REPOST: Could You Have Carpal Tunnel Syndrome?

Jessica Alba is one of the many people who suffer from carpal tunnel syndrome. Women's Health delves into the nature of this painful condition and presents treatment options.


When Jessica Alba woke up with a completely numb arm, she thought she’d suffered a stroke. But one trip to the ER and one CAT scan later, her doctors discovered the real culprit: carpal tunnel syndrome, a painful condition caused by compression of a nerve in the wrist. While you may associate the syndrome with arthritis-addled seniors, it’s actually incredibly common—and women are three times more susceptible to carpal tunnel syndrome than men, according to the National Institutes of Health.

Image Source: womenshealthmag.com

What Is It? 

When too much fluid fills the space inside your wrist—or the tendon inside it thickens due to age or overuse—the adjacent nerve is squeezed and your fingers lose sensation. Eventually, this prevents normal circulation in your arm, which means the pain and numbness can creep from your fingertips all the way to your upper arm and neck.

While these symptoms are definitely scary, they’re different from what you’d experience if you were having a stroke, says Steven Beldner, M.D., an orthopedic surgeon at Beth Israel Hand Surgery Center in New York City. In that case, you’re more likely to lose feeling in an entire limb.

You’ll know you have carpal tunnel syndrome because it always begins in the wrist, thumb, or one of your fingers—and it can only extend as far as your neck.

Risk Factors 

Ever sleep in a strange position and wake up with tingling fingertips? That’s carpal tunnel syndrome. Most people experience brief bouts of the condition at least a few times in their lives, but there are certain circumstances that make some people more prone to it than others.

Abnormal levels of estrogen (common among pregnant, menopausal, or overweight women) are one of the leading causes of carpal tunnel syndrome—which is why your lack of a Y-chromosome makes you more likely to suffer from the condition.

And since the wrist tendon gets bigger and stronger the more you use it, doing activities like typing, knitting, or lifting weights too frequently also makes you more susceptible. (Alba blames her condition on the long hours she spends working on her new eco-friendly business, The Honest Company.)

Other people who have a higher carpal tunnel syndrome risk: those with small wrists, thyroid issues, arthritis, diabetes, or previous wrist injuries, Beldner says.

Treatment Options 

An occasional case of the tingles is no reason to freak out: Just shake off numbness or boost circulation by making a fist, relaxing it, and repeating the cycle.

If you tend to lose sensation in your fingers a few times a week, anti-inflammatory meds, warm compresses, and wrist splints can help keep your carpal tunnels clear.

Make sure to see a doctor if you begin to lose control of your hand muscles, can’t feel your fingers no matter how much you move them, or feel like the pain is getting progressively worse. Depending on your condition, he or she may prescribe a cortisone injection or surgery.

To prevent a problem from happening in the first place, minimize activities that use your wrists, or wear wrist splints while you do them. Stretching helps, too: Just like a rubber band, your tendon gets smaller when it’s pulled, so stretching periodically can help release the tension in your carpal tunnels.



Carpal tunnel syndrome may occur in people with rheumatoid arthritis. Dr. Kinga Vereczkey-Porter is a rheumatology expert who can diagnose and treat carpal tunnel syndrome. Follow this blog for more discussions on health.

ACR issues guidelines for the treatment of five common rheumatic diseases

As part of its participation in the American Board of Internal Medicine Foundation’s Choosing Wisely campaign, the American College of Rheumatology has listed a set of reminders for the rheumatology community when dealing with the five common tests and treatments in rheumatology.

Published in the ACR’s journal, Arthritis Care & Research, the guidelines read:

Image Source: webmd.com

“Do not test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate exam findings.”

Lyme disease’s musculoskeletal manifestations include arthralgia attacks or arthritis episodes in the joints, especially the knee. Without these features, there will be an increased risk of getting false positive results.

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“Do not perform magnetic resonance imaging (MRI) of the peripheral joints to routinely monitor inflammatory arthritis.”

MRI is inadequate to monitor inflammatory arthritis. It is also not cost-effective compared to clinical disease activity assessments and plain film radiography.

Image Source: npr.org

“Do not prescribe biologic drugs for rheumatoid arthritis (RA) before a trial of methotrexate or other conventional non-biologic drugs.”

RA should be treated with methotrexate and other non-biologic disease-modifying antirheumatic drugs (DMARDs) because they are proven to be effective, unless a patient has an inadequate response to methotrexate during a three-month trial.

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“Do not routinely repeat Dual-energy X-ray Absorptiometry (DXA) scans more often than once every two years.”

DXA scans performed more frequently than every two years is unnecessary because “changes in bone density over short intervals are often smaller than the measurement error of most DXA scanners.”

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“Do not test anti-nuclear antibody (ANA) sub-serologies without a positive ANA and clinical suspicion of immune-mediated disease.”

If the ANA test is negative, the results of the ANA sub-serologies are also negative. The choice of autoantibodies should depend on the specific disease under consideration.

ACR says that these guidelines do not serve as a “prescriptive set of rules” but as reminder for the rheumatology community to discuss the best and cost-effective treatments for patients. Although clinical autonomy is important, the choice of treatment agreed by the rheumatologist and the patient must be based on the patient’s clinical needs, values, and preferences.

This blog of Dr. Kinga Vereczkey-Porter tackles multiple concepts in rheumatology and internal medicine.

Golfer's elbow: Not quite the tennis elbow problem

Most people are familiar with tennis elbow, the condition where the outer elbow inexplicably becomes tender. It is associated with wear and tear– such a player might obtain from years of tennis– though its exact pathology has yet to be determined. Few are aware of a similar condition called golfer's elbow, the inflammation of a part of the elbow joint.


Image source: coreconcepts.com

Unlike with tennis elbow, golfer’s elbow is actually eponymous– acquired from the repeated swinging motion required by proper golf-player form. When golfers swing their club, the motion stresses the elbow tendon, causing it to swell. This impact is particularly exacerbated by having an incorrect or non-overlapping grip. Over time, this causes the golfer increasing pain. In some cases, the golfer will attempt to alleviate the pain while playing by swinging in a different manner. This merely exacerbates the inflammation.


Image source: mooreortho.net

Treatment for golfer’s elbow starts with a regular round of analgesics. Doctors will normally recommend a combination of non-steroid anti-inflammatory medication and pain relievers. At home, it is also suggested that heat and cold compress are placed alternately on the affected elbow. If the pain persists or the doctor does not observe any significant improvement, the patient may be advised to wear an “elbow strap.” The counter-force band functions mainly like a cast, reducing the pressure on the patient’s elbow and preventing further damage to the join. Of course, patients are advised to cease golfing and other sports activities until the elbow heals.


Image source: tenniselbow.piknchuz.com

Golfers can go for weeks without realizing that the pain in their joints needs serious attention. Rheumatology specialist Kinga Vereczkey-Porter’s advice on preventive care for joints and bones may be accessed on this Twitter account.

The importance of coughing and sneezing etiquette

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Viruses - just because people can’t see them, does not mean they’re not there. When people sneeze, they spew a great number of viruses into the air, enough to infect people in an entire room. As if that isn’t bad enough, a study in Applied and Environmental Microbiology has found out that viruses can survive longer, from 3 to 17 days, on objects such as a dollar bill. Medical professionals, such as Dr. Kinga Vereczkey-Porter and Dr. James Donohue of Sanford Specialty Clinics, also warn that the cold weather increases the concentration of viruses in a specific area.

So what can people do to shield themselves from flu?

The key here is to get an annual flu shot and to brush up on one’s coughing and sneezing etiquette. People must understand that coughing or sneezing directly into their hand is a perfect recipe for contagion.

Image source: nccn.com

Patients are advised to cover their mouth or nose with tissue when sneezing or coughing. If there’s no tissue available, the Centers for Disease Control and Prevention (CDC) recommends coughing or sneezing into the upper sleeve or elbow. Other proven and tested rules are frequent hand washing, proper tissue disposal, and sanitizer or alcohol use.

Image source: blog.medbroadcast.com

More medical facts are available on this Wordpress blog.

Managing arthritis in winter

Many old people complain about their aching joints and limbs during winter. During low temperatures, arthritis kicks in, making the cold months truly painful for elderly people suffering from the condition. For both sufferers and their loved ones, managing arthritis in winter can be challenging, but it is in no way impossible.

Image credit: arthritiswa.org.au

Keeping warm
The muscles and joints become more prone to injury when exposed to extreme cold, even in people who are not suffering from arthritis. Sufferers should keep their bodies warm during the winter. Taking warm baths is great for this purpose, and helps ease muscle stiffness and relieve pain.

Image credit: arthritiswa.org.au

Exercising
Older bodies tend to have more difficulty maintaining a stable body temperature, so exercising in winter can be more difficult for the elderly. Exercising however, offers plenty of benefits to people suffering from arthritis. It strengthens the muscles surrounding a joint, making it more stable. It also allows blood to circulate and flow to the cartilage, which then aids in maintaining supple joints.

Losing weight
Arthritis affects the knees in most cases, as these joints support the whole upper body’s weight most of the time. Losing weight helps reduce pressure on the knees and eases the pain caused by arthritis.

Image credit: blogs.babble.com

Eating right
Because arthritis is a disease that affects the bones, acquiring nutrients that support bone development is a must. Seniors must have a steady supply of calcium and vitamin D to maintain healthy bones and joints.

Arthritis poses many obstacles to both sufferers and family members, especially during winter. But with proper precautions, the elderly can avoid complications, and enjoy the holidays.

Dr. Kinga Vereczkey-Porter is a specialist in rheumatology who practices in North Carolina. Visit this Facebook page for more on how to take care of your muscles and bones.

REPOST: Lilly arthritis drug shows durability in study

This article from Reuters discusses how the trial drug developed by Eli Lilly and Company helped reduce pain brought by rheumatoid arthritis.

(Reuters) - A pill for rheumatoid arthritis being developed by Eli Lilly and Co and Incyte Corp maintained its effectiveness in reducing painful symptoms through 24 weeks of treatment in a midstage extension study, according to data presented at a medical meeting on Tuesday.

A sub-study of patients taking part in the trial of the drug, baricitinib, also showed that the two highest doses tested helped to reduce joint damage, based on Magnetic Resonance Imaging (MRI) tests.

The companies in June released positive data from the 301-subject Phase II study after 12 weeks of treatment in patients with mild to moderate RA who had an inadequate response to methotrexate. Data from the ongoing extension study, presented Tuesday at the American College of Rheumatology meeting in Washington, measured baricitinib treatment through the 24 weeks.

Based on the data collected from its Phase II programs, Lilly said it has moved into late-stage testing of the drug.

Four Phase III RA studies of baricitinib using the 2 milligram and 4 mg doses are planned for patients who have not previously been treated with methotrexate or injectable biotech drugs and also in patients who did have prior treatment with biologics, or drugs made from living organisms or their products, the companies said. Those studies will form the basis of the data package used to seek approval of the drug.

After 24 weeks, 73 percent of patients who received 8 mg of the Lilly drug once daily achieved the ACR20 goal, or a 20 percent improvement in rheumatoid arthritis symptoms. That compared with 78 percent who hit ACR20 at 12 weeks.

For the 4 mg dose, 78 percent of patients hit ACR 20 at 24 weeks, up from 75 percent at week 12.

The 2 mg dose that failed to show statistical significance compared with a placebo at 12 weeks had 63 percent of patients achieve ACR20 by week 24 of treatment, the data showed.

The study also measured ACR50 and ACR70 rates, or 50 percent and 70 percent improvement. All three doses showed improvement at 24 weeks from measurements taken at 12 weeks.

"These data are important because collectively they show patients experienced improvement with baricitinib as early as week two that was sustained through week 24," Dr. Mark Genovese, co-chief of the division of immunology and rheumatology at Stanford University School of Medicine, said in a statement.

"Also of note is that the percentage of patients achieving ACR50 and ACR70 increased over time and no unexpected safety findings emerged with continued dosing," said Genovese, a member of the steering committee for the study.

Baricitinib belongs to a hot new class of oral medicines called Jak inhibitors that aim to compete with the injected rheumatoid arthritis drugs that currently dominate the market with billions in sales. Pfizer Inc last week became the first company to bring one of the new drugs to market with the U.S. approval of tofacitinib, which will be sold under the brand name Xeljanz.

Jak inhibitors block enzymes believed to be involved in the inflammatory process.

In the sub-study of 154 patients who underwent MRI testing, there was a statistically significant improvement in measures of inflammation and joint damage at the 4 mg and 8 mg doses after 12 weeks compared with placebo, the companies said. The effects persisted through 24 weeks, they said.

In order to compete with the biologic blockbuster injected drugs, such as Abbott Laboratories' $8 billion a year Humira, the Jak inhibitors must show that they can prevent or delay joint deterioration as well as alleviate symptoms.

(Reporting by Bill Berkrot in New York; editing by Matthew Lewis and Prudence Crowther)

It's a sign of old age: Kinga Vereczkey and myths about rheumatoid arthritis

Despite how common arthritis is, the general public seems to know little about it. To raise awareness, rheumatologists, like Kinga Vereczkey, try to educate people about the truths behind the popular myths surrounding rheumatoid arthritis. Some examples are:

Kinga Vereczkey-Porter Image Credit: arthritiswa.org.au

Arthritis is a sign of old age 
This misconception is due to the number of grandparents who have arthritis. The truth is that the disease can develop at any age. Inflammation in the joints and surrounding tissues can manifest in people as young as 25 years old. According to the vice president of public health for the Arthritis Foundation, most sufferers are actually under the age of 65.

Arthritis can be cured by special diets 
This myth has been held about roughly all diseases but is particularly untrue for rheumatoid arthritis. Rheumatology specialists, like Kinga Vereczkey, clarify that no specific kind of food can cure osteoarthritis or rheumatoid arthritis. However, eating healthily can lead to weight loss, which relieves arthritis symptoms like joint pain.

Kinga Vereczkey-Porter Image Credit: healthydietingandeating.com

Arthritis sufferers should avoid exercise 
When a person is in pain, their first instinct is to cease all movement in an attempt to alleviate it. However, people with osteoarthritis should exercise regularly to reduce the pain and strengthen their joint muscles. Of course, exercises should be mild and low-impact in nature. Doctors, like Kinga Vereczkey, often recommend walking, biking, Tai chi, and yoga.

Rheumatoid arthritis patients will be bedridden 
In the past, when rheumatoid arthritis was less understood, sufferers were sometimes confined to wheelchairs at the worst of its onset. However, treatments have improved greatly in the last 20 years, and early detection can prevent arthritis progression. These days, treatments and medication help patients manage the symptoms and allow doctors to detect symptoms early, thus preventing the onset of full-blown rheumatoid arthritis altogether.

Kinga Vereczkey-Porter Image Credit: thearthritiscenter.com

To read more about Dr. Kinga Vereczkey and her practice, follow this Twitter account.