Ask the Doctors November 2006 Issue

Ask The Doctors: (11/06)

I have osteoarthritis in my hands, knees,and feet. I’ve been going to my family doctor, but friends have told me that a general practitioner may not be up to date and I should be seeing a rheumatologist. What’s your opinion?

For most patients with osteoarthritis, treatmentby a family doctor is perfectly acceptable. Mostfamily doctors use the standard medications forOA, as do rheumatologists. A rheumatologist ismore likely to be able to inject all the necessaryareas since he or she does this frequently. A goodfamily doctor can usually prescribe or administermost of the treatments that are needed to addressOA pain.

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My doctor recently told me that I have “rheumatoid factor.” Does that mean I have rheumatoid arthritis?

Having rheumatoid factor in the blood does not mean you have RA. Other conditions can indicate the presence of rheumatoid factor, including many chronic conditions—such as lung and liver disease—and infections.

If you have the clinical features of RA (inflammation in the small joints of the hands, morning stiffness) and test positive for rheumatoid factor, there is a higher likelihood of your having RA.

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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?

Patients with hip (trochanteric) bursitis can often benefit by weight reduction, stretching exercises, and proper footwear for exercise activities. 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 resolved, the application of heat may be helpful. Experiment with applications of ice and heat to determine which is more effective for you. 

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 “heating” creams designed to relieve muscle and joint aches may provide some short-term relief.

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I was recently diagnosed with episcleritis, a redness on the white of the eye near the cornea. I’m told it’s related to my rheumatoid arthritis. Are there any other eye conditions that can result from RA? How do you treat them?

Episcleritis is characterized by the abrupt onset of mild inflammation of the episclera of the eye. The disorder is not a threat to vision, is frequently not associated with systemic disease, and normally responds to topical therapy.

By comparison, scleritis, an inflammatory process involving the sclera of the eye, is a chronic, painful, destructive, and potentially blinding disorder. It is frequently associated with systemic disease (a disease, including RA, that involves several organs or the entire body) and requires the administration of systemic therapy to control the underlying inflammation.

Milder forms of scleritis are sometimes difficult to distinguish from episcleritis.