您对毒品和特定条件的问题

Q)我被提供了一种生物疗法的选择ankylosing spondylitis，我已经严重，但是我觉得我有足够的知识来做出决定最适合我的决定。您能提供任何建议吗？

马克，西米德兰兹 - 2014年

A)You will be aware that I can only offer the most general advice about this. Treatment choice is a matter for discussion between clinician and patient and should be an individualised decision. I would think that your rheumatology department has skilled nurses who can spend time with you and who can go over the various treatment options with you. The cost and potency of biological drugs mean that there are certain conditions to fulfil before you can be offered them, and these will have been taken into consideration by your rheumatologist. It is usually necessary for you to have not responded to two different疾病改良的抗风湿药（DMARDS）并具有一定程度的疾病活动，这是由您的医生判断的。如果您有结核病，多发性硬化症或癌症的史，那么这些药物通常不建议使用。通常，通过阻断TNF（肿瘤坏死因子）和它们都具有相似疗效的所有用于强直性脊柱炎的生物学药物，因此，选择稍微取决于注射的频率（大多数是自我注射），或者，如果患者认为他们可以可以进行注射的频率’t self-inject, there is an intravenous preparation.

This answer was provided by Dr Philip Helliwell in 2014, and was correct at the time of publication.

Q)我是一个73岁的女人，被诊断出患有纤维肌痛20 years ago. I've generally been able to manage this and take no medication other than vitamin supplements. My GP has begun treating me for hypertension. As I've recently been diagnosed with sicca syndrome (and am awaiting the results of a test forSjögren的) this provoked a major flare-up of the fibromyalgia. I wonder if other fibromyalgia patients experience difficulties in adapting to hypertensive drugs?

June, Gloucestershire - 2011

A)我认为这不是仅限于纤维肌痛患者的问题。人们经常在找到一种适合它们的抗高血压药物之前服用几种抗高血压药物。副作用可能很奇怪，并且涵盖了许多症状。纤维肌痛可能与眼睛和口腔干燥（SICCA症状）有关，无论是作为相关症状还是作为治疗该疾病的药物的副作用，例如阿米替林. Many people on amitriptyline (this class of drugs are known as tricyclics) complain of dryness.

该答案由Philip Helliwell博士在2011年提供，在出版时是正确的。

Q)帮助！我只是从另一个攻击中恢复过来痛风. During the past six years I've had attacks of gout approximately once a year but from January 2009 have had frequent attacks, occurring every three weeks, in the big toe, ball of the foot joint and other parts of the foot. In January my doctor prescribed a daily intake of别嘌醇300毫克，在8月中旬，他们将剂量增加到600毫克。您能为为什么我仍会受到攻击而阐明什么？血液测试显示尿酸水平较低。我今年84岁。

Mrs Collins, Essex - 2010

A)This is a difficult one. Allopurinol lowers the level of uric acid in the blood and tissues. This clearing of uric acid may take some time to happen and can be associated with new attacks of gout while the clear out is occurring. This is well recognised and usually stops after about three months. However, in some people, and particularly those people with large deposits of gouty crystals in their tissues, called tophi, this process can take longer. If you have these tophi, this may apply in your case, but don’t despair, things will improve eventually.

There are other reasons why you might be getting more attacks of gout. Even while you're taking allopurinol certain other drugs can work against it. These drugs include low-dose aspirin, which is commonly prescribed nowadays. A high alcohol intake will also work against allopurinol, as will kidneys that don’t function too well (also common in the elderly). So plenty of reasons there, and best to discuss with your doctor which may apply in your case.

该答案由Philip Helliwell博士在2010年提供，在出版时是正确的。

Q)我77岁，很严重骨质疏松症. I've been taking alendronate once a week. A recent bone density scan showed little improvement, although it's no worse. My GP recommended a daily dose of risedronate but I found I wasn't so well on that, so I'm back on the aledronate. Which one do you think would be more beneficial? My GP is open to whatever suits me.

橄榄，西米德兰兹 - 2011年

A)alendronate和risdronate称为bisphophonates在班上,有其他人,其中一些are only taken annually by injection. That you haven't lost bone is good, as the natural tendency at your age is to lose bone density, so the alendronate is working to some extent. In changing drugs there are many factors to consider. If you've been on these drugs for 10 years or more it may be time for a change. If you've recently had a fracture this might indicate that a treatment change is necessary. And there's your lifestyle to consider – smoking and alcohol accelerate bone loss and if you tend to have falls it's important to keep your bones as strong as possible. There's no easy or simple answer to your question as each case must be considered on its merit.

该答案由Philip Helliwell博士在2011年提供，在出版时是正确的。

Q)您能告诉我脊椎滑脱或宫颈脊椎病会变成或变成关节炎吗？还是他们根本没有与关节炎没有联系？

什罗普郡谢丽尔 - 2012年

A)These terms are confusing and doctors often use them to mean different things. Spondylolisthesis is one vertebra slipping on the next. This can occur because of minor abnormalities in the bones that are present at birth, or because of arthritis in the joints between the vertebrae. Spondylosis is another term for arthritis of the spine.

This answer was provided by Dr Philip Helliwell in 2012, and was correct at the time of publication.

Q)Can a whiplash injury cause spondylitis? I was in a crash over a year ago and I am still in incredible pain, with numbness and tingling in right hand.

事故发生前我从未遭受疼痛，我的研究指向脊柱炎。我的医生感到困惑，所以我试图诊断自己。他们给了我一个Tens机器.

Lesley, via email - 2015

A)Let's clear up a bit of unhelpful terminology here. Spondylitis is a bit of a useless term, in my opinion. It refers to inflammation of the joints of the neck and it's used as a diagnosis for a lot of neck problems. But it's a bit of a catch-all phrase that doesn't properly describe what's happening to you – pain in your neck with radiation to the right arm and hand.

事物的声音是鞭打（由头部向前和向后移动造成的伤害）造成neck pain，可能来自支撑脊柱的肌肉和韧带，并通过它的声音对从颈部传播的神经有些刺激，压力或伤害。从颈部辐射到手的疼痛，尤其是与麻木和刺痛有关的疼痛，几乎是神经离开脊椎时受伤的标志。

如果您有一年的症状，并且没有明确的理由，则需要进一步研究 - 首先进行MRI扫描，然后进行神经传导研究（也称为EMG - 肌轮学），如果MRI没有完全解释发生了什么。

也就是说，一台机器是您痛苦的合理建议。这是安全有效的，可以在您等待调查时开始。但是，只有在您有适当的诊断时才能知道全部治疗选择。如果您的医生感到困惑，那么他们需要将您推荐给可以给您适当诊断，解释和管理计划的人。

该答案由汤姆·马格姆（Tom Margham）博士在2015年提供，在出版时是正确的。

Q)Is there any connection between运动过度在关节和关节炎中？我今年43岁，已经遭受了多年的膝盖疼痛，并且在过去的十年中也瘫痪了两张光盘。对于我这个年龄的人来说，这似乎是很多问题。话虽如此，我确实在1985年被一辆汽车撞倒，并被告知我会尽早患关节炎。请感谢您的意见。

苏，西米德兰兹郡哈尔索芬 - 2011年

A)教授霍华德鸟,最近刚刚工夫ed after a long career working as a rheumatologist in Leeds, spent much of his early career looking at the relationship between hypermobility (bendy joints) and arthritis. He found that hypermobility predisposed people to a number of rheumatic complaints, one of which was a tendency to develop osteoarthritis at a younger age. Although the term hypermobility covers a 'mixed bag' of diagnoses, those people who inherit the tendency can get other problems such as varicose veins, piles and slipped discs. This may be because the 'tissue scaffold' is weaker than normal. Although people with generalised hypermobility are born like that, it's possible to acquire hypermobility in just one or two joints with use (or abuse if you like). There's no doubt that hypermobility can convey advantages in certain activities such as ballet, music and gymnastics, but it's a double-edged sword and it requires careful management to avoid future problems.

该答案由Philip Helliwell博士在2011年提供，在出版时是正确的。

Q)脊髓灰质炎是否被调查为影响关节炎变得不可避免的可能疾病？The summer after I was born in 1924 I contacted 'infant paralysis'. It affected my right hip and leg, which grew two-and-a-half inches shorter than my left. As a child I wore a built-up boot and callipers. I developedosteoarthritisin my forties in my hip, knee, ankle, neck and arms and have been unable to walk for the past 20 years so have been confined to wheelchair.

Doris, Great Holm, Milton Keynes - 2013

A)There are no formal studies but the association between polio and arthritis has long been recognised. Polio is a disease of the nerves and, if it happens in childhood, affected limbs and spine do not develop fully. In later life this, of course, alters the mechanics of both the affected limbs and the unaffected limbs, putting additional strain on the bones and joints. Premature osteoarthritis of the major joints and spine is the result. Some of the worst cases I have seen have been in ex-polio sufferers. Thankfully, as polio is eradicated, this is becoming an increasingly uncommon occurrence.

This answer was provided by Dr Philip Helliwell in 2013, and was correct at the time of publication.