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rheumatologist in Delhi

Soft Tissue Rheumatism

What is soft tissue rheumatism?

The good function of the musculoskeletal system depends on the integrity of its components (bones, muscles and tendons, joints, bursae and ligaments). When one of these components does not work well, this is reflected in pain and difficulty in performing the movements. In the case of Soft Part Rheumatism or Extra-articular Rheumatism (outside the joints), these symptoms result from injury or inflammation of the structures around the joints (muscles, ligaments, bursae, enthesis and tendons), resulting in bursitis, tendonitis , enthesitis and myofascial pain. These inflammations are usually temporary and do not cause deformity, but they can become chronic.

Why do these inflammations occur?

Most of the time, the inflammation / injury of these structures occurs due to local trauma. This trauma may occur as a single, violent accident with immediate injury, or it may be the result of chronic trauma resulting from postural or occupational addictions.

What are bursitis?

Bursae are small pockets with liquid inside, which have the function of protecting muscles and tendons from contact with bone and facilitating the sliding between structures. Bursitis (inflammation of the bursae) can occur in different parts of the body, but the most common are on the elbows, knees, shoulders and hips.

What are tendonitis?

The tendons are an extension of the muscles and their function is to connect them to the bones. Like bursitis, tendonitis (inflammation in the tendons) can also occur in several locations, the most common being on the fingers (especially the thumb), shoulders and buttocks.

What are enthesitis?

Encephalons are places where a ligament or muscle is inserted into the bone, and can also suffer inflammation (enthesitis). The most common sites of enthesitis are the elbows (common in tennis players and golfers), knees and feet (popularly known as heel spurs and usually associated with inflammation also of the plantar fascia – better known as plantar fasciitis).

What is myofascial pain?

Another type of soft tissue rheumatism is myofascial pain. It is characterized by localized pain in any muscle in the body that radiates with local palpation. This condition is usually associated with vicious postures and trauma due to repetitive movements. The most common manifestation is pain in the cervical region above the shoulders.

How can these conditions be diagnosed?

The diagnosis of all these conditions is based on the patient’s history and clinical examination. X-rays exclude bone abnormalities. Tendons, ligaments and bursae are not visible on radiographs, however the use of ultrasound and, more recently, nuclear magnetic resonance have brought a great help in defining the inflamed site and the degree of inflammation of the lesion.

How is the treatment performed?

Treatment is based on rest, anti-inflammatory medication and physical therapy (for stretching and strengthening the muscles of the affected region). Eventually, at discretion of your rheumatologist in Delhi, corticosteroid infiltration can be quite helpful. Surgical intervention in these cases is infrequent.

arthritis specialist in Delhi

Low Back Pain: Causes, Symptoms and Treatment

Low back pain means pain in the lower back. The pain is due to injury to the vertebrae, intervertebral disc, ligament, or muscle in that area. It is estimated that 90% of the population will sometime suffer from an episode of low back pain. It is the most frequent cause of incapacity for work in people under 45 years of age. Low back pain is so frequent due to the erect position of the human being that it makes the spine and especially the lower back support more weight, explains the best rheumatologist in Delhi.



The causes are multiple and can be divided into causes of mechanical origin and inflammatory causes. The causes of mechanical origin are much more frequent and lie in alterations in the mechanics and statics of the structures that form the lumbar spine. Among them, lumbar osteoarthritis (it is the most frequent cause of low back pain), osteoporosis, an atrophic lumbar musculature (weak) or scoliosis (alteration of the normal curvatures of the spine, causing a lateral deviation) stands out first. The causes of inflammatory origin are those due to inflammation of the spine. The most frequent disease is ankylosing spondylitis. Other rare causes are infections and tumors. Factors that aggravate low back pain are excessive sedentary lifestyle, inadequate postures, weight bearing, and obesity, explains the rheumatologist in Delhi.



The most common low back pain is one that worsens when standing for a long time or when prolonged incorrect postures are maintained. When lying in bed the pain usually disappears. If the pain appears at rest or at night, it is probably due to inflammation of the spine. This last type of pain is much less frequent and must always be studied by the rheumatologist in Delhi since it can be a symptom of spondylitis (especially in young men). There is also usually a feeling of stiffness in the back and decreased mobility, especially when bending over.

Low back pain can be acute (lasts less than 6 weeks and responds well to treatment) or chronic (lasts more than 6 weeks and is difficult to treat). If low back pain radiates to the leg below the knee it is called lumbar sciatica or sciatica. Tingling usually occurs and sometimes a feeling of lack of strength in the leg. Sciatica is usually due, in younger people, to a herniated disc (the intervertebral disc shifts and compresses the nearest nerve root), and in older people, spinal osteoarthritis (vertebral impingement and bone formation). new (osteophytes) that compresses the nerve root).



The diagnosis is simple and is established according to the characteristics of the pain and the rheumatological examination. If the pain lasts more than three weeks, an x-ray of the spine is performed. If there are any neurological (sciatic) complications that will require surgical treatment, other complementary tests are performed, such as magnetic resonance imaging or computed tomography (CT).



75% of patients with acute low back pain respond to treatment and improve in less than four weeks. The goals are to relieve pain and restore spinal function for work and daily life. Rest, drugs (pain relievers, anti-inflammatories, muscle relaxants) and physical therapy (local heat, massages) are the mainstays of the treatment of acute low back pain. Chronic low back pain is much more difficult to treat, and requires multidisciplinary treatment by specialized health personnel (back school). Only 10% of patients with acute low back pain develop chronic low back pain.

Once the acute episode has been treated, to avoid relapses (one out of four patients with acute low back pain suffers) it is essential to correct postural habits during sleep, standing, sitting, driving vehicles, work place, in the weight load …

It is important not to remain sitting or standing doing the same activity during prolonged episodes. You have to change your posture and activity frequently.

It is essential to perform regular stretching and strengthening exercises for the abdominal and back muscles, as well as performing regular trunk and hip flexibility exercises. And an ideal weight must be achieved and maintained, suggests the rheumatologist in Delhi.


arthritis specialist in Delhi


With age, various changes naturally occur in our body. We have more wrinkles, grey hair appears. All of these are external changes. However, many of us are not aware that ageing also affects our skeletal system. Our bones and joints also change with age. Here we talk about what happens to our skeletal system, and what needs to be done to maintain the health of our bones and joints.


Throughout life, our bones are constantly changing. The body naturally gets rid of the “aged” bone tissue and replaces it with a new one. While we are young, bone tissue is replaced much faster than lost. Therefore, bones at a young age are much denser and stronger. Peak bone mass in most people is about 30 years old.

When the bone mass reaches its peak value for some time, approximately as much new bone tissue is formed in the body as it is lost, however, after about 40 years, bone formation processes begin to lag behind. Bones as a result of this become thinner and weaker, gradually increasing the risk of osteoporosis.

Osteoporosis is a disease characterized by progressive bone loss. Osteoporotic bones are structurally different from normal. In women after menopause, bone loss accelerates.


Our joints are also living and active structures that change with age. The decrease in water content, as well as natural wear and tear, gradually leads to the destruction of articular cartilage – one of the most important components necessary for the normal functioning of the joint.

The articular cartilage covers the articular surfaces of the bones and ensures their free sliding relative to each other, absorbing some of the loads on the joint. A disease characterized by wear of the articular cartilage is called osteoarthrosis.

Some problems associated with age-related changes in the joints can be avoided. One of the problems that often accompany ageing, but which is not its natural component, is low physical activity. As we get older, we move less. It must be understood that the less we move, the less mobile our joints become. Along with joints, muscles also suffer – they become weaker. People leading an active lifestyle despite old age have healthier bones and joints.


Everyone is ageing, but there are many things you can do to keep your bones and joints in good condition, delaying the appearance of problems or even preventing them. Try these tips:

  • Ask your rheumatologist in Delhi what medications may affect your bones. There are many drugs that enhance bone loss, such as long-term use of anticonvulsants, some drugs used to treat cancer, anti-inflammatory drugs from the corticosteroid group used to treat arthritis and many other diseases, such as bronchial asthma, Crohn’s disease, lupus.
  • Exercise regularly. Physical activity not only allows you to maintain the mobility of your joints, it minimizes bone loss, and also supports muscle tone and strength, thereby helping to prevent falls.
  • Eat enough calcium and vitamin D with food. These nutritional supplements are essential for normal bone function. The doctor will tell you how many they need. If you are not sure that you are getting enough of them with food, ask your arthritis specialist in Delhi to give them to you.
  • Maintain a healthy weight. Being overweight is a cause of joint overload and leads to accelerated wear of bones and joints, increasing the risk of osteoarthritis.

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.