Joint Pain Ebooks Catalog
A Avoidance of nonsteroidal antiinflammatory drugs and treatment with alternative modalities ie oral or intraarticular
Active synovitis in a single joint out of proportion to all others intraarticular steroids are quite effective in this setting. The dose of Depo-Medrol (40 mg cc) is proportional to the size of the joint. The full 40 mg is injected into knee joints in the same syringe with 1 cc of 1 xylocaine without epinephrine. Note Steroids should not be injected if there is a possibility of joint infection. 7. Rheumatoid vasculitis (malignant rheumatoid arthritis). Fortunately rare, rheumatoid vasculitis is a polyarteritis nodosa-like disorder that occurs in patients who have had chronic, severe, deforming, seropositive, nodular RA. Presentations might include fever, neuropathy, leg ulcers, and ischemic disease of the intestines, heart, and nerves. This is often an organ- or life-threatening disorder and thus demands aggressive treatment. Steroid dosage varies and is guided by the severity of the disorder. Prednisone (40 to 60 mg d in divided doses 20 mg three times daily with meals) or pulses of...
Infection, although slight, is always present thus, careful aseptic technique is required. (For technique, dosage, and preparations, see Chapter.20.) An evanescent flare in a joint after injection may occur because of inflammation induced by leukocyte ingestion of corticosteroid ester microcrystals. This possibility should be brought to the patient's attention, and the patient should be told to treat this with a pain medication and an ice pack. Within 12 to 24 hours, the injection-induced joint pain should improve, and relief may persist anywhere from a month to forever. If the initial joint pain was primarily mechanical in origin (i.e., resulting from joint damage), the improvement may be very short-lived. Frequent intraarticular corticosteroid injections (more than once in a 2- to 3-month period or more than three times a year) are not advised because there is evidence that they may lead to accelerated cartilage damage.
Side effects Common Apheresis (removing blood, filtering it, and returning it to the patient), whether using the prosorba column or not, often causes minor side effects of short duration such as joint pain, fatigue, nausea, rash, low blood pressure, flushing, dizziness, tingling, fever, and chills. Uncommon Many patients with autoimmune diseases have small fragile veins, and obtaining venous access for apheresis can be a problem. cryoglobulinemia has been described.
If the hip joint is severely damaged, total joint replacement can dramatically improve a patient's quality of life. This is a common operation in AS. However, many patients are young at the time of surgery and are likely to need a second operation years later to replace the artificial hip when it wears out. Patients with AS who undergo hip replacement surgery have a greater chance of developing heterotopic ossification, a condition where new bone grows around and into the new joint, thus restricting its motion. To prevent heterotopic ossification, many orthopedic surgeons treat the hip with a low dose of radiotherapy before surgery. Surgery is also occasionally used to correct a severe spinal deformity when the patient is bent so far forward that forward vision is impossible. The majority of patients with AS can lead an active life and continue to work. Indeed, some patients with mild disease who have had back pain but never sought medical advice for it are diagnosed only when a...
The most common adverse effects are joint pain and swelling, fatigue paresthesias, headache, hypotension, anemia, nausea, sore throat, edema, abdominal pain, hypertension, rash, dizziness, diarrhea, hematoma, flushing, chills, dyspnea, chest pain, and fever. Other complications associated with any procedure involving apheresis may occur, including blood loss, damage to blood cells, and problems arising from mismanagement of fluid balance (e.g., hypertension, hypotension, arrhythmias). In patients with RA, the rate of infection, local thrombosis, or both at the site of central venous catheters is greater than 40 .
Special Concerns Use with caution in diabetes mellitus, hypertension, chronic nephritis, thrombophlebitis, convulsive disorders, infectious diseases, renal or hepatic insufficiency, pregnancy. Chronic use may inhibit the growth and development of children or adolescents. Pediatric clients are also at greater risk for developing cataracts, osteoporosis, avas-cular necrosis of the femoral heads, and glaucoma. Geriatric clients are more likely to develop hypertension and osteoporosis (especially post-menopausal women). Side Effects Small physiologic doses given as replacement therapy or short-term high-dosage therapy during emergencies rarely cause side effects. Prolonged therapy may cause a Cushing-like syndrome with atrophy of the adrenal cortex and subsequent adrenocortical insufficiency. A steroid withdrawal syndrome may occur following prolonged use symptoms include anorexia, N&V, lethargy, headache, fever, joint pain, desquamation, myalgia, weight loss, hypotension.
Creased or decreased libido, gyneco-mastia, menstrual irregularities. GU Difficulty in urination, urinary retention, incontinence, dysuria, enuresis. CV Hypertension, hypotension, bradycardia, tachycardia, palpitations, edema, CV collapse. Hematologic Anemia, agranulocytosis, leu-kopenia, eosinophilia, thrombocyto-penia. Ophthalmologic Diplopia, conjunctivitis, nystagmus, blurred vision. Miscellaneous Joint pain, lym-phadenopathy, muscle cramps, pa-resthesia, dehydration, lupus-like symptoms, sweating, SOB, flushing, hiccoughs, fever, hepatic dysfunction. Following IM use Redness, pain, burning. Following IV use Thrombosis and phlebitis at site.
Visual disturbances are the most common adverse effects and also the most important. These include diminished visual acuity, retrobulbar neuritis, retinal pigment displacement, and (rarely) hemorrhages. Gastrointestinal symptoms (abdominal pain or vomiting), and headache, dizziness, mental confusion, and hallucinations are all rarely seen. Adverse effects are more frequent in elderly patients and patients with alcoholism, diabetes, or renal insufficiency. Stevens-Johnson syndrome, toxic epidermal necrolysis (3), purpura-like vasculitis, acute thrombo-genic purpura, joint pain, drug fever, tachycardia, and leukopenia have been attributed to allergy. As these reactions often arise during combined treatment with other tuberculostatic drugs, it is difficult or impossible to determine which drug is responsible. Tumor-inducing and teratogenic effects have not been described.
In the study by Johnson and colleagues, in which 10 patients who had been taking fresh feverfew leaves were switched to placebo, patients experienced recurrence of migraine, tension headaches, joint pain and stiffness, nervousness, insomnia and disrupted sleep, and tiredness. The investigators
Been determined in children less than 12 years of age. Side Effects Respiratory Paradoxical bronchospasms, upper or lower respiratory tract infection, nasopharyn-gitis, disease of nasal cavity sinus, cough, pharyngitis, allergic rhinitis, laryngitis, tracheitis, bronchitis. Allergic Immediate hypersensitivity reactions, including urticaria, rash, and bronchospasm. CV Palpitations, chest pain, increased BP, tachycardia. CNS Headache, sinus headache, tremors, nervousness, malaise, fatigue, dizziness, giddiness. Oral Dry mouth, dental pain. GI Stomachache. Musculoskeletal Joint pain, back pain, muscle cramps, muscle contractions, myalgia, myo-sitis, muscle soreness. Miscellaneous Flu, dental pain, rash, skin eruption, dysmenorrhea.
Of daily activities to less than 50 below premorbid level. Rest does not significantly improve the fatigue. Other symptoms include muscle and joint pain, headache, low-grade fever, sore throat, muscle weakness, poor concentration, and sleep disturbance. The interpretation that such symptoms are medical in origin and unrelated to psychological factors is common in patients with CFS, as well as their family members.
Side Effects Oral Sore mouth or tongue, dysgeusia, candidiasis, glossitis. GI N&V, diarrhea, abdominal cramps or pain, dyspepsia, glossitis, heartburn, anorexia, flatulence, cho-lestasis. Pseudomembranous colitis. Allergic Urticaria, rashes (maculo-papular, morbilliform, or erythema-tous), pruritus (including anal and genital areas), fever, chills, erythema, angioedema, serum sickness, joint pain, exfoliative dermatitis, chest tightness, myalgia, erythema multiforme, edema, itching, numbness, chills, Stevens-Johnson syndrome, anaphylaxis. NOTE Cross-allergy may be manifested between cephalosporins and penicillins. Hematologic Leukopenia, leukocy-tosis, lymphocytosis, neutropenia (transient), eosinophilia, thrombocy-topenia, thrombocythemia, agranu-locytosis, granulocytopenia, bone marrow depression, hemolytic anemia, pancytopenia, decreased platelet function, aplastic anemia, hypo-prothrombinemia (may lead to bleeding), thrombocytosis (transient). CNS Headache, malaise, fatigue,...
Common side effects include tiredness, flushing of the skin, diarrhea, low blood pressure, headache, and swelling of the feet, ankles, and abdomen. Less common side effects include itching, acne, rash, anemia, bleeding or bruising, unusual blood clotting, stomach bleeding, a heartbeat that is abnormally slow or fast, high blood pressure, heart failure, wheezing, coughing, shortness of breath, dizziness, a numbness or tingling in the hands or feet, a swelling of the arms and legs, muscle cramps, difficulty urinating, nausea, constipation, depression, memory loss, psychosis, paranoia, hallucinations. Rare side effects include temporary blindness, increased angina, fainting, chest pain, fever, liver inflammation or jaundice, joint pain and swelling, hair loss, vivid dreams, headaches, vomiting, and sexual difficulties.
Common side effects include a pulse rate slower than 50 beats per minute, diarrhea, dizziness, drowsiness, fatigue, nausea, numbness or tingling in the fingers and toes, weakness, cold hands or feet, and dryness of the eyes, mouth, and skin. Less common side effects include hallucinations, nightmares, insomnia, headaches, breathing difficulties, joint pain, anxiety, chest pain, confusion, lack of alertness, depression, impotence, abdominal pain, and constipation. Rare symptoms include rash, sore throat, fever, unexplained bleeding or bruising, and dry burning eyes.
Common side effects include a slow pulse rate (fewer than 50 beats per minute), a coldness in the hands and feet, diarrhea, dizziness, drowsiness, a dryness of the mouth, eyes, and skin, fatigue, and numbness or tingling in the fingers and toes. Less frequent symptoms include abdominal pain, a loss of alertness, anxiety, difficult breathing, chest pain, confusion, constipation, depression, hallucinations, headache, impotence, insomnia, joint pain, and nightmares. Rare side effects include excessive bleeding and bruising, eyes that are dry and burning, fever, rash, sore throat, vomiting, and emotional instability. Other possible side effects include short-term memory loss, visual disturbances, weakness, and paranoia.
Addison's disease is the result of an autoimmune process that destroys the adrenal glands it is the most common cause of primary adrenal insufficiency in the industrialized world, accounting for about 65 per cent of cases.(73) Both glucocorticoid and mineralocorticoid secretion are diminished in this condition. Left untreated, Addison's disease is usually fatal. Clinical manifestations of adrenal insufficiency include weight loss, fatigue, vomiting, diarrhoea, anorexia, and salt-craving. Less common findings are muscle and joint pain, abdominal pain, and postural dizziness. Patients with Addison's disease require lifelong replacement of both glucocorticoids and mineralocorticoids. Patients may be misdiagnosed with major depressive disorder, personality disorder, dementia, or somatoform disorders.
Oral Dry mouth, metallic taste, furry tongue, glossitis, stomatitis (due to overgrowth of Candida). GI Nausea, vomiting, diarrhea, abdominal discomfort, constipation. CNS Headache, dizziness, vertigo, incoordination, ataxia, confusion, irritability, depression, weakness, insomnia, syncope, seizures, peripheral neuropathy including paresthesias. Hematologic Leukopenia, bone marrow aplasia. GU Burning, dysuria, cystitis, polyuria, incontinence, dryness of vagina or vulva, dyspareunia, decreased libido. Allergic Urticaria, pruritus, erythematous rash, flushing, nasal congestion, fever, joint pain. Miscellaneous ECG abnormalities, thrombophlebitis.
Relief of intractable pain is one of the core historical applications of cannabis. There are many modern anecdotes as to its utility in cancer pain, bone and joint pain, migraine, menstrual cramps and labour pain (Grinspoon and Bakalar 1993). Cannabis has been shown to have a dose-dependent antinociceptive effect on experimental pain in healthy subjects (Greenwald and Stitzer 2000).
Musculoskeletal side effects are common. Osteoporosis and joint pain can occur and are usually reversible especially in younger patients (12). Avascular necrosis of the hips or other joints can occur in rare cases. These symptoms may be confused with spinal cord compression or peripheral neuropathy. Hip pain radiating down the anterior thigh to the knee or localized to buttock and groin that is exacerbated by walking is a common symptom. MRI scanning is most sensitive in detecting avascular necrosis. In severe cases, joint replacement may be necessary. Steroid myopathy is common with proximal muscle weakness and decreased muscle mass particularly in the thigh muscles. Patients will usually complain of difficulty rising from a sitting position and climbing stairs and if they fall they often have great difficulty getting back up. Myopathy can also be seen in the arm muscles with difficulty lifting. Generalized muscle and joint pain often accompany steroid myopathy. In some instances...
Are flu-like symptoms, fever, and joint pain that can be controlled with acetaminophen. Liver function abnormalities and depression are also seen. IFN-a does not cross the placenta, and thus may be used in pregnant women who have a need for myelosuppression, although the majority of pregnant women do not have an indication for marrow suppression and the CBC may normalize during pregnancy. It can aid in the treatment of pruritus.12
Sulfadiazine (SFDZ) A derivative of sulfonamide that appears as a white or yellowish powder. Sulfa-diazine is used to treat urinary tract infections, chancroid, and trachoma. with pyrimethamine, it is used to treat toxoplasmosis. It is also occasionally used to treat malaria resistant to chloroquine with streptomycin, to treat meningitis and with penicillin, ear infections. It is administered orally. The most common side effects are allergic reactions, including skin rashes, itching, anaphylactic shock, swelling, sensitivity to light, joint pain, fever, and chills. The most serious side effects are blood disorders, including reduced counts of red blood cells, white blood cells, and platelets. other side effects include headache, peripheral neuropathy, mental depression, convulsion, weakness, hallucinations, ringing in the ears, vertigo, insomnia, and kidney
Common side effects include trouble with swallowing or speaking, profuse sweating, stiffness or spasms in the muscles of the neck and back, stiffness or weakness in the limbs, anxiety, hand tremors, pale skin, unnatural tiredness, nervousness, irritability, difficulty in walking or balancing, stomach pain, gas, insomnia, dizziness or lightheadedness when moving from a prone or sitting position to a standing position, coughing, stuffy nose, nausea, vomiting, headaches, constipation, and drowsiness. Less common side effects include chest pain, fainting, breathing problems, vision changes, joint pain, fever, lowered sex drive, impotence, rash or other skin problems, sore throat, increased saliva in the mouth, and toothache. Rare side effects consist of such involuntary actions as smacking the lips, puffing out the cheeks, moving the tongue, and uncontrolled movements of the head, neck, arms, and legs. Life-threatening symptoms are known as the neuroleptic malignant syndrome (NMS), and...
Common side effects include headaches, sore throat, dizziness, fainting, chills, sweating, fever, stomach gas, skin rash, lack of coordination, diarrhea, nausea, vomiting, swelling in the legs and feet, a tingling in the hands and feet, difficulty urinating, joint pain and inflammation, spasticity, hyperactivity, nervousness, sinus inflammation, bronchitis, pneumonia, difficulty breathing, convulsions, liver inflammation, conjunctivitis, blood pressure changes, and broken bones. Less common side effects include loss of appetite, changes in taste, drowsiness, eyes that are dry or itching, eye pain, sties, double vision or other vision problems, glaucoma, cataracts, earache, ringing or buzzing in the ears, deafness, infections of the middle or inner ear, a flushing in the face, facial swelling, a sickly appearance, indigestion, insomnia, muscle aches, runny nose, rash, stomach pain, heavy sweating, dehydration, greater chance of tiredness or weakness, and weight gain, heart failure,...
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