Indian Write-Ups

Introduction

Arthritis and other rheumatic conditions are among the most prevalent diseases in the United States and the most frequent cause of disability1,2. In 1985 an estimated 35 million people were affected by arthritis3. In 1990,1 a study using a broader arthritis definition estimated that 38 million were affected. Findings also support earlier projections that by 2020, 60 million persons may be affected by arthritis and that the activities of 11.6 million may be limited by arthritis.1 Despite being listed among the most common of diseases in India, rheumatoid arthritis is poorly understood resulting in poor diagnosis.

Low back pain is felt in the low lumbar, lumbosacral or sacroiliac region that is often accompanied by sciatica, pain radiating down one or both buttocks and / or legs in the distribution of the sciatic nerve.

Low back pain may be related to acute ligamentous (sprain) or muscular (strain) problems, which tend to be self-limited, or to more chronic fibromuscular, osteoarthritic, or ankylosing spondylitic processes of the lumbosacral area. The prevalence of these conditions tends to increase with age, reaching 50% in person > 60 years. However, any type of back pain may be influenced by psychosocial problems and conflicts; these factors regularly alter the patient’s perception, behavior and reporting of structurally mediated pain, as well as the resultant degree of dysfunction, disability and response to therapy.

Diagnosis of arthritis

Arthritis is not one disease; the International League against rheumatism has recognized over a hundred types of arthritis. Hence, differential diagnosis is critical to the choice and outcome of treatment. However, with the advance in immunology many series of facilities for investigating arthritis is now available.

Laboratory investigations for arthritis

Step 4

Investigations for Collagen muscular disorder, add:

• Anti DNA antibody
• Immunoglobulin profile
• CPK
• Australia Antigen
• Special organ test; ECG, liver function
• Imaging modalities
• ANCA
• ACA

STEP 3

If Collagen Vascular Disease is suspected, add:

• ANF with titre
• Urine examination
• S. Creatinine, BUN
• If SSA is suspected, add:
• HLA B27
• Imaging modalities as required

STEP 2

If Rheumatic fever is suspected, add;

• ASO titre serial
• If Gout is suspected, add:
• 24-hour urinary uric acid
• Crystal demonstration synovial fluid

STEP 1

• RA test with titre
• Serum uric acid
• VDRL
• X-Rays as required conventional

Conventional

• ESR, WBC
• Blood sugar
• RA test
• ANF