motion deficits, strength deficits will also be addressed during our treatment.  Again, your Physical Therapist at First Choice Physical Therapy will prescribe a series of strengthening exercises that we will encourage you to do as part of a home exercise program. These exercises will also be specifically tailored by our Physical Therapist to suit the needs of your affected joints.

Maintaining coordination of your RA joints is also an important part of maintaining normal function. Pain, inflammation, and joint deformity can all affect how well a joint works during functional activities such as grasping items or walking. In addition to the range of motion and strengthening exercises prescribed your Physical Therapist at First Choice Physical Therapy will encourage coordination and proprioception exercises to ensure the joints do not lose normal function.

As a final component of our treatment, your Physical Therapist will discuss the benefits of some gentle aerobic exercise. Aerobic exercise such as swimming, walking or cycling can improve muscle endurance, aerobic capacity and improve your general well-being so is highly encouraged as part of an overall treatment plan for patients suffering with RA. Obviously, during times of flare-ups, aerobic exercise may not be possible, however when able, you should work to include it.

At least half of RA patients don’t get effective relief from treatment and eventually need surgery on the affected joints. Surgery, including total joint replacement, can be a very effective way to help you overcome the pain and loss of movement of RA.

For most patients, RA is a disease that comes and goes throughout their lives but it doesn’t have to be crippling. With the help of health care professionals such as your doctor and Physical Therapist, you should be able to find treatment that works for you and allows you to maintain a normal lifestyle.

Welcome to First Choice Physical Therapy’s resource about Medications for Arthritis.

Doctors have only a few kinds of drugs to help treat the many different kinds of arthritis. The three classes of drugs doctors prescribe are nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs).
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

The most commonly used drugs are NSAIDs. The over-the-counter drugs aspirin, ibuprofen, and naproxen are NSAIDs. Your doctor must write a prescription for other NSAIDs. Almost all of the NSAIDs are taken in pill form. Your doctor will probably prescribe only one form of NSAID at a time.

Inflammation is your body’s response to an injury. In normal circumstances, inflammation is the process that helps the injury heal. In arthritis, the inflammatory response gets out of control and actually causes damage to the tissues. NSAIDs help reduce inflammation and they also decrease pain and fever. However, they are short-acting drugs. After NSAIDs have passed through your body, inflammation, pain, and fever can return quickly.

NSAIDs can be very effective against inflammation, which can then lessen your pain and discomfort but they do not prevent tissue damage. Even when NSAIDs are controlling the inflammation, the joint or organ damage of arthritis can continue to get worse.

Complications of NSAIDs

NSAIDs are safe drugs, however, they have many side effects. The side effects happen more often when they are used over long periods of time, which is common in arthritis patients. Some of the side effects can become very serious. It is important to use the lowest doses possible to control your symptoms.

GI Effects

NSAIDs can irritate the gastrointestinal (GI) tract (the digestive system consisting of your esophagus, stomach, and intestines). They increase the production of gastric acid, and they harm the gastric lining. NSAIDs can aggravate ulcers and GI bleeding. Up to 5 percent of people who use NSAIDs for a year develop ulcers, bleeding, or tears in the GI tract. The risks are higher for older patients, patients with a history of GI problems, and patients with heart disease. Some prescribed NSAIDs, called COX-2 Inhibitors, act slightly differently in the body to affect inflammation, and for this reason, do not cause the GI symptoms often associated with NSAIDs such as aspirin, ibuprofen, or naproxen.

Blood Effects

NSAIDs make it harder for the platelets in your blood to clump together at the site of an injury. This can cause bleeding problems. Aspirin especially has this effect. Before you have surgery, you should stop taking aspirin for two weeks to prevent bleeding problems.

Liver Effects

NSAIDs can be toxic to your liver. You will not feel this, but elevated levels of certain liver enzymes can easily be seen in blood tests. Liver function almost always returns to normal when you stop taking NSAIDs.

Kidney Effects

NSAIDs can make it hard for your kidneys to get rid of some kinds of wastes. If you have a history of kidney problems, or if your disease may affect your kidneys, your doctor will use NSAIDs with caution.

Other Effects

Some people get skin reactions and rashes from NSAIDs. Some get a combination of runny nose, polyps in the nose, and asthma. Different kinds of NSAIDs can have different side effects. Salicylates can cause problems with hearing. Other kinds of NSAIDs can cause headaches and confusion, especially in elderly patients. Many of the possible side effects depend on your health and the disease for which you are being treated.
Individuals can react very differently to the same NSAIDs. You and your doctor must work together to find the type and dose of NSAID that controls your symptoms without causing unwanted side effects.

Uses of Corticosteroids

Corticosteroids are chemical copies of hormones that occur naturally in your body. The most commonly used corticosteroids are prednisone, prednisolone, and methylprednisolone. Corticosteroids can be given orally or put directly into the bloodstream through an intravenous needle. They can also be injected directly into an inflamed spot. Corticosteroid cream can be rubbed on the skin.

Corticosteroids are powerful drugs. They drastically decrease inflammation, but they are also highly toxic. Doctors have different opinions about how corticosteroids should be used.
Corticosteroids can’t cure your disease. But they do seem to affect the progression of some diseases, including rheumatoid arthritis (RA).

Complications of Corticosteroids

Corticosteroids can have many unwanted effects on your body. Whether or not you develop these complications depends on many factors: what type of corticosteroid you take, your dose, the length of time you are on it, and how sensitive your body is to these hormones.

The most common side effects are listed below.

Osteoporosis

All corticosteroids slow bone growth and create conditions that lead to osteoporosis, a disease process that results in reduction of bone mass. Compression fractures of the vertebrae as a result of osteoporosis can happen with long-term corticosteroid use. Women past menopause are most likely to develop osteoporosis. Your doctor may recommend that you take calcium and vitamin D supplements while you take corticosteroids.

Infections

High levels of corticosteroids hinder your body’s ability to fight bacterial infections. High-dose corticosteroids can even mask the symptoms of some types of infections, such as abscesses and bowel tears. Most viral infections are not affected, except for herpes, which can sometimes worsen with the use of corticosteroids.

Adrenal Insufficiency

This means that your pituitary and adrenal glands can’t produce adequate amounts of certain kinds of hormones. This can happen after taking corticosteroids in moderate doses for only a few days. Adrenal insufficiency is most likely to happen as you are reducing the dosage.  Adrenal insufficiency can be a problem if you need surgery or if you get an infection or serious injury.

Withdrawal

When you stop taking corticosteroids, the doses will be slowly reduced over a period of days or weeks. Even if you have only been taking steroids for a few weeks, you will still need to taper off. Corticosteroid withdrawal can be very difficult for your body. In many patients, the disease symptoms become worse. Some people experience a sickness that includes fevers, nausea, vomiting, low blood pressure, and low blood sugar. Others have withdrawal symptoms that include muscle and joint pain, weight loss, fever, and headaches. If you have problems coming off corticosteroids, your doctor will have you taper off the drug even more slowly.  Different people and different diseases react very differently to corticosteroids. You and your doctor will need to find a dose that controls your symptoms but minimizes unwanted effects.

Uses of DMARDs

DMARDs are primarily used to treat rheumatoid arthritis (RA) and other systemic diseases. In the past twenty years, DMARDs (which are also called slow-acting antirheumatic drugs) have become much more widely used.

The idea behind using DMARDs is to prevent joint damage. This means you start using them early on, and you switch drugs or doses when your current drugs stop working. Using DMARDs requires you to be alert for possible side effects. You also need to be patient as DMARDs take time to work, but they can be very effective at slowing the course of your disease. DMARDs, however, do not cure disease. Very few patients see their disease go into a complete remission. Most patients find that their symptoms come back after months, or sometimes years of improvement on DMARDs.

Doctors often prescribe DMARDs, corticosteroids, and NSAIDs at the same time. The DMARDs affect the underlying disease, and the corticosteroids and NSAIDs give relief from pain and inflammation. Sometimes doctors prescribe two or more DMARDs together. There are few studies to prove how well these combinations work, however, using more than one DMARD does not seem to cause problems with higher toxicity. This means that taking more than one DMARD isn’t any harder on your body than taking just one.

Types and Complications of DMARDs

There are many different types of DMARDs, with different effects and complications. Some are used only for specific types of diseases.

Antimalarial Drugs

Hydroxychloroquine and chloroquine have been used since the 1950s for rheumatic diseases but they have been used against malaria for much longer. These drugs are mostly used for RA and lupus.  Chloroquine has more side effects. Side effects include indigestion, rash, and eye problems. Antimalarial drugs take three to four months to show results.

Penicillamine

This drug affects the way your immune system functions. Almost 25 percent of patients who take it experience bad side effects within the first year. The most common side effects are rashes, blood and protein in the urine, low numbers of platelets in the blood, and autoimmune problems including drug-induced lupus. Taking penicillamine requires regular blood and urine tests.

Sulfasalazine

This fairly new drug is used primarily in RA and spondyloarthropathies (arthritis of the spine). It may slow down erosions of bone. Almost half of patients develop side effects in the first four months, but most of the reactions are minor. Side effects include rashes, nausea, abdominal pain, liver and blood disorders, low sperm counts, and discolored urine and sweat. You will need liver and blood tests for the first months on this drug.

Gold

Gold compounds have been used for eighty years to treat RA. They are also used in juvenile chronic arthritis and psoriatic arthritis. Gold is injected into your muscles, usually once a week. Most patients only use gold compounds for one to five years. After about a year, most patients stop seeing benefits from using gold therapy. And most patients also start having complications. Unwanted side effects include diarrhea, rashes, low levels of platelets and other blood disorders, protein in the urine, lung problems, and sores of the mucous membranes, especially in the mouth. Using gold compounds requires regular blood and urine tests.

Methotrexate

Methotrexate shows results in one to two months. Most patients stay on it longer than other DMARDs. In the short term, methotrexate causes nausea, loss of appetite, and high levels of certain liver enzymes. As with all the other DMARDs, there are serious complications with long-term use. It can cause liver damage and lung disease.

Azathioprine

This drug is most often used in RA, lupus, and other connective tissue diseases. It can also help offset the negative effects of steroids. Azathioprine is as effective as other DMARDs, but it also has more side effects. It can cause nausea, vomiting, diarrhea, bone marrow suppression, and hepatitis. The most troubling long-term side effect is cancer of the lymph system.

Nitrogen Mustard Alkylating Agents

Chlorambucil and cyclophosphamide are the main alkylating agents used as DMARDs. Chlorambucil is usually used to treat RA, juvenile chronic arthritis, vasculitis, systemic sclerosis, and ankylosing spondylitis. However, it can damage the chromosomes. This creates a higher risk for leukemia and other kinds of cancers.

Cyclophosphamide can be taken by mouth or intravenously. It is usually used to treat severe RA, lupus, and systemic vasculitis. Significant negative side effects are common. They include inflammation and bleeding of the ulcer, suppression of the immune system, reproductive problems in men and women, and cancer that may show up long after the drug is stopped.

Cyclosporine

Cyclosporine can be very effective against RA, but most people who take it develop kidney problems and high blood pressure. Kidney function goes back to normal when you stop taking the drug.
As with NSAIDs and corticosteroids, you and your doctor will need to work together to find the best type and dose of DMARDs for your disease.

Welcome to First Choice Physical Therapy’s guide to Glucosamine and Chondroitin Sulfate for Osteoarthritis of the Knee

Nonsurgical treatment of knee osteoarthritis (OA) focuses on reducing pain and maintaining or improving joint function. Doctors commonly prescribe acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and swelling in arthritic patients. Newer NSAIDs called COX-2 inhibitors are showing promise as well.

In recent years, people with knee OA have also been taking two unique compounds. These compounds are gaining greater acceptance among many doctors. Glucosamine and chondroitin sulfate are dietary supplements usually taken in pill form that are thought to protect and possibly help repair cartilage cells.

Glucosamine and chondroitin sulfate are somewhat controversial treatments. While some studies have supported their effectiveness in relieving the symptoms of knee OA, the research still leaves many unanswered questions, especially about long-term effects.

This guide will help you understand:

• what doctors believe the supplements can do
• how the treatments are administered
• what to expect after treatment
• what is First Choice Physical Therapy’s approach to rehabilitation

What part of the knee joint does OA affect?

The main problem in knee OA is degeneration of the articular cartilage. Articular cartilage is the smooth lining that covers the ends of bones where they meet to form the joint. The cartilage gives the knee joint freedom of movement by decreasing friction.
The articular cartilage is kept slippery by joint fluid made by the joint lining (the synovial membrane). The fluid, called synovial fluid, is contained in a soft tissue enclosure around synovial joints called the joint capsule.

An important substance present in articular cartilage and synovial fluid is called hyaluronic acid. Hyaluronic acid helps joints collect and hold water, improving lubrication and reducing friction. It also acts by allowing cells to move and work within the joint.
When the articular cartilage degenerates, or wears away, the bone underneath is uncovered and rubs against bone, which causes pain. Small outgrowths called bone spurs, or osteophytes, may form in the joint.

Related Document: First Choice Physical Therapy’s Guide to Knee Anatomy

What do doctors hope to achieve with these compounds?

Glucosamine and chondroitin sulfate occur naturally in the body, mainly in joint cartilage. These substances can also be synthetically made and given in pill form or by injection. The theory is that these supplements can help protect, or possibly even repair, damaged cartilage. Scientific studies lend support to the benefits that these supplements have on reducing pain, swelling, and tenderness, along with improving knee joint mobility.

Laboratory experiments suggest the synovial fluid absorbs glucosamine that is introduced to the body from an external source. Glucosamine supplements also seem to encourage production of hyaluronic acid. Doctors think that normal hyaluronic acid levels in the knee joint keep the cartilage healthy and suppress pain in patients with knee OA.

Glucosamine and chondroitin sulfate also help fight inflammation, which in turn reduces joint pain, swelling, and tenderness from knee OA. These compounds seem to work in a different way than NSAIDs. They take longer to achieve the same benefit, but the results tend to last longer than NSAIDs. Most importantly, they have fewer side effects than NSAIDs. It’s possible that some patients may get good pain relief with a combination of the two.

Though the data isn’t conclusive, these two supplements have been shown to decrease pain and improve joint mobility in patients with knee OA. In a recent study, knee pain from OA was found to decrease mostly in those people suffering from moderate to severe pain, but not those suffering with just mild pain. Most people start to notice a difference after taking the supplements for four weeks. Maximum benefits happen by eight to 12 weeks, and the benefits seem to last even after treatment has ended.   It is usually recommended that glucosamine and chondroitin sulfate can be taken indefinitely as long as one feels that there is relief from symptoms in their affected joints. Long term use (longer than 3 months), however, should be discussed with your doctor to ensure it is safe in each individual case. Studies to support the effectiveness and safe long term use of these supplements are ongoing.

How will I prepare for treatment?

It is best to prepare for this treatment by talking to your doctor and gathering any information regarding these supplements for yourself. Organizations in your area that deal with arthritis can be useful (i.e. the Arthritis Foundation of your country.) Not all forms of arthritis respond to these supplements and taking care of knee OA can involve many possible treatments including treatment with Physical Therapy.  Glucosamine and chondroitin sulfate are not magic bullets. They are one form of treatment in a comprehensive approach to knee OA.

Related Document: First Choice Physical Therapy’s Guide to Osteoarthritis

How are these treatments administered?

Doctors commonly prescribe oral glucosamine in doses of 500 milligrams three times per day or 1,000 milligrams twice per day. A patient may get a quicker response with a higher dosage. Obese patients may require higher dosages. Most studies of chondroitin sulfate use a dosage of 1,200 milligrams daily.

Complications

What might go wrong?

One potential benefit beyond pain relief for both glucosamine and chondroitin sulfate seems to be that patients experience fewer side effects with these drugs than with NSAIDs.

Most people can take these supplements without complications. Some people, however, complain of gastrointestinal problems, which clear up when patients stop taking the supplement. Although rare, negative reactions may include nausea and vomiting, headache, painful digestion, softened or loose stool, abdominal pain, heartburn, throbbing or fluttering of the heart, skin reaction, edema (swelling), and discomfort in the legs.
Patients who take numerous medications should seek the advice of their doctor before supplementing with glucosamine and chondroitin sulfate. As glucosamine sulfate affects the way insulin works, diabetics are encouraged to monitor their blood glucose levels carefully and to alert their doctor of any marked changes. Also, children, pregnant women, and patients who are on blood thinners should only take chondroitin sulfate with the approval of their doctor.

What happens after treatment?

Many patients report ongoing benefits, even after they stop taking these supplements. Past studies have shown that the ability of these compounds to fight inflammation may be slower to take effect than NSAIDs yet the benefits seem to outlast NSAIDs. Until further studies are completed it cannot be said that there is proof to show that these supplements rebuild damaged cartilage. Given the possible protection to the cartilage, however, some doctors have their patients use these supplements in hopes of maintaining joint health.

Although glucosamine and chondroitin sulfate appear to have a useful place in treating knee OA, it is not recommended they be used alone without any other concurrent treatment. Managing knee OA works best when combined with Physical Therapy and lifestyle changes, such as weight loss, and increasing your overall physical fitness.

At First Choice Physical Therapy we believe that the more you understand about OA, the more effective our treatment will be. For this reason, we will assist you in learning about OA so you can understand how best to manage your own symptoms.

Regular treatment at First Choice Physical Therapy can significantly decrease the pain you feel from your OA knee. The use of heat as well as electrical modalities such as ultrasound or interferential current may be used to alleviate your initial symptoms. Ice may also be a useful depending on individual preference and the stage of the OA. Many patients instead find heat to be particularly soothing on their arthritic joint. Anecdotally,  warmer weather often decreases the symptoms of knee OA, whereas cold weather may increase them. This is one reason why many older patients with OA in their joints flock to warmer climates when the colder seasons arrive. Massage to the muscles of the thigh or calf may also be used to aid in pain relief. Acupuncture is gaining popularity as a form of treatment for knee osteoarthritis, and as a result, more studies are being done to validate its effectiveness.

By decreasing the pain you have, it will make it easier for you to do range of motion and strengthening exercises. Knee range of motion often declines as OA progresses so exercises to maintain both the bending and straightening of the knee are important. Your Physical Therapist will teach you exercises that you can do in the clinic, as well as part of your home program. Using an exercise bike, whether stationary or regular, is a good way to maintain some of the range of motion of the knee and keep the joint loose. However, because maximum range of motion is not used during cycling, specific exercises that move the knee from full bending to full straightening are still required. There may be a small amount of discomfort as your knee nears the end of the bending or straightening range and this should be respected while still working through your maximum available range. If needed, your Physical Therapist will assist you in gaining range of motion by mobilizing the joint. This hands-on technique helps to encourage the knee joint to move gradually into the end ranges of motion.

In addition to range of motion exercises, your Physical Therapist will teach you strengthening exercises for the knee and hip. The hip is particularly important as it controls the alignment of the knee so weakness in this area in particular leads to undue forces being put through the knee during everyday activities such as walking or stepping up or down. OA can affect both sides of the knee joint but in many cases the knee cartilage wears down on one side (typically the medial or inside of your knee) quicker than the other side, which then significantly affects the alignment of your knee. Your Physical Therapist may use an electrical muscle stimulator on the muscles around the knee or hip to encourage the muscles in these areas to fire, which supports your joints, improves your alignment, and therefore takes the pressure off of your painful knee. Light weights or elastic bands may also be used to add increased resistance and build up the strength.

Alignment can also be improved by implements such as wedged foot orthotics or knee braces. Wedged orthotics change the ground forces that are applied upwards to your knee and specialized knee braces are designed to unload the pressure off of the most painful side of your knee. Another way to unload the pressure on your knee is to use a cane or walking stick. Research has shown that the use of a cane in the hand that is opposite to your painful knee will decrease the forces applied to your knee and may therefore decrease your pain. On that note, if you are carrying heavy goods, carrying them on the same side as your OA knee instead of in the opposite hand will put the least amount of pressure on your painful joint.  Your Physical Therapist at First Choice Physical Therapy will assess your knee and determine if your knee would benefit from the use of orthotics, a brace, or a walking aid, and will refer you to the appropriate health care professionals to assist you with obtaining these items.

If you are overweight, losing some weight can also take pressure off of your painful knee. Any extra weight that the body carries will put direct pressure on your OA knee and increase the amount of pain you feel and hasten the process of joint deterioration.

Your Physical Therapist will encourage weight loss through both dietary changes as well as strength training, and cardiovascular activities such as walking (if tolerable), stationary or ordinary cycling, or pool activities such as swimming or water aerobics. The pool is a particularly good venue to partake in cardiovascular activities for weight loss as well as perform many of the exercises your Physical Therapist prescribes for range of motion and strengthening. The water naturally takes some of the pressure off of your joint and therefore many patients with OA find the water particularly therapeutic especially if the water is warmer than usual public pool temperature.

The final part of our treatment will include exercises for your balance. As the result of any injury or pain the receptors in your joints and ligaments that assist with balance and proprioception (the ability to know where your body is without looking at it) decline in function. This is true with OA knees as well. Your Physical Therapist at First Choice Physical Therapy will prescribe exercises for you to regain and maintain this balance and proprioception. This might include exercises such as standing on one foot or balancing with both feet on an unstable surface such as a pillow or a soft plastic disc. Depending on the stage of your OA and your ability, your Physical Therapist may even prescribe agility exercises such as gentle hopping or moving side to side.

Fortunately, most patients with knee OA who combine the use of glucosamine and chondroitin sulfate with our rehabilitation program at First Choice Physical Therapy feel that their pain decreases, they are better able to manage their symptoms, and are also able to improve their activity level and quality of life. If, however, your knee does not respond as we would expect to the treatment we provide at First Choice Physical Therapy, we will promptly liaise with your doctor regarding the best management plan to assist you.

Arthritis means inflammation of the joints. Inflammation generally includes symptoms of redness, heat, swelling, and pain. Many different diseases can result in inflammation of the joints. Arthritis is therefore a general term that describes more than one hundred different diseases of the joints of your body.

In some types of arthritis, the cause of the disease is known, but in others it is still unknown. Some types of arthritis come on suddenly, and others develop slowly. Any joint can be affected, including the joints of your back, neck, knees, hips, shoulders, and fingers.

The diseases that cause arthritis can also attack muscle and connective tissue around joints. Some diseases may even damage other organs of the body, such as the kidneys, intestines, and heart. Due to the fact that the diseases inflame the joints, most arthritic conditions and related diseases involve chronic (long-term) pain. Over time, they may cause increasing damage to the joints or soft tissues of your body.

Your joints are beautifully designed to minimize stress and damage while you move. Nearly all joints of the body are synovial joints. Most joints where two bones come together and must move against one another to allow motion are synovial joints. Smooth, slick articular cartilage covers the end of the bones so the bones themselves don’t rub together. Synovial fluid lubricates the joint and allows easier motion as well as helps to provide nutrition to the cartilage of the joint. Around the joint, connective tissue forms a watertight sac that is called the joint capsule. Small, fluid-filled sacs, called bursae, cushion parts of the joint where friction is particularly high and could causing rubbing on bones, muscles, or other soft tissue. Ligaments connect the bones together and tendons connect the muscles to bones.

A problem with any one of these parts of the joint can lead to abnormal biomechanics at the joint, resulting pain, and eventually inflammation of the joints, namely arthritis.

Many people of all ages suffer from arthritis. Almost two-thirds of arthritis patients are women, but for some specific types of arthritis the majority of sufferers are men.
Arthritis and related diseases are often painful to live with and sometimes very difficult to treat. The method of treatment will vary depending on the specific disease, however in nearly all cases, some form of drug management can be helpful. In addition, Physical Therapy can be extremely useful to assist in pain management, as well as to ensure that changes in biomechanics due to pain or the breakdown of the joints from the inflammatory process itself is kept to an absolute minimum. Maintaining range of motion and strength of your joints and muscles is crucial to living with an arthritic condition.

Physical Therapy in Lynn Haven and Panama City Beach for Arthritis

At First Choice Physical Therapy we can assist you in managing your arthritis. The exact treatment you require will depend on the specifics of your disease as well as your individual needs.  Our aim is to assist you in managing your arthritis and helping you to be as active as possible.

When you visit First Choice Physical Therapy your Physical Therapist will begin by taking a complete history of your problem followed by a thorough examination of your affected joints.  Your Physical Therapist will ask you questions about where precisely your pain is, when the pain began, what you were doing when the pain started, and what movements aggravate or ease the pain. They will also want to know if you have had any investigations such as x-rays or other tests done, and if you have tried any other forms of treatment, such as medications, or simply even using ice or heat to decrease your discomfort.

Next your Physical Therapist will do a physical examination of your affected joints. They will palpate, or touch, around your joints looking for signs and symptoms of arthritis, as mentioned above, such as swelling, redness, heat, or areas of tenderness. Depending on which joints are involved your Physical Therapist may want to look at how you sit, stand, walk, or even how you squat, or jump. They will then take specific measurements of any joints that are affected to determine the range of motion in your joints. If possible, they will measure each range of motion so that they can determine if the range of motion improves or decreases over time; decreased range of motion is a tell-tale sign of a progression of arthritis.

Next, your Physical Therapist will assess the stability of your joints to determine if there is any laxity of the ligaments or tissues of your joints. In some forms of arthritis this laxity can be a significant cause of the arthritis, and in other forms, the arthritic process itself causes the laxity.  Too much laxity around the joints affects your alignment and the biomechanics of the joints, which can end up adding extra pressure onto an already irritated joint.

Your Physical Therapist will also check the strength and lengths of the muscles surrounding your joints. Muscles, if weak or too tight, can contribute to the forces applied to a joint, which can lead to further pain and contribute to poor biomechanics.
Finally, your Physical Therapist will assess how well you control your joints. The ability to know where your joints are in space without having to look at them is called proprioception. As a result of any injury, including an arthritic process, the receptors in your joints and ligaments that assist with balance and proprioception decline in their function. If your balance and proprioception has declined, your joints and your limb as a whole will not be as efficient in their functioning and this decline can contribute to further pain and progression of the injury.

Once your Physical Therapist has taken a thorough history from you as well as completed a physical examination, they will determine the best treatment regime for your individual problem. As mentioned above, some forms of arthritis affect many joints and even some of your organs, whereas other forms may only affect one joint of your body, so your treatment plan will need to be specifically designed just for you.
Your Physical Therapist will discuss with you how much activity or rest is advisable in your individual case; some forms of arthritis go through periods of flare-ups and at this time they require rest in order to be effectively managed. Other forms of arthritis do not respond well to limited activity, and actually improve if the joints are being kept mobile and the patient continues to be active.  If you are already an active individual, your arthritis may threaten to slow you down, but your Physical Therapist can discuss with you forms of cardiovascular activity that may be safe to continue even while you are experiencing discomfort. Often these activities involve non-weight bearing sports such as activities in the pool, or cycling.

Physical Therapy treatment at First Choice Physical Therapy can also directly assist with any discomfort you feel in your joints due to the arthritis. You may yourself notice that your joints respond well to ice or heat, so this will be encouraged. Other modalities that we can offer, such as ultrasound or electrical modalities, may also assist with managing your pain.  Your Physical Therapist may even suggest alternative treatments such as acupuncture, which can also assist in managing the pain of arthritic joints.
The range of motion in your joints inevitably will decline due to the arthritic process if you do not actively maintain the motion of your joints. Your Physical Therapist will prescribe specific stretching exercises for you that will combat this decline in range of motion. These stretches should be done as part of a home-program. Your Physical Therapist may even help to maintain the range of motion while you are at the clinic by mobilizing the joints. This hands-on technique encourages the joints to move gradually into their normal range of motion.

Next your Physical Therapist will prescribe the appropriate strengthening exercises to target any weak muscles that are affecting your biomechanics and alignment. These exercises will also be done as part of your home program. In addition, exercises that challenge your proprioception will also be prescribed. Improving your proprioception can ease the pressure on your joints and help to avoid any further injury.

Lastly, your Physical Therapist will discuss the possibility of using braces or taping to ease your arthritic discomfort and to assist your biomechanics and alignment. Taping can often be used on a trial basis before an expensive brace is purchased, but because arthritis is long-term problem, a brace is usually purchased eventually if the tape has been helpful. There are numerous braces and supports that can assist with arthritic joints depending on your individual need, and your Physical Therapist can discuss these with you. If required, they may refer you on to a specialist in bracing and supports, such as an Orthotist or an Occupational Therapist.

Most times arthritis, no matter which type, responds well to the treatment we provide at First Choice Physical Therapy. There are times, however, that some forms of arthritis may not respond as well, or may plateau in their improvement with the treatment we provide at First Choice Physical Therapy.  If this is the case for you, your Physical Therapist will liaise with your doctor regarding the appropriate ongoing management of your arthritis. Some cases may require referral to an Orthopaedic Surgeon to discuss the possibility of joint replacement surgery if the joint is too painful to manage conservatively, or if the alignment of the joint has progressed so far that it is not allowing the joint to function efficiently.

Gout is a disease that involves the build up of uric acid in the body. About 95 percent of gout patients are men. Most men are over 50 when gout first appears. When it does occur in women, they generally don’t develop it until after menopause. In some rare cases gout develops at a young age.

This guide will help you understand:

• how gout develops
• which parts of the body are affected by gout
• what can be done for the condition
• what First Choice Physical Therapy’s approach to rehabilitation is

What is gout?

Synovial fluid is the fluid that the body produces to lubricate the joints. In gout, excess uric acid causes needle-shaped crystals to form in the synovial fluid. Uric acid is a normal chemical in the blood that comes from the breakdown of other chemicals in the body tissues. Everyone has some uric acid in his or her blood. As your immune system tries to get rid of the crystals in the synovial fluid, inflammation develops. For the person with too much uric acid, this inflammation can cause painful arthritis, sometimes called gouty arthritis.  Gout was the first disease in which researchers recognized that crystals in the synovial fluid could be the cause of joint pain.

The first attack of gouty arthritis usually happens in just one joint. Half of the time, gout affects the metatarsophalangeal (MTP) joint at the base of the big toe. Eventually, 90 percent of people with gout will have pain in the MTP joint. Other joints that are commonly affected include the mid-foot, ankle, heel, and knee joints. Less commonly gout affects the fingers, wrists, and elbows.

Over time, patients with gout can develop tophi, or lumps that grow around crystal deposits in joints or near pressure points. Tophi most often occur in the fingers, wrists, ears, knees, elbows, forearms, and heels. Tophi can also grow in the kidneys, heart, and eyes.

What does gout feel like?

Gout causes attacks of very painful joint inflammation. This pain is often described as a burning pain. Early gout attacks usually affect only one joint. As mentioned above, this joint is most commonly the MTP joint at the base of your big toe. The affected joint becomes swollen, warm, and red within eight to 12 hours. Most of the time the attacks occur at night and last 3-10 days. Patients indicate that the pain is so bad that the joint can’t stand the slightest touch. Even the weight of a bed sheet causes excruciating pain. Walking and standing are almost impossible if the legs or feet are affected. Many patients have flu-like symptoms, including fever and chills. The pain may go away on its own over a few hours, or it may take a few weeks.

Gouty arthritis attacks come and go. There may be months between attacks. Over time the attacks generally occur more often, last longer, and involve more joints. Eventually the pain doesn’t ever completely go away; the joints stay swollen and tender even between flare-ups, and the flare-ups start to happen every few weeks. As mentioned above, some patients eventually develop tophi on joints or pressure points as well as kidney stones.

How do health care professionals identify the condition?

Early diagnosis of gout is important because crystals within the joint can lead to joint damage and this can occur without you knowing it. Patients with arthritic episodes that come and go may not seek medical help. Some patients are medically evaluated but complete testing is not done and they are misdiagnosed with rheumatoid arthritis. Either of these situations will delay treatment and increase the risk of erosive damage to the joint.

The diagnosis begins with a history of your symptoms and a physical exam. Your health care professional will want to know when the pain started, what aggravates or eases it, and if any other joints in your body are involved. They may also ask you about your diet, alcohol consumption, or whether or not you have a family history of gout or any other related medical conditions. The synovial fluid from the affected joint will need to be examined in order to identify the needle-like crystals that are part of gout. This is the most important part of the diagnosis. To get a sample of the synovial fluid, a doctor performs an arthrocentesis. During this procedure a long, thin needle is inserted into the affected joint and a small amount of synovial fluid is aspirated (removed.) The fluid is sent to a laboratory where it is viewed under a special polarized light microscope to determine if uric acid crystals are present.

If there are uric acid crystals present in the sampled synovial fluid, then you have gout. Unfortunately only 80 per cent of tests are positive when a person really has gout, so this test is not completely accurate. In some cases (such as in the midfoot), it isn’t easy to aspirate fluid. Without the use of fluoroscopy (a special X-ray imaging) or ultrasound to guide the needle, aspiration isn’t done. In these situations, the diagnosis is made without joint aspiration on the basis of the patient’s history and when they respond favorably to therapy aimed at treating gout.

The diagnosis must rule out the presence of infection, which can be a hidden problem. Your doctor may also get a blood test to look at the levels of uric acid. It should be noted, however, that uric acid levels rise and fall depending on many complex factors in your body. It is possible to have a normal uric acid level while you are having severe gout pain so this is not always a reliable indication of the presence of gout.
Ultrasonography may be helpful in the diagnosis of gout because the crystals form into the shape of rosary beads inside the cartilage on the ends of the bones and this can be seen on the ultrasound pictures. Ultrasonography can also show a ‘double contour sign.’ This sign looks like a top covering or extra coating of the joint surface when crystals are deposited in the hyaline cartilage. Ultrasonography, however, although very useful, should not replace fluid removal and examination in the diagnosis of gout because ultrasound cannot confirm infection.

If you have tophi, your doctor may want to biopsy one of the lumps.

As part of diagnosing gout your doctor will need to rule out other forms of arthritis as possible causes of your symptoms. Gout can occur with other forms of arthritis, such as septic arthritis and other forms of rheumatoid arthritis so the presence of these diseases will need to be determined. There are also other diseases that can cause different kinds of crystals to form in the synovial fluid so further investigation into whether other diseases are present may also need to be completed.
X-rays don’t show doctors much in the early stages of gout. Despite this x-rays may be done as they can help monitor the disease process and they may be needed to rule out other problems.

What can be done for this condition?

Gout cannot be cured, but it can be very successfully treated. The main goal of treating gout is to reduce the amount of urate in your blood. Joint crystals will not dissolve or go away unless the serum urate concentration is below six mg/dL.

During the acute or early phase of a gout attack, doctors prescribe medicines called colchicine, certain nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids to decrease swelling and relieve pain. All of these drugs work quickly and are very effective. The sooner they are given after an attack starts, the faster the pain goes away. These drugs may be given by mouth, through an intravenous line into your bloodstream, or injected directly into the joint. There are some potential adverse side effects of these medications. It may take a bit of time to find the most effective drug with the least intolerable side effects for some patients. Most importantly, one should start drug treatment during the first few days of an attack to get the best results.

Your doctor may also decompress the affected joint. Aspiration of synovial fluid immediately decreases the pressure in the joint and the needle leaves a pathway or track that acts as a vent for continued drainage after the needle is removed.

Lifestyle changes can help you manage intermittent gout without using drugs every day. Your healthcare professional may ask you to do the following:

Change your diet. Diets that are lower in meat, shellfish, and some other foods can help decrease the amount of uric acid in your body. Avoiding fructose sweetened foods and beverages can do the same.

• Quit taking drugs such as diuretics, if possible.
• Lose weight.
• Quit drinking alcohol.
• Avoid activities that stress your joints.
• Drink plenty of fluids to help your kidneys work more efficiently.

If your gout is severe, prolonged, or chronic, you may need to take daily serum uric acid-lowering (SUA) medication to reduce your uric acid levels. Your doctor will put you on the lowest dose possible of medications such as uricosuric drugs or xanthine oxidase inhibitors. Doctors usually prescribe allopurinol (Zyloprim, a xanthine oxidase inhibitor) for patients who overproduce urates or have tophi, kidney disease, or kidney stones. Allopurinol is useful in preventing recurrence of gouty attacks. It blocks the production of uric acid and decreases the formation of purine. For patients who have difficulty getting rid of uric acid through the kidneys, medications to help the kidneys remove more uric acid from the blood may be prescribed as well. Probenecid is one of the commonly prescribed drugs that increase the removal of uric acid in the urine.

Another serum uric acid-lowering (SUA) medication that has been shown to reduce the risk of occurrence is Uloric (Febuxostat). It lowers uric acid slowly enough to avoid flaring up the gout. The kidney doesn’t process this drug, so it’s possible that patients with kidney disease may be able to take it. The liver, however, metabolizes this drug so anyone with a liver problem or who abuses alcohol may not be able to take this drug.
As with all medications, you should report any side effects to your doctor right away. Watch for skin rashes, itching, fever, nausea, vomiting, diarrhea, or other new symptoms not present before taking the serum uric acid medications.

Sometimes patients experience a flare-up after taking urate-lowering agents. This reaction can come as a surprise, since you expect your pain and swelling to get better. Flares of this kind mean that old deposits of crystals stored in the tissues are being released rather than a sign that new crystals are forming. To combat this, don’t stop taking your medication without first checking with your doctor. Getting rid of the old crystals can help protect the joint from further damage.

Doctors seldom treat hyperuricemia without symptoms of gout. However, if hyperuricemia is at least moderately bad over several years, it is more likely to lead to gout. In this case, a doctor may begin treatments to prevent gout. This is called prophylactic treatment.

A program to control uric acid levels and manage symptoms often includes daily colchicine and allopurinol or probenecid (usually both are not taken at the same time) along with dietary restrictions. Regular follow-up with your physician and blood tests to detect serum uric acid concentration that are above the six mg/dL target level are important in maintaining good control and preventing joint erosion.

So far, there are no drug treatments to prevent the formation and deposit of these crystals in the joints. Researchers continue to look for pharmacological and other biologic therapies that might prevent, if not cure, gout for those who suffer from symptomatic outbreaks.  Rehabilitation treatment and advice from a Physical Therapist at First Choice Physical Therapy can be of benefit for gout.

First Choice Physical Therapy provides services for Physical Therapy in Lynn Haven and Panama City Beach.

In some cases of gout when the joint flares up, treatment with a Physical Therapist at First Choice Physical Therapy can be helpful in conjunction with medication. Your therapist may use modalities such as ice, ultrasound, or laser to calm your joint down.  You can also apply ice or a cold compress at home to soothe a joint flare up with gout.  In many cases, however, direct Physical Therapy treatment to the joint is too painful during a flare-up so resting and elevating the joint is the recommended treatment during this time.

Often when a joint is in a flare-up of gout, walking on the joint can be extremely painful or nearly impossible. Your Physical Therapist can advise you on when you should use a walking aid such as a cane/stick to assist your gait. Walking without the proper support or with a limp for even a short period of time due to the pain of gout can cause you to develop incorrect gait patterns and put excess strain on the other joints of your body, particularly those in the lower extremities.  Your therapist will also ensure that once your gout flare-up subsides that you are walking well and that you haven’t developed any poor long-term walking habits.

Being that repeated flare-ups of gout can eventually damage the joints and change the way they move and function, it is important that you maintain good range of motion in the joints, as well as flexibility and strength of the muscles surrounding the joints.  Your Physical Therapist will assess the joints that are commonly affected by gout in your case, and will prescribe range of motion, stretching, and strengthening exercises to help maintain the maximum function of the joints.  Proprioception exercises, which assist in maintaining the joint’s sense of position, will also be prescribed. All exercises should be done between flare-ups rather than during a flare-up.  Exercising a joint inflamed by gout is generally too painful, and may be detrimental to the joint due to the uric acid crystals that can wear on the joint surface during extreme motions of the joint.

As mentioned above, a sedentary lifestyle without exercise, obesity, as well as hypertension are all risk factors for developing gout. For this reason, at First Choice Physical Therapy we feel it is important for all patients with gout to take part in a cardiovascular exercise program in order to reduce these risk factors, which can assist in decreasing the number of flare-ups of gout that occur.  Your therapist can advise you on an appropriate cardiovascular exercise for you to partake in and can devise a program of exercise for you to follow. Some clients will find that doing a cardiovascular exercise in the pool, along with their other stretching and strengthening exercises, is easier and less painful on their joints. As with the other exercises mentioned above, cardiovascular exercise are best done between bouts of gout rather than during a flare-up.

Another risk factor for gout, as mentioned above, is diet. Alcohol, a high carbohydrate diet or one full of rich meats or sugary drinks will affect your gout. Your therapist can refer you to a Nutritionist to discuss altering your diet in order to help manage your gout.

Treatment for gout is a matter of management rather than elimination of the problem.  By working closely with your doctor, Physical Therapist and other healthcare professionals you can successfully manage the disease with as little impact as possible on your everyday life and activities.