Anti CCP test is more specific for screening for Rheumatoid Arthritis as compared to RF - Dr. Intikhab Taufiq

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CME meeting by Dr. Essa Laboratory & Diagnostic Center

Anti CCP test is more specific for
screening for Rheumatoid Arthritis as
compared to RF - Dr. Intikhab Taufiq

Muscle spasm is the most common source
of Low Back Pain - M. Wahajuddin

KARACHI: RF test for screening of Rheumatoid Arthritis is not very reliable but Anti CCP test is more specific. Rheumatoid Arthritis can be a systemic disease which can be quite wide spread and people suffering from RA tend to die young. There is no cure for RA but there are many effective drugs which can improve the symptoms. Management of RA is a teamwork which consists of rheumatologist, orthopaedic surgeons and physiotherapists. Life style changes and use of DMARDs is quite beneficial. This was stated by Dr. Intikhab Taufiq, Consultant Orthopaedic Surgeon at Liaquat National Hospital Karachi. He was speaking at the 149th CME programme organized by Dr.Essa Laboratory and Diagnostic Center at its Gulshan-e-Iqbal Center on April 4th2013. The meeting was well attended by Family Physicians practicing in the area.
Speaking on Common Orthopaedic Problems in general practice Dr. Intikhab Taufiq discussed at length the symptomatology, Aches and Pain, regional orthopaedic problems of upper limb and lower limb besides other orthopaedic problems seen in general practice. In aches and pains, he said the family physicians must ask the patients about neuro vascular symptoms, fever, and general ill health, loss of appetite and weight loss. Regional orthopaedic problems in the upper limb involve neck, elbow, shoulder and wrists while the lower limbs involved include hip, knee, ankle and foot. Cervical collar, he stated, has its own side effects and it has specific indications in which it should be used. The patients can be suffering from neuro deficiency, numbness and also enquire about any urinary problems.
Talking about regional orthopaedic problems he mentioned cervical spondylitis, lumbago sciatica, frozen shoulder, tennis golfer’s elbow, Triger finger and carpal tunnel syndrome, Heberden’s (1773) and Bouhard’s (1866) nodes. Use of Pulley and physiotherapists also has a prominent role in the management of frozen shoulder. The patients with frozen shoulder must be asked to get their blood sugar checked to see if they are diabetic. Pain due to carpal tunnel syndrome can go to the neck. He then talked about Bursa in knee and ankle foot, Achilles, strains like plantar or fasciitis and also mentioned about toe deformities. Strains can result due to injury to the ligaments and injury to tendon. He then talked about osteomalacia, osteoporosis, osteoarthritis, RA and said that Vitamin D deficiency is more in Vegetarians and those who have reduced exposure to sun. One should discourage the use of Sun Blocking lotions. Vitamin D and Calcium supplements are very beneficial.
Osteoporosis, he said, results in frequent fractures of bone. It is more common in women above fifty years of age. Hip fractures are one third due to osteoporosis and one third of these patients usually die within one year of diagnosis. Make sure that you give enough Calcium and Vitamin D supplements and use of biphosphonates are also very helpful and useful in these patients. Osteoarthritis management consists of life style modifications, conservative and surgical procedures. The aim of treatment, Dr. Intikhab opined should be decrease in pain and improvement of functions. Physiotherapy and Hydrotherapy are quite useful. RA is more common in women between 30-40 years of age and morning stiffness lasts more than thirty minutes. ESR will be raised in these patients. He then talked about post fracture rehabilitation i.e. POP care, post POP care, rehabilitation and counseling and emphasized that we must make sure that the treatment does not have any adverse effects. In post surgical management he talked about looking at the stitches, management of fever, taking care of angry wound besides post operative mobilization plan which can be different with different orthopaedic surgeons. The patient should be given advice on weight bearing very carefully so that the full recovery and rehabilitation is achieved without any problem. One should also be extremely careful while ordering investigations. In case of muscle spasm, use muscle relaxants along with pain killers and use drugs in appropriate effective dosage.
Dr. Mohammad Wahajuddin Physiotherapist was the next speaker who talked about Low Back Pain, how to avoid it and how to get better. LBP he said could be due to anatomical issues like Disc, psychosocial issues and medical issues like infection, TB and tumors. Degenerative changes, weakness of muscles and ligaments also results in low back pain. Most disc herniations occur at L5 and S1. There is no correlation between MRI findings and low back pain symptoms. Muscle spasm, back postures can lead to low back pain as such it is extremely important to take complete detailed history from the patient. Ask the patients about their life style and job. Most common low back pain is when one or more muscles forget to relax. Pain can be throbbing, aching, shooting, stalling, dull or sharp. Pain can be down in one leg or both legs or even without pain in the lower back. Patients can also complain of numbness and weakness of legs. They can face sleep problems, have decreased energy, and suffer from depression and anxiety. These can all be symptoms of low back pain. Muscle spasm is the most common source of low back pain, he concluded.

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