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Type 2 diabetic, hypothyroid and osteoarthritis in hip joints. Will knee brace help?

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Practicing since : 1980
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Hi, My mom is 54 years old.. She is type 2 diabetic, dyslipidemic, pre-hypertensive, has hypothyroid, CKD (Stage 2). She also has osteoarthritis on both the hip joints (sacrosiliac), osteoarthritis that was confirmed by orthopedist. She has pain on left knee. Also, pain on ankles on pressing them. 1. Is she having arthritis on knee and ankles? 2. What range of motion confirms arthritis of hip (not able to sit cross-legged?), knee (not able to kneel down - mainly in Vajrasana posture? ), ankles ( ? ) 3. Will wearing knee brace on left knee help the cause? Now, she doesn't have pain on right knee but left. Is she advised to wear brace on right knee to avoid future arthritis on right knee? 4. Does attached X-ray reveal osteoporosis? Please respond to my every query, aptly in DETAIL
Posted Thu, 12 Dec 2013 in Arthritis
Answered by Dr. Rakesh Karanwal 2 hours later
Brief Answer: Your mother has osteoporosis and osteoarthritis Detailed Answer: Hi there, Thanks for your query. Firstly, there are two different skeletal conditions which need to be understood :- (a) Osteoporosis is thinning and consequent weakening of all bones. This process is either age-related or due to deficiency of calcium and Vitamin D. Presence of osteoporosis predisposes to fractures or vertebral collapses. (b) Osteoarthritis (OA) is a degenerative joint disease, that is, due to degeneration of bony ends in the joints. The greater the degeneration, the more would be the disability of that joint, including range of mobility. Hence, there is no specific clinical parameter to classify the degree of osteoarthritis, EXCEPT for the range of mobility. Further, both: the knee and ankle does have osteoarthritis (both of which are weight bearing joints). Other joints, particularly the right knee in your mother's case is bound to develop osteoarthritis at some stage in future. But, wearing knee cap or knee brace IS NOT RECOMMENDED, as it would neither prevent nor delay the onset of OA. On the contrary, we always recommend that mobility of ALL joints (including affected joints) should be encouraged. Knee braces/caps simply reduce the pain and are NOT CURATIVE. Having gone through the X-ray, your mother certainly has osteoporosis along with sacroiliac joints involvement. It may be noted that involvement of both sacroiliac joints, points STRONGLY towards an autoimmune condition called ANKYLOSING SPONDYLOSIS. Investigations such as ESR, CRP, and HLA B27 would confirm this diagnosis, which has an ENTIRELY DIFFERENT treatment. Lastly, in the presence of severe osteoporosis and CKD, deficiency of calcium and Vitamin D is inevitable. Please get her blood Vitamin D level estimation done. I STONGLY RECOMMEND that she be given adequate # calcium + Calcitriol (1 microgram initially to start with) with close monitoring BY monthly estimation of blood calcium, phosphates and Vitamin D levels. The supplements should be given under supervision of her doctor. # Diacerein - in modified doses in view of kidney damage. It may be given under her doctor's supervision, depending on Serum creatinine levels. It will hep in improving osteoarthritis. It is therefore suggested that your consult her treating doctor and apprise him of my opinion. I am certain that he will agree with my opinion/recommendations; order required tests, and- based on the reports- will arrive at a certain diagnosis and prescribe suitable treatment as advised. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Fond regards and have a nice day, Dr. Rakesh Karanwal
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Follow-up: Type 2 diabetic, hypothyroid and osteoarthritis in hip joints. Will knee brace help? 5 hours later
My mom can't sit on vajrasana.. her buttock doesn't touch the heel.. rather knee not bending at all.. Is it due to knee arthritis? She is not able to sit cross-legged: even while on chair.. Why? In Sep '13, we took some lab tests and the results are ESR 32 mm (Women: 05-15) CRP 7.5 MG/l (Adult <5) RA Factor 8.1 IU/ml (<15) Calcium+CA 9.4 mg/dl (8.5-10.5) Creatinine 0.8 mg/dl (Women: 0.6 to 1.1) Uric acid 5.2 mg/dl (Women: 2.6-6.0) Urea 31.5 mg/dl (Women>50: 21-43) What do you infer from this and how severe is the condition? What is the remedy?
Answered by Dr. Rakesh Karanwal 2 hours later
Brief Answer: It's severe arthritis of hip joint sand knee joint Detailed Answer: Hi there, Nice hearing back from you. 1. Her kidneys' function is perfectly normal. 2. ESR & CRP were raised, indicating an acute problem. 3. Other reports are NORMAL. 4. inability to sit on vajrasana, with very limited bending range of her left knee is suggestive of severe osteoarthritis of that knee. 5. Inability to sit cross-legged is primarily due to osteoarthritis of hip joints (joint BETWEEN the thigh bone and pelvis. Involvement of both sacroiliac joints is ENTIRELY DIFFERENT from osteoarthritis of hip joints. Hence, HLA B27 test should be done to confirm/rule out Ankylosing spondylitis, since the treatment for this condition is different from that for osteoarthritis. Lastly, PLEASE ADHERE to the treatment advised earlier by me. Diacerein can be given in full doses, since her kidney functions are normal at present. Calcium, high doses of Vitamin D3 and Diacerein will CERTAINLY reduce her osteoarthritis symptoms. It is therefore advisable that you consult a Rheumatologist and discuss my opinion with him. I am certain that he will agree with me and advise you further course of action best for your mother. I will be happy to answer further clarifications/queries, if any. Fond regards, Dr. Rakesh Karanwal
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Follow-up: Type 2 diabetic, hypothyroid and osteoarthritis in hip joints. Will knee brace help? 35 minutes later
Her Creatinine lvel increased from 0.6 to 0.8 in 2 months time.. Based on creatinine, a renal expert suggested her GFR is low meaning CKD Stage 2 (pre-renal stage).. Also, her uric acid increased with urea too.. which were worrisome count, as I mentioned in my previous message.. Now, she has controlled her salt intake.. drinks nearly 3 lt of water.. would this suffice.. (as uric acid indirectly impacts the joints too) On being so emotional, her left eye closes almost.. It was once in a while a year ago and is very frequent these days: one instance being mobile phone usage..
Answered by Dr. Rakesh Karanwal 2 hours later
Brief Answer: Kidney functions are still within acceptable range Detailed Answer: Hi there, 1. Firstly, kidney disease is due to diabetic complication. It will progress if precautionary measures not taken. Usually, a high protein diet (till creatinine exceeds the upper limit of normal); plenty of water; mild diuretics (urine-forming drugs), such as indapamide or hydrochlorthiazides; and, ACE inhibitors, such as Ramipril OR ARBs, such as, Telmisartan/Olmesartan to delay the progression of kidney damage as well as control of Blood Pressure; restricted salt intake are the standard measures. 2. Normal range of creatinine is upto 1.2mg%. It may vary slightly among laboratories. Most sensitive investigations to assess stage of kidney disease is to measure creatinine clearance in urine and; GFR. 3. Further, uric acid tends to increase with deterioration of kidney functions. Presently, your mother's level is within normal range and does not require any treatment. 4. Closure of the left eye is not related to kidney disease or diabetes; though, under-corrected hypothyroid may lead to eye closure. Other causative condition is Myasthenia gravis, which may sometime co-exist with thyroid problem and diabetes. Consult your doctor and apprise him of this additional problem. He may order additional tests and prescribe appropriate treatment, if the condition warrants. TO SUMMARIZE, Your priorities should be :- * METICULOUS control of diabetes (which will delay the onset of other diabetic complications) * Meticulous control of Hypothyroid. The target of TSH should be between 0.5 - 1.0 The dose of Thyroxin should be titrated to maintain TSH within the desirable levels. * METICULOUS control of Blood Pressure to less than 120/80!!!! * Weight reduction to maintain it around a BMI of 24-25 * PROMPT treatment of infection, whenever it occurs. * Regular supplements of calcium, Vitamin D3 and diacerein (till the kidney function tests are within normal range. Hope I have answered all your queries to your satisfaction. You are welcome to post further queries, if any. Take care, Dr. Rakesh Karanwal
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