Ask the Doctors August 2005 Issue

Ask Dr. Marks: 08/05

The pain and swelling in my hands, which comes and goes, was recently diagnosed as palindromic rheumatism. What is it, and how can I treat it?

Far less common than rheumatoid arthritis, palindromic rheumatism consists of intermittent, brief episodes of arthritis due to soft-tissue inflammation. Between attacks, which last less than 48 hours, the patient experiences neither pain nor disability. About one-third of patients with palindromic rheumatism will develop rheumatoid arthritis. Although no conclusive trials have been conducted on the disease, it is generally treated with the same medications (methotrexate, sulfasalazine, penicillamine, plaquenil) used to treat rheumatoid arthritis.

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After being diagnosed with osteoporosis six years ago, my doctor put me put on Fosamax. Recently, I was diagnosed with osteoarthritis in my knees. If Fosamax helps bones, can it also help rebuild the bones in my knees?

Fosamax (alendronate) is a medication designed to reverse the structural deterioration of bone. Your knee pain is not primarily a bone problem. Rather, it is due to the deterioration of cartilage, the lining over the bones that helps the bone glide smoothly and painlessly—until it is lost. The end result of osteoporosis is fracture. The end result of osteoarthritis is joint failure, in which case joint replacement is the recommended treatment.

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With heels flat, back and knees straight, flex forward until tension is felt in calf muscle. Hold for 10 seconds. Do not bounce.

I have RA and have developed a soreness in my heel that has been diagnosed as Achilles tendinitis. How can I treat it?

Achilles tendinitis is an inflammation of the Achilles tendon that causes pain on the back of the heel. The most important part of treatment is a physical therapy program that concentrates on stretching the Achilles tendon. To get an effective stretch, you should feel a pulling sensation in your calf. Using a wall as support (right), complete a series of 10 stretches three times per day.

During the first two weeks of stretching, the pain may get worse, then it will slowly get better. It can take six weeks to see a reduction in the pain with stretching.

In addition to stretching, you may find a heel cup in your shoe helpful —it can elevate your heel and reduce the tension on the Achilles tendon. Anti-inflammatory medication (Motrin, aspirin, Aleve) can also help lessen the pain and allow more aggressive stretching. If you don’t see improvement after six weeks of stretching, you might try a night splint, which keeps your Achilles tendon stretched through the night. In very painful cases, you can try a cast or walking boot. Only after three to six months of trying these treatments should you consider surgery.