Ask the Doctors December 2012 Issue

Ask The Doctors: December 2012

Arthritis and Lungs...Hip Bursitis...Dehydration and Gout...OA Progression

Q. Is there such a thing as arthritis of the lungs? If so, what are its symptoms and how is it treated?

A. Although we usually think of arthritis as affecting the joints, rheumatoid arthritis can affect the lungs (rheumatoid lung disease) as well. It can cause inflammation of the lining of the lungs, which causes pain when breathing (pleurisy). Fluid may accumulate around the lungs and cause shortness of breath. Small lumps (rheumatoid nodules) also may form in the lungs. These are most frequent in patients who have nodules on other parts of the body, such as under the skin. Scarring of the connective tissue, which supports the air sacs of the lungs, may also cause shortness of breath.

The primary symptoms of rheumatoid lung disease are coughing, shortness of breath, chest pain, and fever. Chest X-rays or CT scans may be sufficient for diagnosis, but other tests, such as echocardiogram or bronchoscopy, may be necessary. Sometimes a crackling sound in the lungs can be heard with a stethoscope. Corticosteroids may be helpful to reduce inflammation and, of course, to treat the underlying cause, rheumatoid arthritis.

Q. I have chronic bursitis in both of my hips. Is there anything I can do to relieve the pain besides electrotherapy or having to go through injections every three months? Can exercise or diet help?

A. Patients with hip (trochanteric) bursitis can often benefit by weight reduction, stretching exercises, and proper footwear for exercising. Generally, patients should avoid hills and stairs, and direct pressure on the affected hip while symptoms are present. It is important to identify the activities that cause or aggravate the problem and to make modifications accordingly.

Regularly applying ice or heat to the hip can produce relief. Try icing the area for 15 to 20 minutes two to three times a day. After the acute pain has diminished, the application of heat may be helpful. Experiment with applications of ice and heat to determine which is more effective.

A. physical therapist can demonstrate pelvic tilt exercises as well as strengthening and stretching exercises for the leg muscles, and physical therapy treatments such as ultrasound and deep massage may also be beneficial. Over-the-counter topical ďheatingĒ creams designed to relieve muscle and joint aches may provide short-term relief.

Q. Iíve suffered from gout for several years and am taking colchicine to control it. I donít drink a lot of water because I have congestive heart failure and am on diuretics. Does my lack of water intake contribute to my gout flare-ups?

A. Yes, dehydration may cause gout attacks. Most diuretics increase serum uric acid and the likelihood of gout attacks. Alcohol can also cause gout flare-ups, and minimal use is therefore recommended. If your attacks are still occurring while on colchicine and your uric acid levels are high, allopurinol is usually prescribed. It can lower your uric acid levels and, after approximately three to six months, is usually effective in preventing further attacks.

Q. Iíve suffered from osteoarthritis in my knees for several years. Recently I was diagnosed with OA in my wrists and hands. Can it spread?

A. As a disease, osteoarthritis is not known to spread. A significant number of patients have what is referred to as generalized osteoarthritis, which affects three or more joints. Common sites are the hands, base of the thumb, spine, hips, and knees. It is believed that patients who experience stiffness or pain in these areas have a defect in their bodyís cartilage that causes widespread damage. To date, no therapy has been developed that can prevent the progression of osteoarthritis.††