Brief Answer:
Need some more information.

Detailed Answer:
Hi, thanks for writing to XXXXXXX

I have gone through the attached reports. The RBS (blood sugar) level is on the higher side. ESR is also high.

I need to have some more information on your mothers ailment.
- Duration of symptoms in the joints
- Please specify, which joints are affected by arthritis
- since how long your mother is complaining of pains
- Is the pain associated with swelling of the joints
- Whether pain in the joints is associated with Fever
- Nature and pattern of pain? is it present continuosly throughout the day? or is associated only with physical activity?
- Does she has early morning pain and stiffness in the finger joints of both hands
- If possible, upload any xrays and the treatment prescription given by your treating doctor.

Please provide information for the above queries, so that I can provide you better suggestions.

Regards

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Brief Answer:
Please find the best possible suggestions.

Detailed Answer:
Hi Mr.XXXX, Nice to hear from you.

As per your response to my queries and your doctors prescription, your mother is likely to be suffering from Rheumatoid Arthritis (RA). This is a chronic disease affecting the joints and the treatment for this condition is to be taken lifelong. The only positive aspect regarding the symptoms is that remissions (symptom free intervals which may range from few weeks to few months) are seen during the course of the disease.

The Mainstay of management of RA involves the use of DMARD's (disease modifying anti rheumatic drugs) & HCQS prescribed by your doctor is one among the DMARD. The DMARD's are not useful in relieving the acute pain in the joints and as the name implies they modify the course of the disease.

So, for the symptomatic treatment of acute pain either an NSAID (non steroidal antiinflammatory drug) or STEROID has to be given. Steroid preparations are to be used only to supress the acute painful episodes but are not to be taken for prolonged periods as they tend to produce serious systemic side effects.

There is no NSAID (pain killer preparation) in the given prescription of your mother. I prescribe ACECLOFENAC 200MG SUSTAINED RELEASE tablet once daily in the morning to all my Rheumatoid patients for a few weeks. The advantage of this drug is that it offers "Chondroprotection" (prevents the cartilage damage in the joints).

Your mother's knee joint xrays show only mild degenerative arthritic changes, so i personally think that she has good chances of recovery with medical management. I also suggest to use OSICARE PLUS tablets (which contains Glucosamine sulfate and Diacerin), one tablet daily after dinner for atleast 2-3 months as it will provide good relief from pain arising from the joints.

The general conservative line of management of Arthritic joints is as follows -

* PHYSICAL THERAPY : The mainstay of treatment in the early case is physical therapy, which should be directed at maintaining joint mobility and improving muscle strength.
Exercise can strengthen the muscles, which can help keep the joints more stable, and the stronger muscles help to absorb energy and protect the joint surface. Stick to gentle exercises, such as walking, biking or swimming.
Other measures, such as massage and the application of warmth, may reduce pain.
* LOAD REDUCTION : Protecting the joint from excessive load may slow down the rate of cartilage loss. It is also effective in relieving pain. The heavier you are, the more stress you put on your joints. Weight reduction for obese patients, wearing shock-absorbing shoes, avoiding activities like climbing stairs and using a walking stick are worthwhile.
* USE OF HEAT & COLD : Both heat and cold can relieve pain in your joint. Heat also relieves stiffness, and cold can relieve muscle spasms and pain.
* OVER THE COUNTER PAIN CREAMS : Local massaging with creams and gels may provide temporary relief from osteoarthritis pain. Some creams numb the pain by creating a hot or cool sensation. Other creams contain medications, such as aspirin-like compounds, that are absorbed into your skin.
Pain creams work best on joints that are close to the surface of your skin, such as your knees and fingers.
* GLUCOSAMINE & CHONDROITIN SULFATE : Daily intake of Glucosamine & chondroitin supplements over a period of 3-4 months will help in reducing the arthritic pains and thereby decreases the necessity to take daily analgesic medications. Research suggests that vitamins C and D may help protect you against the progression of osteoarthritis.

Hope I have justified your query. Good day

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Brief Answer:
I suggest you to consult an ORTHO SURGEON.

Detailed Answer:
Hi, the above mentioned medicines are general recommendations. A direct clinical examination of the patient is necessary to prescribe which medicines best suits for her ailment. So, I suggest you to consult a reputed orthopedic surgeon in your locality for a better management.

You can use Aceclofenac for 2-3 weeks intermittently based on demand for pain but you have to check her Serum Creatinine level (blood investigation) before starting the drug. If it is above normal value, then NSAID's (TRAMADOL or PARACETAMOL as they are less likely to produce Kidney damage than other painkillers.

Osicare plus can be taken for 3 months without any issues as it provides significant pain relief arising from arthritic joints.

I won't suggest you to stop all the currently taking medications and as said above, approach a good orthosurgeon in your area and discuss issues.

Volini gel will provide good symptomatic relief with local application and can be used.

Hope I have justified your query. Good day

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