Doyt L. Conn, MD
Rheumatologist

Drug-Related Hair Loss
Q. I have been taking Plaquenil for 10 years for my polymyositis. (My current dose is 200 milligrams twice a day.) It has helped me a lot, but during the past few years I have experienced increasingly severe hair loss. Could this medication be responsible?

A. Although certain medications are frequently associated with hair loss, with hydroxychloroquine sulfate (Plaquenil) this problem is extremely rare. Hair loss is listed in the Physicians' Desk Reference as a potential side effect of Plaquenil; however, only six cases of hair loss have been reported to the drug's manufacturer.

Furthermore, in individual cases, it is difficult to be sure that hair loss was caused by the drug instead of another cause, such as dietary deficiency, stress or hormonal problems, just to name a few.

Even though I know very little about your specific situation, I would suspect that there is probably another cause for your hair loss. And because you seem to be doing well on Plaquenil, I would not recommend stopping the drug. Instead, consult your physician about other possible causes for your hair loss and what might be done to slow or stop it.

More information on hair loss, including drugs that promote hair loss, can be found at www.keratin.com. You might find some other useful information there, although I wouldn't recommend purchasing any drugs advertised on the site without first consulting your doctor.

Don Miller, Pharmd
Pharmacist

CREST Syndrome Spelled Out
Q. I have had rheumatoid arthritis for eight years. I have now been diagnosed with CREST syndrome. Can you tell me what that is?

A. CREST is an acronym for calcinosis (calcium deposits in the skin); Raynaud's phenomenon (blanching of the fingers in response to stress or cold temperatures); esophageal dysmotility (difficulty swallowing); sclerodactyly (tightening of the skin of the fingers); and telangectasias (red vascular skin lesions), frequently on the face and hands.

CREST syndrome is a variant of a more serious and diffuse disease known as scleroderma. Many people with CREST also have joint pain and swelling (arthritis) and may not have all the characteristic symptoms I mentioned above. There is no cure for the syndrome; however, treatment can help alleviate the symptoms. For example, swallowing problems may be treated by drugs called H2 blockers -- including cimetidine (Tagamet), ranitidine hydrochloride (Zantac) -- or proton pump inhibitors, including omeprazole (Prilosec) and lansoprazole (Prevacid). Raynaud's syndrome may be treated with drugs that open the blood vessels including calcium channel blockers, such as bepridil (Vascor), diltiazem (Cardizem) and felodipine (Plendil).

Leonard H. Calabrese, DO
Rheumatologist

Will Arthroscopy fix Arthritis in the shoulder?
Q. My husband recently had arthroscopic surgery to “smooth off” the rough areas in his osteoarthritic shoulder. Is this a permanent fix for his problem?

A. When joint cartilage is damaged by osteoarthritis, smoothing the rough cartilage and removing cartilage debris through arthroscopic surgery can offer temporary, symptomatic relief. The procedure may slow down the arthritic process and relieve symptoms for a while -- maybe several months, maybe more -- but it can't stop the disease.

I can't say how long your husband will experience relief, as the effects vary from patient to patient; however, proper medication and exercise can help maximize the effectiveness of the surgery.

If your husband continues to have problems or suffers severe, chronic pain, total replacement of the shoulder joint offers excellent results.

Jeffrey Nugent, MD
Orthopaedic surgeon

What is Inflammatory Arthritis?
Q. My rheumatologist classifies my arthritis as inflammatory arthritis. Is this different from rheumatoid arthritis, or is it just a term to use when no tests are conclusive?

A. As you suspected, the term inflammatory arthritis is often used when a doctor is unable to make a definitive diagnosis. Arthritis by definition means inflammation of the joints, although there are, in fact, many different forms of the disease. Most forms do show evidence of inflammation, such as redness, heat, swelling, tenderness and difficulty with movement.

Generally a doctor can make a more specific diagnosis on the basis of laboratory tests, including the rheumatoid factor; X-ray findings; and the occurrence of other signs.

However, when joint inflammation is present without other findings to pinpoint the diagnosis, the term inflammatory arthritis is used. This term can be helpful to distinguish the condition from osteoarthritis, which is usually considered non-inflammatory in origin.

Just because your doctor is calling your condition “inflammatory arthritis” now doesn't mean that will always be your diagnosis. Sometimes, it takes a while for findings to appear that enable a doctor to make a specific diagnosis.

David Pisetsky, MD, PhD
Rheumatologist

Thyroid/Arthritis Connection
Q. Is there a connection between thyroid problems and arthritis?

A. There is a very interesting relationship between arthritis and disorders of the thyroid gland: Thyroid disease can lead to a type of arthritis, and certain forms of arthritis can increase the risk of thyroid disease.

Arthritis can occur with either hypothyroidism (too little thyroid hormone) and hyperthyroidism (too much thyroid hormone). In fact, it is not uncommon for people with thyroid disease to first seek medical attention for musculoskeletal problems.

People with hypothyroidism commonly develop profound fatigue and a fibromyalgia-like syndrome with diffuse muscle aches and tender points. In addition, they may develop arthritis in the hands and knees that resembles rheumatoid arthritis (RA). Musculoskeletal complications are much less common in people with hyperthyroidism, but can include severe osteoporosis, as well as an unusual swelling of the fingers and legs called “thyroid achropachy.” In general, rheumatic complaints resolve as the thyroid disease is treated.

When thyroid disease occurs as a complication of an inflammatory disease, such as RA, lupus, scleroderma or polymyositis, treatment of both the underlying arthritis and the thyroid disease is generally needed.

John Klippel, MD
Rheumatologist

Heartburn in the Back?
Q. I have arthritis of the knees and often feel as though I have heartburn in my back. Is this possible, or could this be an early sign that arthritis is spreading to my back?

A. I guess it's possible that the feeling you describe could be arthritis in your back, but what you're experiencing is more likely to be heartburn, or more properly called gastroesophageal reflux, the backflow of stomach acid into the esophagus.

The symptoms of gastroesophageal reflux can be felt in the abdomen, back or chest. The reason is that sometimes pain or other sensations are perceived by our brains as originating from sites other than that from which they actually originate -- a phenomenon called referred pain. (An example of referred pain is the pain from a heart attack that is felt in the left arm or jaw.)

Although gastroesophageal reflux is my best guess as to what's causing your symptoms, I cannot say with certainty. To find the specific cause of your symptoms -- and to determine whether they have anything to do with arthritis -- you'll need to see your doctor.

C. Tim Lambert, MD
Family Physician