Expert Advice Archives

Hi! Auto-immune diseases apparently run in my family. I have been diagnosed
with endometriosis and fibrocystic breasts as well. Very briefly, my symptoms have been around since the late 80's. They first appeared one summer when both of my hands and forearms got very red, hot and swollen. For the rest of the day I felt completely washed out. The minute I got hot or overheated those symptoms cropped up. Now the problem ahs spread to my lower extremities. Now it's winter and my feet are doing exactly what my hands and elbows do; they hurt and ache like the dickens! It's a hot pain, like the muscle is burning. This what-ever-I-have makes my joints ache all the time. My hands, wrists, elbows (on occasion), shoulders, hips, knees,, ankles and feet are affected.

It sounds to me as if you are describing erythromelalgia which is a rare condition characterized by red, hot and painful extremities. It is almost the opposite of Raynaud's phenomenon. In patients with erythromelalgia, the pain is often relieved by cooling and worsened by warming the extremity. Symptoms are often symmetrical and usually involve the lower extremities as well as the upper extremities. Aggravating factors include warm rooms, floors or water, placing the extremity near hear, wearing shoes or gloves, sleeping under the covers. Some patients have no other associated problems - i.e. primary disease whereas others have another illness - secondary including various hematologic, metabolic, connective tissue, malignant or infectious diseases. It is not clear what causes erythromelalgia but a common mechanism may be skin microvascular shunting with corresponding hypoxia. Several case reports describe response to aspirin as well as intravenous treatment with nitroprusside and prostaglandins in severe cases. There is a patient organization, The Erythromelalgia/Erythromalgia association located in Seattle who can supply more information.
I hope this information is helpful to you.
Good luck

-Dr Susan

3/12/01

I am currently taking 17.5mg of methotrexate. Could you tell me what the
recommended top dosage for this drug is? I have been on this dosage for
3 months and have tolerated it well. As my RA progresses I was wondering
if I will be prescribed more or if I am on the top end of the dosage for
this drug? Thanks

Most doctors go up to 9 pills (22.5 mg) and no higher than that. If 6 or 9 pills aren't working well enough we add something else (Enbrel, Remicade, Arava, etc.).

-Dr Waters

3/12/01

I have osteoarthritis. I had surgery on my shoulder to repair the tendens and
scrape the bone spurs after years of lifting.
What is the recovery time after physical therapy ?

6-12 weeks to moderate activity, may be full work at 12 weeks.

The point of Maximum Medical Improvement (MMI) is frequently as much as 24 months ( 2 years) from the time of surgery. Long term exercise of a maintenance program is indicated to prevent future problems.

-Dr. Merriman

3/6/01

I NEED INFO ON A NEW PROCEDURE THAT I HAVE HEARD ABOUT ON TV TO INJECT A SUBSTANCE INTO THE KNEE JOINT TO REPLACE CARTILAGE (90 YEAR OLD FATHER WITH NO CARTILAGE LEFT AND DISABLING PAIN)....WHAT IS THE PROCEDURE CALLED? IS IT AVAILABLE BEYOND THE EXPERIMENTAL STAGE? IS IT ONE INJECTION OR MULTIPLE? DO INSURANCE COMPANIES COVER IT? DOES MEDICARE COVER IT?..... THANKS FOR YOUR HELP.

There is no such procedure to inject a knee and get new cartilage, at least not yet
There are some things that can help in some situations:
1) hyaluronic acid injections -FDA ok'd in us for the knee used long term elsewhere and in veternary for years seems to help but does not reverse disease
It is a symptomatic treatment in about the same league as cortisone shots.
2) Curticel is lab grown chrondrocytes (cartilage cells) that can be used in very specific situations where cartilage loss is highly localized ( ie a divot out of the joint surface). Reported to work but long term is still unknown.
3) Other operations designed to put some type of cartilage over divot areas which can improve things in some patients with early disease

It does not sound as though your Dad is a candidate for these
If he is healthy enough he may be an appropriate candidate for a total knee arthroplasty.
Regards,

-Dr Merriman

3/6/01

My rheumatologist wants me to begin Enbrel therapy. He wrote me the script on 1-18. I called the Enbrel folks the next day to be placed on the waiting list, received the paperwork, filled it out and returned it to them. Does anyone know how long (a ballpark figure) it is taking for someone on the waiting list to actually get the drug? The Enbrel people wouldn't give me any indication at all--only saying that when my name "comes up" they will call me. Thanks.

I have a patient in my practice who is waiting for Enbrel since December 28.

I don't know how long the list is or how many names are ahead of him and neither does he.

As I understand it, all the product they can make is called for by people who were on the drug as of December 15. So, for Enbrel to come available now, someone has to stop the drug or die. They are not going to have increased production capacity until at least 6 months and likely longer.

-Dr Susan

3/6/01

I just finished reading a story about Tara Lipinsky the ice skater who had to
have hip surgery. She has since returned to the ice. The doctors tell her
that ice skating is the worst thing for her because they felt she was
developing arthritis. When the doctors did the surgery they found cartilage
growing all over the hip bone, I was under the impression that arthritis
ruins and destroys cartilage, did I miss something?

I am not familiar with the story, but it certainly doesn't sound correct. Remember that the general media almost always messes up health-related stories. The reporters don't know enough to know when they are misinterpretting what was said.

My guess is that Tara had remodeling occuring, but with calcium deposits and bone, not cartilage. But without seeing her case file, I couldn't say for sure.

-Walt