Monthly Archives: April 2020

Mutilated Psoriatic Arthritis

Mutilated arthritis is a rare and severe form of arthritis that affects the hands and feet. It is most common in people with psoriatic arthritis, but can also develop in those with rheumatoid arthritis.

Mutilated psoriatic arthritis is very rare. About 5% of people with psoriatic arthritis (PsA) develop this condition. Mutilated arthritis can cause loss of bone mass, also called osteolysis, which leads to changes in the shape of the fingers or toes and can affect a person’s mobility. It can also cause a sore throat or back pain.

PsA mutilation can lead to permanent damage to the fingers, hands, and feet. However, studies have shown that early diagnosis and Psoriatic Arthritis Treatment in Delhi can prevent the progression of joint damage to the stage of mutilating arthritis.

Symptoms of mutilating psoriatic arthritis

Mutilating PsA occurs by worsening PsA, resulting in inflammation attacking bone tissue and destroying it. The body then reabsorbs the bone. When someone develops mutilating PsA, they experience the following symptoms:

– the fingers or toes are shortened and coupled together, which is called telescoping.
– The skin gathers over the shortened fingers.
– the mobility of the joints of the hands and feet is reduced.
– bone fusion also called ankylosis.
– other anatomical abnormalities of the fingers.

Patients with mutilating PsA also have other symptoms of PsA and psoriasis:

– joint pain or tremor.
– stiffness or swelling of the joints.
– fatigue.
– separating the nails from the finger.
– red spots on the skin with silver “scales”.
– tenderness, pain, and swelling of the tendons that connect the muscles to the bones.
– uveitis, which can cause redness and pain in the eyes as well as blurred vision.

Causes of mutilating psoriatic arthritis

Mutilated PsA occurs by aggravating PsA and interferes with normal bone growth and regeneration. PsA and psoriasis are autoimmune diseases in which the immune system attacks healthy cells in the body.

At PsA, the immune system attacks healthy joints and leads to inflammation, pain, swelling, and other symptoms.

In psoriasis, the immune system causes the epithelial cells to renew too quickly, leading to rashes that cover the skin with silver scales, which exfoliate.

The exact cause of the excessive immune response is not clear, but it could have a genetic component. Researchers have identified several genes that increase the risk of exposure to psoriasis and PsA.

About 40% of PsA patients have a family member suffering from psoriasis or arthritis.

However, we cannot limit ourselves to hereditary causes. Experts believe that certain environmental factors, such as injuries or infections, could also affect a person’s chances of contracting psoriasis.

Risk factors

Patients with PsA or psoriasis are at risk of developing mutilating PsA. However, most people with these conditions will not reach mutilating PsA.

The authors of a case study say that with today’s effective treatments for PsA, mutilating PsA has become extremely rare. Many of the cases reported in the medical literature show that mutilating PsA often develops when a person with PsA has not received proper treatment for several years.

One possible conclusion is that even if a person has PsA, the risk of mutilating PsA is low when effective medications are given to control inflammation.

Experts are not sure why PsA occurs in some people and not in others. One study found that both obesity and severe psoriasis symptoms increase a person’s risk of having PsA. However, studies have not correlated these factors with a person’s risk of developing mutilating PsA.

Diagnosis of mutilating psoriatic arthritis

The best rheumatologist in Delhi may identify mutilating arthritis during a body check, noticing the distinct changes in the fingers. However, other tests may be needed to determine if PsA or rheumatoid arthritis (RA) has led to mutilating arthritis. These analyzes may include:


Any x-ray can show damage or reabsorption of bones and joints. Doctors may notice a “pencil in the glass” formation of the joints. One part of the joint or one end of the bone resembles the sharp tip of a pencil, while the adjacent bone has a flat, glass-like appearance.

The blood test

Although arthritis doctor in Delhi cannot use blood tests to diagnose PsA, they can help diagnose RA. Patients with RA usually have a specific antibody in their blood. In addition, patients with PsA may have higher levels of inflammation in their blood.


An MRI can provide a more detailed look at the joints.

Skin examination

The symptoms of psoriasis can be an indication. In this case, look for distinct red eruptions with silver scales.

Natural treatments and remedies

There is no specific treatment for mutilating PsA per se, but effective PsA treatments can stimulate or stop joint damage and bone loss. Such treatments include:

– non-steroidal anti-inflammatory drugs.
– Non-steroidal anti-inflammatory drugs may relieve pain, but are not as effective as a treatment in itself for mutilating PsA.
– disease-modifying antirheumatic drugs (DMARD).
– DMARD helps control PsA by reducing the body’s hyperactive immune response. DMARDs are also effective in controlling the inflammation caused by PsA and in stopping its worsening.

Organic products

Biological products stop certain proteins or cells from attracting an immune response. They are given as an injection or by intravenous infusion.

New oral treatments

These pills target small molecules in immune cells to stop the mutilating PsA inflammation.

Physical therapy

Aggressive physiotherapy can help some people with mutilated PsA keep their joints mobile. Joint movement can help relieve inflammation resulting from mutilating PsA.

Turmeric (turmeric)

Turmeric has strong anti-inflammatory properties and could help prevent or reduce PsA eruptions.

There is insufficient evidence to suggest that turmeric alone can treat mutilating PsA or PsA. However, the authors of a systematic report and meta-analysis concluded that it could complement drugs and other clinical treatments.

It is important to talk to a rheumatologist in Delhi before taking supplements and other remedies, as they may interfere with some medications and may have side effects.

Physical exercises

Physical activity offers several benefits to people with PsA. This can help maintain joint flexibility, stimulate mood, and improve overall mental well-being.

Exercise can help with weight loss, which reduces stress on the joints and the risk of type 2 diabetes, most likely to affect people with psoriasis.

How can mutilating PsA be controlled

Because mutilating PsA can cause loss of function in the affected joints, it can interfere with the patient’s quality of life. People who have digital abnormalities from mutilating PsA may have difficulty performing daily tasks.

Some of the following measures can help a person with mutilated PsA cope with the symptoms:

– consult an arthritis doctor in Delhi regularly to guarantee the functioning of the treatment and prevent the aggravation of the disease.
– discussing all health issues with a doctor. Pain may be a symptom of PsA, but studies suggest that the disease could also cause depression, anxiety, and other mental disorders. Tell arthritis specialist in Delhi if mutilating PsA affects your well-being in any way.
– finding a support group. Talking about PsA and mutilating arthritis with others who understand the situation can help emotional health. These support groups are available both online and locally and nationally for PsA patients.
– ask for help. If possible, seek the help of friends, neighbors, or family members for difficult things. Patients with mutilating PsA could benefit from private health care or a nurse if they are unable to perform personal or household tasks.


Experts have not identified a clear way to prevent mutilating PsA, but taking PsA medications and keeping inflammation under control can help prevent or at least slow its progress.

Many can reach remission through today’s drug treatment. Remission means that the condition is not active in the body and does not get worse, which can help reduce the risk of the individual developing mutilating PsA or joint damage from PsA.

Even after remission, however, a person will need to continue taking PsA treatment to prevent the disease from returning.

Gout, a disease associated with excessive meat consumption

Gout is a common and complex form of arthritis that causes intense pain, inflammation, and stiffness in the joints. In many cases, the disease affects the big toe (toes).

Episodes of the disease can occur quickly and return periodically, slowly damaging the tissues in the inflamed region.

In addition, gout has been linked to an increased incidence of cardiovascular and metabolic diseases. It is the most common form of inflammatory arthritis in men, but women can also be affected, especially after the onset of menopause.

Causes and risk factors

Normally, uric acid is dissolved in the blood and is excreted in the body through urine. If too much uric acid is produced or it is not eliminated properly, urate can form which can build up in the joints producing the clinical picture of gout.

Excess uric acid in the blood is called hyperuricemia and can be the result of eating foods rich in this substance, such as red meat and seafood.

The factors that increase the risk of developing gout are the following:

– Diet – consumption of meat, seafood, and drinks sweetened with fructose increase the chances of developing gout. It should be noted that alcoholic beverages, especially beer, can increase uric blood levels;

– Obesity – obese or overweight people should know that their body produces more uric acid, and the kidneys do not cope with this amount;

– Associated medical conditions – there are so-called diseases that increase the risk of gout, for example, untreated hypertension, diabetes, heart, and kidney disease;

– Certain medications – thiazide diuretics are used to treat high blood pressure. However, they increase the risk of gout. Even low-dose aspirin can have this effect;

– Family history – people with close relatives with gout have a higher risk of developing the disease;

– Age and sex – gout occurs more frequently in men. They are more likely to develop gout between the ages of 30 and 50.

However, after menopause, women’s uric acid levels approach those of men, so the risk becomes equal for both sexes;

– Lead exposure – chronic lead exposure has been associated with some cases of gout;

– Surgery or recent trauma – these changes in the body’s balance have been associated with an increased risk of a gout attack.

Clinical picture

Gout usually becomes symptomatic during the night, suddenly and without warning. The main symptoms are:

– Extremely severe joint pain – frequently affects the toe joint, but also the ankles, knees, elbows, and wrists. Any joint can be affected.

The pain is most severe in the first 4-12 hours, later reducing its intensity;

– Discomfort – after the pain disappears, the unpleasant sensations can persist for even a few weeks. It is possible that new painful episodes will occur, with longer durations and affecting a greater number of joints;

– Reduction of movement – as gout progresses, it is possible to have difficulties in the normal movement of the joints.

In severe cases, gout can lead to various complications, including kidney stones. Uric acid crystals can build up in the urinary tract causing this condition. Also, in advanced cases, gout can lead to the formation of gouty tufts.

They appear on the fingers, hands, feet, elbows, or ankles. Gouty tufts are usually not painful but can become inflamed during gout attacks.


There are different stages through which gout progresses. These stages correspond to different types of gout and are represented by:

– Asymptomatic hyperuricemia – uric acid levels may be high, but no manifestations. At this stage, treatment is not necessary, although the crystals formed are stored in the tissues. People at this stage should avoid factors that contribute to the accumulation of uric acid;

– Acute gout – this stage occurs when uric acid crystals cause acute inflammation and intense pain. It normally disappears within 3 to 10 days. Attacks of this type can be triggered by stressful events, alcohol and drug use or even cold weather;

– Intercritical period – this period is asymptomatic and is located between two acute gout attacks. During this period, uric acid crystals are still stored in the tissues;

– Chronic gout to face – is the most serious form of gout and causes permanent damage to the joints and kidneys. At this stage, gouty tufts develop ie large accumulations of uric acid crystals.

It should be noted that it takes about 10 years to reach this stage. Gout treatment in Delhi offered from an early stage can stop the progression of the disease to this stage.

A condition easily confused with gout is chondrocalcinosis. It is also called pseudogout, and the symptoms are very similar. The major difference between these two conditions is the substances accumulated in the joints.

In the case of pseudogout, it is calcium phosphate, and in the case of gout uric acid crystals. Also, pseudogout requires a different treatment than gout.


Gout is a condition that can be difficult to diagnose. Its symptoms may be similar to those of other diseases, and hyperuricemia is not always present. In addition, not all people with hyperuricemia develop gout, which is why blood tests are misleading.

Synovial fluid analysis is one of the most important investigations made to diagnose gout because it can highlight the presence of uric acid crystals in this fluid.

Because infections can cause gout-like symptoms, rheumatologist in Delhi also check for bacteria in your synovial fluid.

X-rays cannot detect gout but can be used to rule out other causes of joint inflammation. However, CT scans can help detect the presence of uric acid in the joints, even when symptoms are not present.

Computed tomography is not commonly used in clinical practice because it involves expense and irradiation. For this reason, ultrasound is used more often. And this method can detect uric acid crystals in the joints or tufts.


Gout treatment in Delhi involves the administration of drugs. These are prescribed by the arthritis doctor in Delhi based on the patient’s health and help treat current symptoms and prevent future attacks. In addition, medications can reduce the risk of complications, such as gout.

To stop an acute gout attack, your arthritis specialist in Delhi may prescribe a higher dose of medication, and reduce the dose to be taken daily.

Non- steroidal anti-inflammatory drugs are frequently recommended. To reduce the pain caused by gout, colchicine may be prescribed. Its effectiveness is very good, but it also has side effects, such as nausea, vomiting, and diarrhea.

Corticosteroid medications can control inflammation and pain and can be given orally or injected into the joint.

However, these drugs are only given to people who cannot take either non-steroidal anti-inflammatory drugs or colchicine. Side effects of corticosteroids may include mood swings, high blood sugar, and high blood pressure.

To prevent complications, your joint pain specialist in Delhi may recommend the following medications:

– Xanthine oxidase inhibitors – have the effect of limiting the production of uric acid, so that its blood level decreases and the risks are reduced.

– Uricosuric drugs – have the effect of improving the ability of the kidneys to eliminate uric acid from the body, reducing the chances of gout. However, the level of uric acid in the urine becomes increased.

Lifestyle and diet can be changed to reduce the chances of gout. Thus, best rheumatologist in Delhi recommends that alcohol be avoided and water be consumed in quantities of about 2-3 liters per day.

Also, bodyweight should be kept within normal limits, and foods high in purines should be avoided. Some of these forbidden foods are: asparagus, brain, red meat, dried beans, peas, mushrooms, liver, and seafood.

Stages of Knee Osteoarthritis

Osteoarthritis (OA) is divided into five stages. Stage 0 corresponds to a normal and healthy knee, while stages 1-4 are pathological, the last stage is severe osteoarthritis. At this advanced stage, osteoarthritis can cause significant pain and disrupt normal movements.

Step 0

Stage 0 is classified as “normal” knee health. The knee joint shows no signs of osteoarthritis, the mobility of the joint is not affected and there is no pain. In stage 0 of osteoarthritis, no treatment is needed.

Stage 1

Stage 1 of osteoarthritis is characterized by the appearance of very small bone growths (bony spurs). These bone growths are bone growths that often develop when the bones meet in the joint.

At this stage of osteoarthritis, there is no pain or discomfort in the knee joint due to very little wear of the joint components.


It is not mandatory to follow a treatment because there are no external symptoms.

However, if a patient is prone to osteoarthritis or is at increased risk of developing this disease, rheumatologist in Delhi recommends treatment with supplements such as glucosamine or chondroitin, or starting routine exercises to prevent minor symptoms of osteoarthritis or to slow the progression of arthritis.

Stage 2

Stage 2 of osteoarthritis is considered the “mild” stage of this condition. At this stage, an x-ray of the knee will reveal a more pronounced growth of the bone, but the cartilage is usually still at a normal, healthy size. In this case, the space between the bones is normal and the bones do not rub against each other.

Synovial fluid is also present in sufficient amounts to ensure normal joint movement. Synovial fluid is a clear, sticky fluid that lubricates the joint, reducing friction and improving joint mobility.

However, at this stage the symptoms characteristic of osteoarthritis may occur:

– pain (after a long day of walking or running);

– greater stiffness in the joint (when it is not used for several hours);

– sensitivity (when the patient kneels or bends the knee).


At this early stage, the best rheumatologist in Delhi will detect and diagnose the condition of the patient’s knee and the level of development of OA, but for a correct diagnosis, the doctor must know very well the signs and symptoms present in the patient.

There are several therapies that can help relieve the pain and discomfort caused by this mild stage of osteoarthritis. In general, these therapies are non-pharmacological, which means that no medication is needed to relieve the pain.

Aerobic exercise and resistance training can help strengthen the muscles around the joint, which increases stability and decreases the likelihood of further joint damage.

The joint must be protected from exertion by avoiding kneeling, squatting or jumping. Knee pads can help stabilize the knee. Shoe soles can help adjust the foot and reduce pressure on the joint.

Some patients may request medication for mild pain relief. These are commonly used in conjunction with non-pharmacological therapies.

For example, the administration of non-steroidal anti-inflammatory drugs is very well associated with exercise, weight loss, and protection of the knee from stress.

Long-term treatment with nonsteroidal anti-inflammatory drugs can cause other problems, can cause stomach ulcers, cardiovascular problems, or kidney and liver damage.

Stage 3

Stage 3 is classified as a “moderate” stage of osteoarthritis. At this stage, the cartilage between the bones shows obvious damage, and the space between the bones begins to narrow.

Patients with stage 3 OA are likely to have frequent pain when walking, running, bending, and kneeling.

They may also have joint stiffness after sitting for long periods of time or in the morning, and after long periods of movement, swelling of the joints may occur.


If non-pharmacological therapies do not work and do not relieve pain and discomfort, cortisone injections are recommended.

Cortisone, a steroid produced naturally by the human body, has the effect of relieving the pain caused by osteoarthritis when injected near the affected joint.

The effects of an injected dose of cortisone disappear in about 2 months. However, it is recommended that the administration of cortisone doses be closely monitored by an arthritis specialist in Delhi.

Studies have shown that long-term use of the steroid can even worsen the joint damage.

If nonsteroidal anti-inflammatory drugs are no longer effective, medications, such as codeine and oxycodone, can help relieve the intense stage 3 pain of osteoarthritis. In the short term, these medications can be used to treat moderate to severe pain.

Narcotic drugs are not recommended for long-term use due to the risk of increased tolerance and possible dependence.

People who do not respond to conservative treatments for physiotherapy of osteoarthritis, weight loss, administration of nonsteroidal anti-inflammatory drugs or analgesics, may resort to infiltrations with hyaluronic acid in the knee. Hyaluronic acid is a natural component of synovial fluid.

The technique involves injecting synthetic hyaluronic acid preparations directly into the knee joint, which tend to replace the joint fluid. This osteoarthritis treatment in Delhi requires 1 to 5 injections of hyaluronic acid per week.

The effect of these injections is not immediate, it takes a few weeks for the full effect to be fully felt by the patient, and the effect usually lasts for several months. Not all patients respond to this treatment.

Step 4

This stage is considered a severe stage of osteoarthritis. Patients with stage 4 OA experience intense pain and discomfort when walking or moving the joint.

At this stage the joint space between the bones is dramatically reduced, the cartilage is almost completely damaged, and the joint becomes rigid and almost immobile. Synovial fluid drops dramatically and no longer helps reduce friction.


An osteotomy is an option for patients with severe osteoarthritis. This is the surgical sectioning of a bone in order to change its axis, size, or shape performed by orthopaedic surgeon in Delhi. This surgery is often effective in younger patients.

Arthroplasty is the last option for patients with stage 4 OA. This surgery involves removing damaged ligaments and articular cartilage and implanting a prosthesis.