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Systemic Lupus Erythematosus (SLE)

Systemic Lupus Erythematosus (SLE), often referred to simply as "lupus," is an autoimmune rheumatic disease where the body's immune system attacks its own tissues, causing inflammation and damage. This can affect various organs and systems, including the skin, joints, kidneys, and blood, among others. The term "lupus" is derived from the Latin word for wolf, a reference to the facial rash resembling a wolf bite seen in some patients. Causes of SLE SLE is influenced by both genetic and environmental factors. Certain genes increase susceptibility to the disease, which can be triggered by environmental factors such as certain medications or sunlight.   Diagnosis Diagnosing SLE involves clinical evidence combined with laboratory tests, including blood and urine tests. Clinical evidence includes symptoms like joint inflammation, kidney inflammation, and others that align with SLE. Laboratory indicators can include antibodies like ANA, anti-dsDNA, and others.   Symptoms Common symptoms indicating a flare-up include fever, fatigue, and malaise. Lupus can affect multiple systems simultaneously, manifesting in skin rashes, joint pain, kidney issues, and blood abnormalities. Patients might experience symptoms only in specific systems at different times, and the severity depends on the affected organs.   Treatment Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) These are commonly used to manage pain and inflammation but can cause stomach issues. They should be taken with food.   Corticosteroids Used to control severe flare-ups, these can cause long-term side effects like bone weakening and increased infection risk. Antimalarials These help manage skin and joint symptoms and reduce flares. Immunosuppressants Used for severe cases or when other treatments fail, these drugs require regular monitoring due to potential side effects. Self-Care Recommendations Maintain good hygiene : Regular hand washing, clean eating habits, and dental care are crucial. Infection prevention : Avoid raw and uncooked foods and crowded places. Sun protection : Use sunscreen with high SPF to protect against UV rays. Consult doctors before pregnancy : Pregnancy can aggravate lupus, and certain medications may need to be adjusted. Do not alter medication without consulting a doctor : Unsupervised changes can be dangerous.   This overview provides essential insights into managing and understanding lupus, emphasizing the need for medical guidance and careful lifestyle adjustments.

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Ultrasound in Rheumatology and Joint Diseases

Ultrasound in Rheumatology and Joint Diseases   What is Ultrasound in Medicine? Ultrasound uses high-frequency sound waves to create images of internal structures. The transducer emits these sound waves, which penetrate and reflect off different tissues, sending echoes back to the transducer. These echoes are converted into electrical signals and displayed as images. Ultrasound distinguishes tissues based on their sound wave reflection properties, allowing visualization of various tissues and blood flow. Musculoskeletal ultrasound specifically assesses abnormalities in joints and muscles. Ultrasound has diverse medical applications, like abdominal imaging, vascular studies, and echocardiograms (heart ultrasounds).   Use of Ultrasound in Joint and Rheumatic Diseases Various specialists use musculoskeletal ultrasound, including radiologists, rehabilitation physicians, orthopedic surgeons, and rheumatologists. Its popularity has surged due to advancements in technology, providing detailed images. Ultrasound machines have become smaller and more portable, facilitating use in outpatient clinics, inpatient wards, and emergency rooms. Ultrasound is rapid, safe (no radiation exposure like X-rays or CT scans), can assess blood flow and inflammation with Doppler imaging without dye injections, allows visualization during motion, and is cost-effective compared to MRI. It's helpful for diagnosis, monitoring treatment, and guiding procedures like joint fluid analysis, injections, tendon sheath injections, and biopsies. However, ultrasound can't visualize structures beneath bones and provides high-resolution images only of superficial structures. It's also time-consuming for multiple areas and relies heavily on the practitioner's expertise.   Ultrasound in Rheumatology Ultrasound in rheumatology goes beyond joints and muscles. It's used to assess related organ abnormalities, like salivary glands in Sjogren's syndrome, blood vessels in vasculitis, and lungs in autoimmune-related lung diseases. While ultrasound isn't widely used in rheumatologic patient care due to certain limitations, its increasing accessibility, improving quality, portability, and effectiveness suggest a growing role in future rheumatology practices.

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Spondyloarthritis

Spondyloarthritis   What is Spondyloarthritis? Spondyloarthritis is a group of inflammatory joint diseases. It's divided into two main categories: axial spondyloarthritis, primarily affecting the spine, and peripheral spondyloarthritis, mainly involving other joints. Conditions within this group include ankylosing spondylitis (visible by X-ray), non-radiographic axial spondyloarthritis, psoriatic arthritis, reactive arthritis, and arthritis associated with inflammatory bowel diseases.   Axial Spondyloarthritis This group mainly involves back pain or buttock pain. It's divided into non-radiographic (not visible on X-ray) and ankylosing spondylitis (visible on X-ray), differentiated by X-ray visible inflammation of the sacroiliac joints. Non-radiographic cases can be detected through MRI. Some non-radiographic cases may progress to ankylosing spondylitis over time. Indicators of axial spondyloarthritis include back pain starting before 45 years of age, gradual onset, lasting at least three months, night pain, morning stiffness lasting over 30 minutes, improvement with movement or NSAIDs, and no relief with rest. Other associated symptoms include a history of eye inflammation, psoriasis, chronic inflammatory bowel disease, peripheral arthritis, sausage-like finger or toe swelling, tendon inflammation, or a family history of similar conditions. If these symptoms are present, consult a rheumatologist. If back pain doesn't suggest inflammation, consult an orthopedic surgeon.   Peripheral Spondyloarthritis Patients may experience inflamed joints, inflamed tendon attachment points, or sausage-like swollen fingers or toes. Affected joints might include the knees, ankles, elbows, wrists, or fingers/toes, usually asymmetrically inflamed (e.g., one wrist but not the other). Enthesitis, the inflammation at tendon attachment points, is common in areas like the heel or elbow.   Extra-Spinal and Extra-Articular Symptoms Patients might also have eye inflammation, psoriasis, and chronic inflammatory bowel disease. They are at higher risk of depression, fibromyalgia, and cardiovascular diseases. Eye inflammation can cause pain, blurred vision, redness, and light sensitivity. Psoriasis presents as thick, scaly silver or white patches on red skin, possibly with nail changes. Chronic inflammatory bowel disease causes abdominal pain, diarrhea, and sometimes blood in the stool.   Diagnosis Spondyloarthritis is usually diagnosed by a rheumatologist using patient history, physical examination, blood tests, and imaging (X-rays or MRIs). Diagnosis isn't just about meeting criteria but interpreting symptoms, blood tests (like HLA-B27, CRP, ESR), and imaging results. Blood tests might include rheumatoid factor, anti-CCP, or ANA to differentiate from other diseases. Imaging can show abnormalities in sacroiliac joints, but interpretation can be challenging and needs to consider clinical context.   Treatment Treatment approaches for different types of spondyloarthritis are similar but vary in specifics according to symptoms and severity.   Exercise Exercise is crucial in managing spondyloarthritis, focusing on strengthening core muscles, aerobic exercises for lung and heart health, exercises to expand the chest for better breathing, and exercises to improve spinal and joint mobility. Stretching exercises are also recommended. Posture in daily routines and suitable sleeping positions (like using a flat pillow for ankylosing spondylitis patients) are important. Avoid high-impact sports like boxing, football, or rugby, and certain massage or chiropractic techniques that can harm the spine.   Medication - NSAIDs are often the first-line treatment for reducing inflammation and pain. - Targeted steroid injections can reduce inflammation in specific areas. - Sulfasalazine and methotrexate can help control peripheral joint inflammation. - Biologic and targeted synthetic DMARDs like infliximab, etanercept, adalimumab, golimumab, secukinumab, ixekizumab, and tofacitinib may be considered if initial treatments are ineffective.

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Joint Pain

What is Joint Pain? Joint pain can have many causes. Besides pain, symptoms may include swelling, redness, warmth, and morning stiffness or stiffness after remaining in one position for a long time. Movement might become restricted. Other symptoms like fever, rash, fatigue, muscle weakness, weight loss, sore throat, diarrhea, painful urination, eye inflammation, mouth ulcers, and hair loss can also occur. These details help doctors diagnose the cause of joint inflammation.   Causes of Joint Pain Joint pain can arise from abnormalities in the joint itself or the surrounding structures, or it might radiate from another area. Joint structures include the joint lining, bone, cartilage, tendons, muscles, and bursae. Pain might stem from one or more of these structures. Identifying the specific cause is crucial as different diseases have different prognoses. Some conditions resolve spontaneously, some respond well to treatment, some are chronic but harmless, and others need prompt treatment due to long-term effects or potential fatality.   Examples of Joint Pain Causes: • External causes, such as tendinitis, muscle pain around the joint, fibromyalgia, or nerve disorders. • Internal joint issues, like: Non-inflammatory conditions, e.g., osteoarthritis, joint injuries. Inflammatory conditions, e.g., gout, pseudogout (CPPD), rheumatoid arthritis, lupus (SLE), ankylosing spondylitis, infectious arthritis. Diagnosis Diagnosis involves medical history (including accidents, family history, pre-existing conditions, previous treatments, symptoms leading to joint pain, duration and nature of pain, exacerbating or alleviating factors, and symptoms in other organs). Physical examination focuses on the affected joint(s) to identify specific structural issues. Examination might extend to other body parts to find relevant signs, like skin rashes, nail changes, scalp examination, oral inspection, lump palpation, lymph node examination, lung and heart assessment. Blood tests, joint fluid analysis, and imaging (X-rays, ultrasounds, MRIs, CT scans) support or refute suspicions. Blood tests can confirm specific conditions like rheumatoid arthritis or lupus. Imaging techniques assess different aspects but must be interpreted in the context of clinical symptoms.   Treatment Approach Treatment depends on the cause of joint pain. Examples include: - Paracetamol for mild pain relief. - Tramadol for more severe pain. - Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and etoricoxib for pain relief and inflammation reduction. - Physical therapy to alleviate pain, address joint and tendon adhesions, and strengthen muscles. - Steroid injections to reduce inflammation in inflamed joints. - Antibiotics for infectious arthritis. - Immune-modifying or suppressing drugs (like hydroxychloroquine, steroids, methotrexate) for autoimmune-related conditions.

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Rheumatoid Arthritis   What is Rheumatoid Arthritis? Rheumatoid arthritis (RA) is one of many diseases that can cause joint inflammation. Affected joints can be painful, swollen, or stiff. RA occurs when the immune system mistakenly attacks the body's own joints, leading to inflammation. It is a chronic disease, requiring long-term medication to control and prevent flare-ups.   Symptoms of Rheumatoid Arthritis Key symptoms include pain, swelling, and stiffness in the joints, often starting in smaller joints like fingers, wrists, ankles, and toes. Larger joints, such as knees, elbows, and shoulders, can also be affected. RA usually progresses slowly and can affect almost all joints except the lower back and thoracic spine. Inflammation often occurs in multiple joints simultaneously and symmetrically (e.g., both wrists or both ankles). Stiffness is usually worst after waking up and improves over hours. Without treatment, inflamed joints may become damaged and deformed over time.   Diagnosis of Rheumatoid Arthritis Diagnosis relies on medical history, physical examination, and blood tests. Tests may include rheumatoid factor (RF) or anti-CCP, but their presence alone doesn't confirm RA as they can be found in other diseases. Conversely, some RA patients may not have these markers. X-rays can help in diagnosis, but early RA may not show up on them. In cases of pain and stiffness without clear swelling and normal X-rays, ultrasound or MRI might be used.   Treatment of Rheumatoid Arthritis RA treatments include anti-inflammatory drugs like ibuprofen and naproxen; steroids like prednisolone and dexamethasone; disease-modifying antirheumatic drugs (DMARDs) like methotrexate and hydroxychloroquine; and biological agents like infliximab and etanercept. Treatment plans depend on the disease's severity, patient age, co-existing diseases, side effects, administration methods, and cost. It's crucial to follow the treatment plan consistently as interruptions can lead to flare-ups.   Self-Care for Rheumatoid Arthritis Patients should maintain an active lifestyle and exercise regularly. While movement can initially be painful, lack of exercise can lead to increased stiffness and muscle weakening. Activities should be adapted to avoid joint strain. For example, use tools to open jars instead of hands, and lift heavy items with the arms instead of fingers. Exercise recommendations are similar to the general population, with at least 30 minutes of exercise three times a week. Patients with heart conditions or osteoporosis should adjust their exercise plans accordingly. Smoking cessation, weight control, and oral health care are also important to manage RA.

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Calcium Pyrophosphate Deposition (CPPD)

Calcium Pyrophosphate Deposition (CPPD) disease, also known as pseudogout, is a condition caused by the accumulation of calcium pyrophosphate (CPP) crystals in the joints. These crystals lead to inflammation and are composed of calcium and pyrophosphate. CPPD is a common type of inflammatory joint disease, second only to gout. Some people with CPPD may not experience any symptoms, while others might suffer from sudden acute joint inflammation, and some may develop chronic joint inflammation. The symptoms of CPPD can vary greatly and can affect multiple joints, often resembling other joint diseases. Symptoms include: Sudden acute joint inflammation, similar to gout. This form is well-known and often reported first, hence the name pseudogout. The inflammation is characterized by pain, swelling, redness, and warmth in the affected joint, lasting from days to a week. The knee is the most commonly affected joint, but other joints like ankles, wrists, fingers, and hips can also be inflamed. The big toe base, frequently affected in gout, is less commonly involved in CPPD, helping to differentiate between the two conditions. Asymptomatic individuals who have radiographic evidence consistent with CPPD. Chronic inflammation in multiple joints, resembling rheumatoid arthritis, sometimes called “pseudo-rheumatoid.” Fluctuating joint inflammation in patients with osteoarthritis, or causing degeneration in joints not typically affected by osteoarthritis, like wrists, finger bases, or shoulders. Spinal inflammation, particularly in the neck, mimicking meningitis symptoms. Risk factors for CPPD mainly include older age, joint injury history, genetics, conditions like hyperparathyroidism and hemochromatosis, and low magnesium levels. Diagnosing CPPD involves a combination of patient history, physical examination, joint fluid analysis, and imaging like X-rays or ultrasounds. Identifying CPP crystals in joint fluid is key and is done using microscopy. This analysis not only confirms CPPD but also helps exclude conditions like gout or infectious arthritis. Radiographic evidence of crystal deposits in cartilage, known as chondrocalcinosis, is also indicative. Ultrasound can be more sensitive than X-rays in detecting chondrocalcinosis and can guide joint aspiration in difficult-to-access joints. Current treatments for CPPD focus on managing symptoms, as there is no cure to remove CPP crystals from cartilage. Treatments include: Joint aspiration and steroid injections, especially when one or two joints are inflamed. This procedure reduces the amount of fluid and crystals in the joint, thereby decreasing pressure and relieving pain. Anti-inflammatory medications are often the first choice, especially for hard-to-aspirate or multiple inflamed joints. These include non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, or steroids, which can also be used in low doses to prevent recurrent or chronic inflammation. Immune-modifying or suppressing drugs, such as hydroxychloroquine or methotrexate, may be necessary if other treatments fail to control the disease.

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Gout

Gout is a type of inflammatory arthritis caused by uric acid crystals. It usually occurs after a period of high uric acid levels in the blood (over 6.8 mg/dL), but not everyone with high uric acid develops gout. High uric acid can lead to uric acid crystal accumulation in various body tissues, causing symptoms like joint inflammation, gout nodules or tophi, kidney stones, and reduced kidney function. Uric acid levels and gout are related to genes, diet, and other diseases. Genes affect protein production that controls uric acid levels, particularly through its elimination in the kidneys, which is the most critical process for maintaining uric acid balance. Diet only partially influences blood uric acid levels. Risk factors for gout include obesity, chronic kidney disease, genetics, certain medications like hydrochlorothiazide and pyrazinamide, and consuming too much alcohol, red meat, and sugary drinks. Gout symptoms include severe, sudden joint inflammation and pain, with the joint becoming red, swollen, and tender. The pain typically peaks within 24 hours and can subside in a few days to two weeks even without treatment. Initially, gout may affect one joint at a time, like the big toe, ankle, or mid-foot. If untreated, flare-ups become more frequent and involve more joints. Over time, tophi can develop in various body parts, causing bone damage and deformity. Tophi are usually painless but can become inflamed. Diagnosing gout involves considering the patient's history and physical exam. The most accurate diagnosis is confirmed by finding uric acid crystals in joint fluid under a microscope. If this isn't possible, ultrasound or dual-energy CT scans can detect uric acid deposits. High blood uric acid levels support the diagnosis, but levels can be normal during flare-ups. Treating gout during flare-ups aims to reduce inflammation, pain, and swelling as quickly as possible. Treatment depends on factors like patient's other diseases, severity of inflammation, and history of gout. Options include cold compresses and rest, and avoiding massaging the affected joint. Non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen, ibuprofen, and indomethacin reduce inflammation and pain. They have risks for patients with kidney, liver, heart diseases, stomach ulcers, or bleeding risks. Colchicine reduces inflammation without increasing stomach ulcer risk but must be taken within the first 24 hours of a flare-up. It can cause side effects like diarrhea, nausea, and stomach pain. Steroids like prednisolone are effective for severe, multi-joint inflammation and patients who can't take NSAIDs or colchicine. They temporarily increase blood sugar and suppress immunity, so they're used cautiously. Preventing gout flare-ups involves low-dose colchicine, adjusting for kidney function. In the first 3-6 months of uric acid-lowering treatment, flare-ups might still occur. Long-term use of colchicine without uric acid-lowering medication can lead to tophi without warning inflammation. Low-dose NSAIDs or steroids may also prevent flare-ups in specific cases. Long-term treatment involves lowering uric acid levels to prevent flare-ups, tophi, joint damage, and possibly slow kidney deterioration. The goal is a uric acid level below 6 mg/dL, possibly stricter in severe cases. Not all gout patients need this medication. It's for frequent, severe flare-ups, existing tophi, or concurrent kidney disease. Uric acid-lowering drugs include allopurinol and febuxostat, which inhibit uric acid production. Allopurinol is first-line but can cause allergic reactions, especially in Thai or Chinese patients with specific genetic risks. Febuxostat is an alternative but more expensive and used cautiously in heart disease patients. Both require liver enzyme monitoring. Drugs that increase uric acid elimination through urine include probenecid, sulfinpyrazone, and benzbromarone. They require high water intake to prevent kidney stones and have limitations in reduced kidney function patients. Benzbromarone is effective but can have severe liver side effects. Losartan and hydrochlorothiazide, blood pressure medications, also affect uric acid elimination. Losartan helps lower uric acid, while hydrochlorothiazide can increase it. Dietary changes can help manage gout. Limiting alcohol, red meat, and sugary drinks is recommended. For overweight patients, weight loss is crucial for reducing uric acid levels and overall health. In summary, gout is a manageable condition with medication and lifestyle changes, focusing on reducing and controlling uric acid levels.

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Weather Changes Or Global Warming?

Weather Changes Or Global Warming?   Dr. Phakin Lovasthaphon, Department of General Medicine.   The changing seasons, undoubtedly influenced by global geography, have highlighted the undeniable impact of global warming. Our daily lives significantly contribute to Earth's resource consumption. In recent times, I've observed an increase in patients experiencing high fevers, body aches, and headaches within 1-2 days, accounting for about 60-70% of all visits. It's uncertain if this is linked to global warming. Typically, such symptoms within the first few days can arise from various causes. For example, some may experience painful urination due to urinary tract or kidney infections, while others with sore throats and swollen, pus-filled tonsils may be diagnosed with tonsillitis. Those who have recently visited forests might suffer from malaria. Diagnosing specific illnesses becomes challenging when patients present with acute fever, headaches, body aches, back pain, loss of appetite, and nausea. It often requires epidemiological data to identify any prevailing diseases, with influenza being the most suspected currently, which aligns with the symptoms observed, primarily in working adults who often lack adequate rest and exercise. If one falls ill, the most crucial treatment is ample rest to allow the immune system to recover and combat the illness. Since the common cold is viral, there are no direct antiviral medications, and one must rely on their immune system, along with symptom-relieving medications and clean water intake. Severely fatigued patients are advised to seek hospital treatment. To prevent catching a cold, one should avoid close contact with symptomatic individuals, wear masks, wash hands regularly, stay in well-ventilated areas, and avoid crowded places. Maintaining good health through regular exercise, adequate rest, and proper diet is also vital. Regardless of the frequent weather changes or global warming, it's essential to maintain robust health. Importantly, we should all contribute to energy conservation to help mitigate global warming.

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Preventing Colds By Exercising And Eating Healthy!

Preventing Colds By Exercising And Eating Healthy!   Dr. Chidwate Vorapiankul, medical doctor at Vibhavadi Hospital, suggests that during this rainy season, many individuals experience poor health. Therefore, it is important for everyone to exercise regularly while incorporating a diet rich in fruits and vegetables high in vitamin C. Consuming warm foods also helps to create warmth in the body and boost the immune system against colds.   In times of frequent weather changes like these, it is crucial to take extra care of our health, especially to allow our bodies to adapt to the changing weather without negative impacts on our well-being. This is particularly true for vulnerable groups such as infants, young children, and the elderly, who are more susceptible to health issues. Parents, guardians, and the elderly themselves must have understanding and knowledge in safely taking care of their own health and their children's during the rainy season, in order to prevent various respiratory diseases, especially colds. If one falls ill with a cold and does not practice good health care, it could potentially lead to bronchitis and pneumonia, particularly among the elderly. Hence, it is crucial for the elderly to keep their bodies warm and engage in exercise properly.   Physical exercise not only helps to generate body warmth but also plays a vital role in strengthening the immune system against colds. It is recommended to engage in aerobic exercises such as brisk walking, jogging, cycling, continuous movement sports, or even traditional Chinese martial arts. These exercises will contribute to a faster respiratory rate, and exercising for at least 30 minutes, five days a week, is sufficient to promote immunity in the respiratory system. It is important to avoid excessive physical exertion or exhaustion. When starting an exercise routine, it is advisable to begin with lighter activities and shorter durations, gradually increasing the time each week, allowing the body to adapt. Later, one can increase the intensity or load, but it is important to note that extreme or excessive exercise is not necessary.   Another important aspect to consider, in addition to physical exercise for generating body warmth, is nutrition. Emphasize a diverse intake of vegetables, whether raw, boiled, steamed, or stir-fried, and fruits that are high in vitamin C, such as oranges, guavas, apples, grapes, and pineapples. These foods help to boost the body's immune system and raise its temperature. Therefore, if you can follow these practices for self-care, it will not only promote good health during the rainy season but also contribute to long-term well-being.

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Influenza: The Most Commonly Seen Illness by Physicians

Influenza: The Most Commonly Seen Illness by Physicians   Influenza, also known as the flu, is an infection of the nose and throat, primarily caused by viral infections known as Coryza viruses, which include Rhino-viruses as the main strain. Other types of viruses involved are Adenoviruses and Respiratory syncytial virus. When the infection enters the nose and throat, it causes swelling and redness of the nasal tissues, along with the production of mucus. Although the illness typically resolves on its own within a week, it is the most common reason for patients to seek medical attention. On average, children experience the flu 6-12 times per year, while adults have it 2-4 times. Women are more susceptible than men due to their close proximity to children. Elderly individuals may experience it once a year.   Symptoms in adults include sneezing and a runny nose as the initial signs, accompanied by mild fatigue and minor headaches. Fever is not commonly observed. The virus is released from the patient's respiratory tract for 2-3 hours and usually clears within two weeks. Some individuals may also experience earaches, blood-tinged ear secretions, or conjunctivitis, along with a sore throat and difficulty swallowing. The illness typically lasts for 2-5 days, but nasal discharge may persist for up to two weeks. In children, the flu can be severe and may lead to complications such as bronchitis and pneumonia.   Transmission:   This disease tends to spread during the winter season due to low humidity and cold air. It can be transmitted through saliva and respiratory secretions. Additionally, the virus can be contracted by touching contaminated surfaces and subsequently rubbing the eyes, nose, or mouth. Infected individuals can transmit the virus before experiencing symptoms and up to 1-2 days after symptoms appear. Those most susceptible to the flu are children under 2 years old, malnourished children, and children in daycare centers.   Methods of Transmission:   Touching surfaces or objects contaminated with the virus and then touching the eyes, mouth, or nose. Inhaling the virus released through coughing from an infected individual. Inhaling airborne droplets containing the virus.   Treatment:   There is no specific treatment for the flu. If fever is present, paracetamol can be used to reduce it, while aspirin should be avoided. Medications can be provided to relieve symptoms, such as decongestants, nasal sprays, and mild cough suppressants. Rest and drinking plenty of fluids are recommended. Generally, the illness lasts for 2-4 days, after which the symptoms subside. However, middle ear inflammation is a significant complication in children and may require antibiotic treatment.   Prevention:   Avoid crowded places such as movie theaters and shopping malls during flu outbreaks. Cover the mouth and nose when coughing or sneezing with a facial tissue or the inner elbow. Wash hands frequently. Avoid touching the face, as it can introduce the virus into the body. Minimize close contact with individuals suffering from the flu for an extended period.   It is difficult to fully prevent contracting influenza, and currently there is no vaccine available…therefore self-care and personal health management is the most crucial.   Dr. Chidwate Woraphiankul Physician at Vibhavadi Hospital  

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Healthcare During The Winter Season

Healthcare During The Winter Season Dr. Chidvate Vorapienkul, Physician at Vibhavadi Hospital We have entered the winter season, and during this time, many people may experience colds and flu. For those who have allergies, the cold weather can exacerbate symptoms such as sneezing, runny nose, or for individuals with asthma or chronic lung diseases, it can worsen breathing difficulties. This is especially true if they also contract the common cold or flu. Therefore, taking care of our health becomes crucial. By following these 8 ways to maintain our health, we can better cope with the winter season.   1. Maintain overall health by consuming a balanced diet consisting of all five food groups, drinking plenty of water, engaging in regular exercise, and getting sufficient rest and sleep. 2. Avoid close contact with individuals who have colds or the flu and refrain from sharing personal items such as facial tissues, water glasses, plates, or utensils. 3. Stay in well-ventilated areas and avoid crowded places. 4. If you have a cold or the flu, cover your mouth and nose with a tissue when coughing or sneezing, avoid close contact with others, and frequently wash your hands. 5. Avoid smoking, consuming alcohol, and using illicit drugs, as they can weaken your immune system and make you more susceptible to infections. 6. Wash your hands frequently, as we may come into contact with disease-causing germs on various surfaces such as handrails, doorknobs, or water faucets. Wash your hands with soap and water for 15-20 seconds or use hand sanitizer. 7. Keep your body warm during cold weather or when there are significant temperature changes. Wear a hat to prevent heat loss from your head. 8. Take care of your skin by keeping your body warm at all times. Wear layered clothing when it is very cold and avoid prolonged exposure to water. After bathing, apply lotion or moisturizer to your skin. In case of cracked lips, use lip balm and avoid excessive licking.   We should always be vigilant in taking care of our health as it is the best way to prevent diseases. Nobody knows when illness might strike, but having good health can reduce the chances of falling sick. Remember, "Good health is a gift."

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Rheumatoid Arthritis

Rheumatoid Arthritis By Dr. Anawat Suesuwan Rheumatologist, Vibhavadi Hospital   What is Rheumatoid Arthritis? Rheumatoid arthritis is a chronic inflammatory joint disease. Patients experience simultaneous inflammation in multiple joints, and prolonged inflammation leads to joint destruction, deformity, and potential disability. In addition to joint symptoms, some patients may also exhibit manifestations in other organs.   What are the causes of Rheumatoid Arthritis? The exact causes of rheumatoid arthritis are still not fully understood. Studies have identified several factors that play a role, including genetic factors, infectious agents, sex hormone influences, and immune system dysregulation. Currently, it is believed that the development of rheumatoid arthritis requires the interplay of multiple components. Patients have genetic predispositions that contribute to disease development and are triggered by various factors.   What are the key symptoms of Rheumatoid Arthritis? The main symptoms include inflammation in multiple joints, particularly the wrists and finger joints. Patients experience constant joint pain regardless of joint usage and morning stiffness. Apart from joint symptoms, other possible manifestations may include low-grade fever, fatigue, rheumatoid nodules, dry mouth, and dry eyes. Joint involvement leads to loss of function and reduced mobility. Prolonged inflammation results in joint destruction and deformity. When the disease reaches its full manifestation, diagnosis becomes relatively straightforward as patients exhibit inflammation in multiple joints, mainly in small joints, particularly in the hands and feet. The affected joints demonstrate a symmetrical distribution and characteristic deformities. However, in the early stages, patients may present with various symptoms, making diagnosis challenging.   What are some diseases that have symptoms similar to or resemble rheumatoid arthritis? Diseases that resemble rheumatoid arthritis include systemic lupus erythematosus (SLE), Sjögren's syndrome with non-Sjögren's syndrome arthritis (SNSA), gout, infectious arthritis, and rheumatoid arthritis associated with cancer.   Why is it necessary to conduct laboratory tests frequently in patients with rheumatoid arthritis? Frequent laboratory testing in patients with rheumatoid arthritis is necessary for several reasons. It is used for disease diagnosis, assessing the severity of the disease, evaluating patients before considering medication options, monitoring treatment response, and tracking potential side effects that may occur during treatment.   How is rheumatoid arthritis treated? The treatment of rheumatoid arthritis consists of three components: non-pharmacological treatment, pharmacological treatment, and surgical intervention.   1. Non-pharmacological treatment: Patients should have knowledge and understanding of the disease, self-care practices, and medication usage. Patients should avoid excessive physical strain and ensure sufficient rest. Medical rehabilitation techniques play an important supportive role in helping patients manage and improve their condition, reducing joint pain, and enabling better self-care. Environmental modifications within the home may be necessary, such as replacing twist taps with lever taps or using bidets instead of wiping. These are some examples of non-pharmacological treatment methods.   2. Treatment with medications: Currently, the understanding and knowledge of rheumatoid arthritis have improved, leading to the development of various combined medication treatment methods. This has resulted in better control of inflammation, reduced joint damage, and a lower risk of disability compared to the past. The medications used for treatment consist of several groups of drugs, including the following:   Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, indomethacin, and diclofenac. These drugs have properties that alleviate pain and reduce inflammation. However, they may have potential side effects such as gastrointestinal irritation, liver inflammation, edema, high blood pressure, and difficulty in blood clotting. It is recommended to take these medications immediately after meals. Newer drug groups with fewer gastrointestinal side effects have been developed, but they provide similar pain relief and anti-inflammatory effects. Examples of these drugs include meloxicam, celecoxib, and etoricoxib.   Disease-modifying antirheumatic drugs (DMARDs) that modify the course of the disease. These medications do not directly relieve pain but exert their effects by reducing inflammation and suppressing the inflammatory cells. They help control the disease more effectively. Since these drugs do not have immediate pain relief effects, it may take several weeks or months for them to show their full efficacy, depending on the type of drug. There are several types of DMARDs available, such as chloroquine, sulfasalazine, methotrexate, gold salts, and leflunomide. These drugs have varying potential side effects, such as effects on the optic nerve, liver inflammation, bone marrow suppression, and interstitial lung disease. Therefore, the use of these medications should be closely monitored by a healthcare professional.   Corticosteroids, also known as steroid medications, can rapidly and effectively suppress inflammation. However, they have significant side effects, including thinning of the skin, weight gain, osteoporosis, cataracts, and adrenal insufficiency. Currently, healthcare professionals try to avoid using these medications unless patients have severe symptoms or for disease control during the initial stages when DMARDs have not yet shown their effects. Once the disease is well-controlled, the dosage of corticosteroids should be minimized, and their use should be discontinued as soon as possible.   Targeted synthetic DMARDs: It has been discovered that one of the key inflammatory substances in rheumatoid arthritis is cytokines. Therefore, medications targeting these cytokines have been developed. Examples of medications in this group include infliximab, etanercept, and adalimumab. These medications have shown great efficacy in treating rheumatoid arthritis by rapidly reducing inflammation and inhibiting joint damage. They can be used in patients who do not respond to DMARDs that modify the disease course. Potential side effects may include an increased risk of tuberculosis infection. However, treatment with medications in this group is costly.   3. Surgical treatment: Surgical treatment is an important method in the management of rheumatoid arthritis patients. It plays a crucial role in enhancing patient care and has various procedures involved. Surgical interventions for rheumatoid arthritis patients include synovectomy, joint replacement, and corrective surgery for deformities, among others.   With advancements in medical science, there have been significant progress and improvements in the treatment of rheumatoid arthritis. These advancements have helped reduce suffering, minimize disability, and enhance the quality of life for rheumatoid arthritis patients. However, it is essential to rely on early diagnosis and treatment, a comprehensive understanding of the disease, and proper patient management.  

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Well-being and Health Issues from Work

Well-being and Health Issues from Work   Dr. Phakin Lowasataporn Internal medicine at Vibhavadi Hospital In this month's special issue of the magazine celebrating the 25th anniversary of the hospital's founding, I have had the chance to write an article that is accessible to both readers and medical staff. It focuses on health problems in clinical practice that are commonly encountered in the workplace, yet are often overlooked. As of now, I am currently conducting a patient examination and the patient happens to be a working woman. Therefore, I would like to ask permission to use her as a case study in my article.   The patient presented with a headache around their temples, neck pain, occasional nausea, dizziness like they hadn't slept, and waking up in the middle of the night for unknown reasons. From further history taking, it was revealed that the patient works as a financial analyst and has to use the computer all day and bring their work home every day, leading to staying up late and waking up early to send their kids to school. The patient reported being in a good mood and having no work stress. Physical examination revealed no neurological abnormalities, but the patient is obese and has high blood pressure, as well as muscle pain in the nape of the neck when pressed. It seems likely that the headache is caused by prolonged sitting in the same position and looking at a computer screen all day, leading to tension in the temples, scalp, neck, shoulders, and back muscles. In addition, the patient's lifestyle of eating fast food, lack of exercise, and living in a hurry has led to an increase in their weight and blood pressure.   Did you see that? Not only was the headache of this patient a problem - but there were also other issues occurring without their knowledge. Therefore, treatment of this patient should not just be limited to oral medication. It would be beneficial to refer them to physical therapy or even acupuncture in order to loosen up tight muscles and determine the cause of the issue. Additionally, resting the eyes after using a computer for a while, as well as exercises for the neck, shoulders, and waist muscles, are all important for strengthening the body and improving overall immunity and weight control. Furthermore, eating healthy is key to a person's health, especially for busy city dwellers - as the saying goes, you are what you eat, and this will be reflected in your body.   Eating a diet high in fat can cause hyperlipidemia, which is an adjunct to coronary artery disease. Eating too much sweet food can result in diabetes, and obesity can lead to the same issues. After introducing this information to a patient, I realized I had said too much when the patient asked for an injection of pain medication to relieve their headache. I stopped the conversation and took the patient to wait for the injection, but I made an appointment for them to follow up on the headache and to have their blood pressure, blood sugar, and lipid levels monitored. This is why I want to remind everyone to pay more attention to their health since good health can be achieved through self-care.

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The Health Risks of Late Rain and Early Winter

At this time of year, the weather is unpredictable and can cause the body to take time to adjust, resulting in an increased risk of sickness. Common illnesses associated with this period are the common cold, influenza, pneumonia, measles, rubella, chickenpox, and diarrhea. Causes and Symptoms Cold and flu are caused by viruses that are easily transmitted. The virus enters the body through the nose, mouth, and eyes. It can also be transmitted through saliva of the infected person. The disease is highly contagious in crowded, poorly ventilated places. Signs The patient will experience fever, headache, runny nose, cough, sneezing, and sore throat. There may also be chills. For those with influenza, the more severe symptoms include a high fever, headache, muscle aches, and often nausea and vomiting. With proper rest and treatment, the patient is likely to recover from the disease within 5-7 days. However, some may develop complications such as pneumonia, bronchitis, and strep throat, which can be particularly dangerous for those in risk groups, such as pregnant women, obese individuals, those with chronic illnesses such as asthma, chronic lung disease, cardiovascular disease, liver disease, kidney disease, diabetes, and the elderly and young children. Treatment and Prevention 1. Avoid contact with patients, as well as not sharing items such as plates, cutlery, glasses, handkerchiefs, towels, etc. If there is a patient in the home, wear a hygienic mask when coughing or sneezing. 2. Wash your hands often with soap and water or use alcohol hand sanitizer. 3. During an influenza epidemic, reduce the number of places you go to and avoid poorly ventilated areas. 4. Work on maintaining your physical health regularly, eating nutritious food, exercising, getting enough rest, keeping warm, and not wearing wet clothes. 5. When flu symptoms occur, take a lot of rest, drink plenty of water, and use antipyretic medications and warm washcloths to wipe your body if it is hot. If symptoms do not improve, such as more coughing, tightness in the chest, and fever for more than two days, see a doctor immediately. 6. If you have flu-like symptoms and have had close contact with someone with influenza, see a doctor immediately.                                                                          Dr. Montri Wongniraspai, Internist at Vibhavadi Hospital

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