Ask The Doctors: January 2012
Blood-Vessel Growth...RA and Periodontal Disease...Healing Torn Knee Ligaments
Q. Iíve heard that excessive growth in blood vessels can contribute to joint damage associated with rheumatoid arthritis. IĎve also been told that studies are underway to develop drugs that control blood-vessel growth. Whatís the latest on this?
A. Angiogenesis, the medical term for blood-vessel growth, is only one step in a complex disease process that results in joint damage. The real culprit in joint destruction is the synovial membrane, which produces chemical substances called cytokines that activate bone resorption, or bone loss.†
Angiogenesis allows the cytokine-producing synovial membrane to proliferate. The control of angiogenesis is an active area of research for both rheumatoid arthritis (RA) and some cancers. Currently, no medications on the market can control this process.
Q. After suffering from rheumatoid arthritis for several years, Iíve now developed periodontal disease. Both, Iím told, are caused by a disruption of the inflammatory response. Can one cause the other?
A. Rheumatoid arthritis (RA) does not cause periodontal disease, nor does periodontal disease cause RA. Some people with RA, however, do develop dental problems.
SjŲgrenís Syndrome, an autoimmune disease in which white blood cells attack the bodyís moisture-producing glands, occasionally occurs in patients with RA. This condition causes dryness of the eyes and mouth, which can lead to dental problems and periodontal disease.†
Q. What do I have to do to help heal a torn knee ligament? Iíve had cortisone injections and fluid drained. Do you recommend a brace?
A. The two most common knee ligament tears are to the medial collateral ligament (MCL) and the anterior cruciate ligament (ACL), and treatment differs with each.
The MCL is located on the inside of the knee. It heals well by itself and rarely requires surgery. The goals of treatment are early mobilization and early function. These goals are achieved by weight bearing and a structured physical therapy program, including range-of-motion and strengthening exercises. The patient usually uses a double upright knee brace for a six-week period. If returning to strenuous activity, such as sports, the patient will continue to use a brace for two to three months to protect the healing ligament. The results are generally good.
ACL tears, on the other hand are more problematic. The ACL heals poorly and usually does not heal even with bracing. The treatment depends on the expectations and the lifestyle of the patient. If movements are confined to the activities of daily living, 85 percent of patients will do well without repair. Only 15 percent of patients with ACL injuries will require surgical repair. If the patient is active in sports (running, jumping, twisting) or has an occupation that requires strenuous activity, 85 percent will have ACL symptoms serious enough to be considered for surgery.
If nonsurgical treatment is chosen for an ACL tear, the type of treatment will largely depend on your symptoms. Bracing is not required, and weight bearing can be done as soon as the patient is comfortable. Aspiration of the blood within the knee is done only if it becomes uncomfortable. Cortisone injections have no place in the treatment of ACL injuries.