My sister is suffering from rheumatoid arthritis or lupus from last 4 years, she is now 35 year old. Last 6 -8 months she is having severe pain in all her joints. Shoulder, knee, wrist, stiffness and severe pain is there, weakness in shoulder and hands. Her recent medication includes. She used to take hydroxychloroquine tablet hcqs 200 mg and prednisolone dispersible tablet 5 mg or sometimes 10 mg. Can you please suggest which kind of doctor is best for the same.

Dr. Julie Mercy J DavidPhysiotherapist24yrs exp

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Treatment goals ?to protect the joint from further damages. ?provide pin relief. ?prevent deformity and disabilities. ?increase functional capacity. ?improve flexibility and strength. ?encourage regular exercise. ?improve general fitness. Physiotherapy modalities - hot/cold applications- electrical stimulation- hydrotherapy and spa therapy rehabilitation treatment technique - rest and splinting - compression gloves - assistive devices and adaptive equipment - massage therapy - therapeutic exercise - patient education assistive devices and adaptive equipment occupational therapy improves functional ability in patients with ra. Occupational therapy interventions such as assistive devices and adaptive equipments have beneficial effects on joint protection and energy conservation in arthritic patients.Assistive devices are used in order to reduce functional deficits, to diminish pain, and to keep patients' independence and self-efficiency. Loading over the hip joint may be reduced by 50% by holding a cane. In fact, most of these instruments are originally designed for patients with neurologic deficits; therefore, certain adaptations may be needed for them to be used in patients with arthritis. Elevated toilet seats, widened gripping handles, arrangements related with bathrooms, etc. Might all facilitate the daily life. The procedures needed to increase compliance of the patient with the environment and to increase functional independence are mainly determined by the occupational therapist. Massage therapy that improves flexibility, enhances a feeling of connection with other treatment modalities, improves general well being, and can help to diminish swelling of inflamed joints. Massage is found to be effective on depression, anxiety, mood, and pain. Therapeutic exercise every joint should be moved in the rom at least once per day in order to prevent contracture. In the case of acutely inflamed joints, isometric exercises provide adequate muscle tone without exacerbation of clinical disease activity. Moderate contractures should be held for 6 seconds and repeated 5?10 times each day. Dynamic exercise therapy in improving joint mobility, muscle strength, aerobic capacity and daily functioning in patients with rheumatoid arthritis (ra). Finally, in chronic stage with inactive arthritis, conditioning exercises such as swimming, walking, and cycling with adequate resting periods are recommended. They increase muscle endurance and aerobic capacity and improve functions of the patient in general, and they also make the patient feel better. Patient education in patients with ra, sociopsychological factors affecting the disease process such as poor social relations, disturbance of communication with the environment, and unhappiness and depression at work are commonly encountered. The treatment of rheumatic diseases should provide education and information to their patients about their condition and the various physical therapy and rehabilitative options that are available to improve their quality of life. Passive treatments for rheumatoid arthritis ?cold therapy reduces circulation, which ultimately decreases swelling. For example, a cold compress may be placed on the painful area. ?cold therapy in acute phase ?dosage 10-20mints/1-2 times a day. ?heat therapy eases muscle tension and gets blood to flow more quickly to the painful area. For example, a moist, warm cloth may be used to promote circulation. ?heat therapy in chronic phase ?dosage 20-30mints/1-2 times a day. ?hydrotherapy involves reducing your ra-related pain and other symptoms with water. With hydrotherapy, you will be submerged in warm water to relieve your symptoms. ?massage can help reduce muscle tension and promote good circulation. It's also a fantastic way to help you manage stress (especially important for people with rheumatoid arthritis). ?transcutaneous electrical nerve stimulation (tens) works by blocking pain signals from getting to your spinal cord. It also helps decrease muscle spasms. ?tens short term pain relief (6 to 18 hrs) ?ultrasound creates warmth using sound waves, which enchanes circulation and decreases joint pain, inflammation, and stiffness. Exercise for acute phase: ?preformed exercise at least once a day. ?general assisted movement through normal range (joint mobilisation). ?isometric-?static movements? helps to maintain muscle tone without increasing inflammation. Exercise for the chronic phase: ?can progress the above exercise to include use of light resistance. ?postural/core stability exercises. ?swimming/walking/cycling to maintain cardiovascular fitness. ?gentle stretch for areas that become tight, such as knees &calves. Regular exercises: ?maintaing muscle strength is important for joint stability & preventing injury. ?muscles can become weak following reduced activity. ?pain signals from yours nerves and swelling can both inhibits muscles. ?muscle length can be affected by prolonged positions immobilization and tightness can limit daily activities. Alternative therapies: ?thi chi. ?musical therapy. ?yoga therapy. ?relaxation techniques. ?pilates. Active treatments for rheumatoid arthritis ?flexibility and strengthening exercises improve your range of motion and help you build muscle strength. Yoga and pilates are flexibility and strengthening exercises. ?low-impact aerobic exercise is gentle but effective at helping you manage rheumatoid arthritis symptoms. Light walking is an example of this type of exercise. Your physical therapist will let you know how often to do these exercises. For example, you may need to do a few specific exercises 3 times a day, or your physical therapist may recommend a routine that incorporates 30 minutes of low-impact aerobic exercise a day and 30 minutes of strengthening exercises every other day. If your pain is more in the proximal joints, ie. In the upper limbs if the pain is present in the fingers/wrist and in the lower limbs it the pain is present in the toes/ ankle, then we shall definitely say it is rheumatic arthritis. Wear elbow brace and wrist brace which will make her to feel warm and that will make the joints become firm. Hot water fermentation will helpknee cap will also help to prevent the damaged cartilagesif your pain is more in the distal joints, ie. In the upper limbs if the pain is present in the fingers/wrist and in the lower limbs it the pain is present in the toes/ ankle, then we shall definitely say it is rheumatic arthritis. If your proximal joints (ie. Shoulder, hip & knee has pain) then you can pour hot (warm) water in that area to reduce the inflammation. If you have pain in the distal joints ie. Wrist, fingers, ankle, toes then you can wear either elbow brace or wrist brace which will help you to feel warm and very protective. And also immerse the distal joints in the hot water tub which will help you to reduce the pain.  

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Dr. PoornanandOrthopedic Doctoryrs exp

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Hi as you know the diagnosis, you need to be seen by rheumatologist. As the medications needs regular reviews because of steroids. Better to keep regular follow ups. Rheumatoid arthritis is life time problem, unfortunately it needs patience and regular checkups. Vitamin d and calcium supplements need to take along with your medications.  

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