Ask the Doctors March 2004 Issue

Ask Dr. Marks: 03/04

I’ve started to feel a little unsteady on my feet, and have nearly fallen several times in the past month. What could be causing this?

There are many causes for feeling unsteady. The two most common are musculoskeletal and neurological conditions. Joint stiffness and muscle weakness secondary to osteoarthritis can cause unsteadiness. When a hip or a knee lacks the range of motion necessary to make the moment-to-moment adjustments required in walking, the sensation is that of an unstable gait. Weakness in the muscles of the lower extremities can lead to buckling of the knee and the fear of falling. Neurogenic problems (brain, spinal cord, peripheral nerves) are common causes of an unsteady gait. Early Parkinson’s disease, peripheral nerve problems or central nervous system conditions, such as brain tumors or multiple sclerosis, may lead to this symptom.

Peripheral nerves can be either sensory or motor. Sensory nerves send information to the brain on touch, pain, or joint position. If peripheral sensory nerves are damaged by disease, the central nervous system lacks the input necessary to make fine adjustments to control posture and gait. When disease attacks a motor peripheral nerve, the result is muscle weakness and unsteadiness. Spinal stenosis may also be perceived as gait unsteadiness.

In the absence of obvious arthritis, gait unsteadiness should be evaluated by a neurologist to rule out serious neurological problems. The prevention of falls includes the treatment of the underlying condition, physical therapy, use of a cane or walker, and occasionally hip pads. In more advanced cases, a physical-medicine specialist should be consulted.

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I suffer from arthritis, a result of a bout with Lyme’s Disease last summer. While recently undergoing chemotherapy for breast cancer, my arthritis symptoms strangely disappeared. After going off chemo, however, my symptoms returned with a vengeance. Is this normal?

Lyme’s Disease is one of the most over-diagnosed of musculoskeletal problems. This infectious condition, which causes acute joint inflammation and pain, is treated with antibiotics, usually doxycycline. In its later stages, it is treated with I.V. antibiotics for a prolonged period. Many chemotherapy agents have a potent anti-inflammatory effect, and because of this they can reduce joint pain. However, if adequately treated with antibiotics, the recurrence of pain due to inflammation should not be as severe as you describe. It is important to be sure that the pain is coming from a joint involved with inflammation caused by Lyme’s Disease and is not due to other causes. An X-ray—and, if necessary, a bone scan—should be obtained to rule out pain caused by your breast cancer.

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What’s the connection between psoriasis and arthritis?

Psoriasis is a chronic recurrent skin condition that is evidenced by distinctive lesions —generally patches of silvery gray scaling. An inflammatory arthritis similar to rheumatoid arthritis develops in approximately 7 percent of patients with psoriasis. In the past, psoriatic arthritis was considered part of the spectrum of rheumatoid arthritis. The two diseases can now be differentiated by radiography as well as by clinical and laboratory data. The treatment—the use of NSAIDs for mild symptoms, progressing to methotrexate and eventually biologicals such as Embril—is identical for both diseases.