Ask the Doctors May 2006 Issue

Ask the Doctors: 05/06

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?

Although first described more than 60 years ago, not much is known about palindromic rheumatism. It is a rare type of inflammatory arthritis that causes recurrent episodes of pain, swelling, warmth, and stiffness of joints. Usually two or three joints are affected, and the symptoms may last hours, days, or weeks before subsiding. Symptom-free periods between attacks can last for weeks to months. In 30-40 percent of patients with palindromic rheumatism, symptoms become more frequent, and rheumatoid arthritis develops; in some patients, the disease seems to diminish with time, and eventually the attacks cease. Treatment is difficult because episodes are transient and unpredictable.† Once symptoms are present, nonsteroidal anti-inflammatory drugs (NSAIDs), intraarticular corticosteroid injections, or oral prednisone may be helpful. Some of the disease-modifying antirheumatic drugs (DMARDs) and colchicine (an anti-inflammatory medication) have been useful to prevent attacks.

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My doctor prescribed allopurinol/purinase for my gout to control uric acid. It helped at first, but the relief doesnít last as long as it did before. My problem, Iím told, is that I take the medication intermittently when I should be taking it on a continuing basis. Do you agree?

Gout is caused by an excess of uric acid in the body, a condition called hyperuricaemia. Allopurinol works by causing the body to produce less uric acid. Allopurinol will not relieve a gout attack that has already started. Also, it does not cure gout, but it can help prevent gout attacks. However, it works only after you have been taking it regularly for a few months. When you stop taking your medication, the level of uric acid increases, which can result in an acute recurrence of your gout.

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I recently had a hip replacement. Iíve read that revision surgery is sometimes necessary. Why, and what symptoms or signs that further surgery is needed should I be aware of?

Hip replacement is one of the most successful orthopaedic surgeries performedómore than 90 percent of people who have hip replacement surgery will never need revision surgery.

Hip replacements wear out very slowly, but the problem does progress over the years. Ten years after a hip replacement, there is a 90 percent chance that the implant will be functioning well; 20 years after surgery, the chances increase to about 80 percent; and by 25-30 years after surgery, about 50 percent of hip replacements will still be working well.

The most common problem with hip replacements is that they begin to loosen over time because of wear of the implant surfaces and weakening of surrounding bone. Loosening of the implant causes pain and difficulty when walking. If you experience these symptoms after your initial recuperation and rehabilitation, let your doctor know. Regular follow-up visits with X-rays will allow your doctor to determine whether the implants are in the proper position. If you follow the recommendations of your doctor and physical therapist, your hip replacement should function well for many years.