Treatment Options For Rheumatoid Arthritis

Patients with rheumatoid arthritis need proper management and control of their symptoms to improve the quality of life. Although taking analgesic medicines for a long duration of time leads to gastric problems but it is important to give patient some relief from disturbing pain and inflammation.

Non Pharmacological Management

  • Encourage regular exercise, physio and occupational therapy.
  • Provide household aids and personal aids e.g wrist splints.
  • Good mental and social support to improve life style and cope up with the disease.

Pharmacological Management


If there is no contraindication e.g an active peptic ulcer start with an NSAID, such as ibuprofen. There is no single NSAID that is superior to other agents, and newer agents have not been shown to have a decreased incidence in toxicity. If patient cannot tolerate NSAIDs then consider COX2 inhibitors that prevents gastrointestinal side effects.


Steroids may decrease joint damage and control difficult symptoms but using them for prolonged period of time leads to decreased bone density and predisposition to osteoporosis as well as other side effects related to prolonged steroid use.

Disease Modifying Drugs

Start DMARDs if there is persisting synovitis for more than 6 weeks. Sulfasalazine and methotrexate are typical 1st choices and are often used together. The drugs included in this group include: Continue reading “Treatment Options For Rheumatoid Arthritis”

Brief Summary About Anal Fissure


An anal fissure is a cutaneous tear in the ectodermal portion of the anal canal and is usually found in the postero-lateral wall  or in other words at 12 o’clock or 6 o’clock positions around the anal circumference.

Clinical Features

  • It commonly occurs after a bout of constipation and is very painful.
  • Patients find themselves in a vicious circle where they appreciate that the next bout of defecation will be painful, hence they avoid passing a stool and progressively become more constipated.
  • When the bowel is eventually opened the tear is made more worse.
  • Fresh bleeding is common and this can be a cause of bleeding per rectum in many patients.

Clinical Diagnostic Feature

A diagnostic feature of an anal fissure is anal pain after defecation and in chronic cases the skin at the lower part of the fissure becomes swollen and can be used as a marker of an anal fissure- the sentinel pile. This may be the only sign of a chronic anal fissure and it is often too painful to examine the patient proctoscopically.


Anal fissures are very common in young infants, but may occur at any age. The rate of anal fissures drops with age. Fissures are much less common among school-aged children than infants.

In adults, fissures may be caused by passing large, hard stools, or by having diarrhea for a long time. Other factors may include:

  • Decreased blood flow to the area in older adults
  • Too much tension in the sphincter muscles that control the anus

Anal fissures are also common in women after childbirth and in persons with Crohn’s disease.


Most fissures heal on their own and do not need treatment. To prevent or treat anal fissures in infants, be sure to change diapers often and clean the area gently. Continue reading “Brief Summary About Anal Fissure”

A Brief Introduction To Sabaceous Cyst


Sabaceous cyst which is also known as an epidermoid cyst is derived from hair follicles and it is a closed sac under the skin that is filled with a cheese like or oily material. It may be felt as small lumps or bumps under the skin.


Sabaceous cyst represent one of the commonest skin lesions, occurring at any age after childhood. They are often multiple and occur in any hair bearing site on the body most commonly on the trunk, face and neck and particularly on the scalp and scrotum. They do not occur on the palms and soles.

Clinical Features

The main symptom is usually a small, non-painful lump beneath the skin.

If the lump becomes infected or inflamed, other symptoms may include:

  • Skin redness
  • Tender or sore skin
  • Warm skin in the affected area

Grayish-white, cheesy, foul-smelling material may drain from the cyst.

The lesions are well defined and hemi spherical, growing slowly from 1-2 cm across. they lie in the subcutaneous tissue but are tethered to the skin by blocked duct, there being a pit on the surface at the site of hair follicle. gentle squeezing of the skin over the cyst demonstrates this point of tethering though the punctum is sometimes difficult to demonstrate, particularly over the scalp; when present it is diagnostic.

Important things to remember in relation to sabaceous cysts

  • Sabaceous cysts are associated with osteomas and intestinal polyps in Gardner’s syndrome.
  • Sabaceous cysts may occasionally ulcerate and in these cases can look very much like a malignant skin lesion.


Sebaceous cysts most often arise from swollen hair follicles. Skin trauma can also induce a cyst to form. Excessive testosterone production will also cause such cysts.  Continue reading “A Brief Introduction To Sabaceous Cyst”

Skin Manifestations Of Non Malignant Systemic Diseases

The skin functions as a barrier against potentially harmful physical and chemical agents as well as against different microorganisms. Sometimes different features may be seen that help to differentiate different systemic diseases. A brief list of the skin manifestations of non malignant systemic diseases is given here:

1. Erythema

  • Collagen disease
  • Carcinoid
  • Mitral valve disease
  • Polycythemia
  • Superior vena caval obstruction
  • Liver disease
  • Hyperviscosity syndrome

2. Erythema Multiforme

  • Fever
  • Inflammatory bowel disease
  • Rheumatoid arthritis
  • Thyrotoxicosis
  • Viral Infections

3. Urtricaria

  • Collagen disorders
  • Xanthomatoses
  • Hereditary angioneurotic edema
  • Urtricaria pigmentosa
  • Henoch-Schonlein purpura
  • Cold aglutinins

4. Scaling

  • Vitamin deficiencies
  • Hypothyroidism
  • Acromegaly
  • Malabsorption
  • Refsum’s and Reiter’s diseases

5. Papules and Nodules Continue reading “Skin Manifestations Of Non Malignant Systemic Diseases”