Eldersburg Arthritis

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Phone: (410) 795-9700

Address: 6190 Georgetown Blvd, Sykesville, MD 21784

Website: http://eldersarthritis.com

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Eldersburg Arthritis

General Practitioners

Osteoporosis
Arthritis
To more accurately assess the incidence of childhood arthritis and to better understand its etiology, it is necessary to both more rigorously and more inclusively define the diseases which cause arthritis in children. As a result, the older term juvenile rheumatoid arthritis (JRA) is being replaced by the term juvenile idiopathic arthritis (JIA). JIA will incorporate all of what has been called JRA in the past, but also will incorporate all other forms of "idiopathic" arthritis in childhood. JIA has classically been divided into three subsets based upon associated symptoms and the number of joints involved...
Fibromyalgia
Fibromyalgia (FM) is a common cause of chronic musculoskeletal pain. It is one of a group of soft tissue pain disorders that affect muscles and soft tissues such as tendons and ligaments. None of these conditions is associated with tissue inflammation and the etiology of the pain is not known.Fibromyalgia, like other functional somatic syndromes, has been a controversial illness. Patients look well, there are no obvious abnormalities on physical examination, and laboratory and radiologic studies are normal. Thus, the role of organic illness has been questioned, and fibromyalgia has often been considered to be psychogenic or psychosomatic. Current pathophysiologic concepts focus on alterations in central nervous system pain processing.
Plantar Fasciitis
Sinusitis
Medical Weight Loss
Early signs: fatigue, muscle pain, a low-grade fever, weight loss, Joint pain, stiffness (worse in the morning for more than 1 hour), and swelling in the hands, wrists, elbows, shoulders, knees, ankles, feet, hips and neck. Gel phenomenon is defined as stiffness and immobility after sitting still for a period of time. RA nodules are painless lumps under the skin on the dorsal aspect of the fingers, around the elbows or Achilles tendons. Other organ involvement in RA patients: Pleural and pericardial fluid collection. Inflammation of the lung may cause shortness of breath and a dry cough. Inflammation of the eyes may cause vision problems. Dry eyes and dry mouth. Blood tests positive in RA: Rheumatoid factor (RF), anti -CCP Antibody, positive ANA, high C-reactive protein and anemia.
Rheumatology
Multiple alternative terms, diagnostic, and classification approaches and criteria have been proposed. None of the alternative terms, criteria, or diagnostic approaches has been validated by prospective studies, nor are any universally accepted by the scientific community. Many of the studies generating these diagnostic approaches involve patients seen in rheumatology clinics, but the patient populations seen by rheumatologists may be very different from those seen in the general community. Thus, strictly speaking, reactive arthritis is still an evolving concept rather than an entity with validated diagnostic, or even classification, criteria.
Primary Care
We are working in a friendly environment, with the highest degree of medical technology and an up-dated, state-of-the-art infrastructure, including new computers and telephone systems. We are also working in a complex team with primary care physicians, orthopedic surgeons, podiatrists, physical and occupational therapists, nutritionists and pain management specialists to provide the best care and a complex approach to the challenging problems our patients face with their medical condition.
Irritable Bowel Syndrome
Patients also may have a variety of poorly understood pain symptoms, including abdominal and chest wall pain and symptoms suggestive of irritable bowel syndrome, pelvic pain and bladder symptoms of frequency and urgency suggestive of the interstitial cystitis/painful bladder syndrome, formerly female urethral syndrome. Other common complaints include ocular dryness, multiple chemical sensitivity and "allergic" symptoms, palpitations, dyspnea, vulvodynia, dysmenorrhea, sexual dysfunction, weight fluctuations, night sweats, dysphagia, dysgeusia, and orthostatic intolerance. In patients with fibromyalgia, the only reproducible finding on physical examination is tenderness in specific anatomic locations. The tender point examination requires that the examiner knows where to palpate and how much pressure to apply. In an attempt to provide some homogeneity in patient populations in clinical studies, various classification criteria for fibromyalgia have been developed and tested. The final 1990 ACR FM classification criteria included...
Bronchitis
Diarrhea
Immunizations
The only genital pathogen commonly accepted to be the cause of reactive arthritis is Chlamydia trachomatis. The classical symptoms of these infections are diarrhea or urethritis. Patients with arthritis induced by enteric bacteria can also develop aseptic urethritis. It is also possible for the causative infection to be asymptomatic. A number of other bacteria have been reported to cause reactive arthritis, including Mycoplasma genitalium, Ureaplasma urealyticum and Chlamydia pneumoniae, beta-hemolytic Streptococci, Neisseria gonorrhea, and vaccination with some live vaccines. These organisms can induce arthritis, but they are not regarded as a spondyloarthritis or reactive arthritis. Reactive arthritis has been reported in patients with HIV infection. In HIV-infected Caucasians, but not Africans, an association between reactive arthritis and HLA-B27 has been noted.

Ophthalmologists

Glaucoma
Cevimeline (Evoxac®) is a derivative of acetylcholine with a higher affinity for muscarinic M1 and M3 receptors on the lacrimal and salivary epithelium than for receptors on heart tissue. Doses of 30 or 60 mg three times daily alleviate the symptoms of dry mouth, dry eyes, and stimulate salivary flow; the 30 mg dose is nearly as effective as the higher dose and is better tolerated. Major side effects of cevimeline include excessive sweating, nausea, rhinitis, diarrhea, and visual disturbances. It is contraindicated in patients with asthma, narrow-angle glaucoma, or iritis.
Cataracts
Nonsteroidal anti-inflammatory medication (NSAIDs) used to reduce the inflammation in the joints and subsequently to relieve the pain. NSAIDs do not reduce the long term damaging effects of rheumatoid arthritis on the joints (do not stop the disease progression). Disease-modifying antirheumatic drugs (DMARDs) may reduce the inflammation of RA and can slow disease progression and prevent joint damage. Drugs in this class include hydroxychloroquine, methotrexate, sulfasalazine, leflunomide. These medications act slowly, in several weeks to months. The biologic medication is an advanced therapeutic option for severe RA working as a down-regulator of the immune system to prevent tissue damage. Anti-TNF agents bind the immune cytokine molecule named tumor necrosis factor (TNF) and include: Etanercept (Enbrel), Adalimumab (Humira), and Infliximab (Remicade). Abatacept (Orencia) interferes with the activation of T cells. Abatacept is now approved for use in moderate to severe RA treatment as first line therapy or if failing the DMARD therapy. Rituximab (Rituxan) depletes a subpopulation of immune cells named B cells. Rituximab is usually recommended only for people with moderate or severe RA that is not controlled with methotrexate and an anti-TNF agent. Steroidal medication like Prednisone and Prednisolone has rapid and strong anti-inflammatory effects and are usually used in emergent situations. Due to severe and multiple side effects (bone loss, hypertension, weight gain, skin fragility, diabetes, cataracts etc) steroids are usually used at the lowest possible dose for the shortest period of time. Simple analgesics relieve pain, but they have no effect on inflammation and include: Acetaminophen (Tylenol), Tramadol (Ultram), and Voltaren gel or Diclofenac (Flector) and Lidoderm patches. Narcotic analgesics such as codeine, oxycodone, and hydrocodone are generally not recommended long term because of the risk of dependence and addiction.
Eye Exam
Hydroxychloroquine - (Plaquenil) has immune system modulating effects that reduce the inflammation of arthritis in some people. This drug may be recommended for patients with severe inflammatory OA and to those who have bone damage related to osteoarthritis, the most advanced form of OA also named “inflammatory erosive OA”. An eye exam yearly is recommended for patients using this drug for more than 6 months to avoid any type of toxic effects on the retina, the inner layer of the eye.

Pelvic Pain
Pregnancy

Internal Medicine
Dr. Nic was born and educated in Romania. He graduated Medical School (M.D. degree) and then obtained a Ph.D. degree in biochemistry and immunology at the University of Medicine and Pharmacy in Cluj-Napoca, Romania. He came to the US as a research fellow at the University of Maryland School of Medicine. He was then an intern and resident in Internal Medicine at “St. Agnes Hospital” in Baltimore MD, then a fellow in clinical rheumatology and immunology at the “University of Maryland School of Medicine”. He was actively involved in medical research at this institution and he is co-author of 8 book chapters and more than 80 research papers published in peer-reviewed medical journals in the field of immunology and immunopathology, with special reference to autoimmune mechanisms associated to rheumatic disorders. Please see: NCBI Pubmed for more details.
Kidney Stones
Gout is a very painful condition that develops in some people who have chronically high blood levels of uric acid, which is produced in the liver, and insufficiently eliminated through the kidney. Crystals of uric acid may precipitate in the joints and produce the gouty arthritis. Uric acid crystals can also be deposited in the kidney or urinary tract, and cause kidney stones and occasionally impairing kidney function. More than 15 % of patients with gout develop also kidney stones. It is estimated that gout affects approximately 2% of people in the United States.
Interstitial Cystitis

Carpal Tunnel Syndrome
Patients also often report paresthesias, including numbness, tingling, burning, or creeping or crawling sensations, especially in both arms and both legs. However, unless a concurrent neurologic disorder, such as carpal tunnel syndrome or a cervical radiculopathy, is present, a detailed neurologic evaluation or formal testing is usually unremarkable.

Depression
Mental Health
Patients with fibromyalgia generally respond best to a multidisciplinary, individualized treatment program that incorporates physician as well as non-physician providers. This includes a team of physical medicine, rehabilitation, and mental health specialists.
Anxiety

Endocrinologist

Diabetes Care

MRI
●If there is only one BME lesion for each MRI slice, the lesion should be present on at least two consecutive slices.
X-Rays
Computed Tomography

Joint Replacement
Etiology and pathogenesis: The osteoarthritis (OA) is the leading cause of physical disability, increased health care utilization and costs, as well as a substantially impaired quality of life, in our modern, industrialized society. More than 56 millions Americans suffer from this condition today, and this is a number much larger than all the patients with diabetes, cancer, HIV/AIDS and hypertension taken together. Moreover, the impact of this arthritic condition is expected to grow with both the population increase and its aging during the coming decades. OA was thought in the past to be a normal consequence of aging, therefore considered a “degenerative joint disease”. Now, however, we realize that OA results from a multi-factorial pathogenesis, affecting the joint integrity and including aging itself, trauma or other mechanical forces, a certain genetic predisposition, a local inflammation associated to the late stages of cartilage degeneration, as well as a complex cellular and biochemical process. Despite an extensive prevalence and a very heterogenous pathogenesis, only in part understood today, the progression of OA remains beyond our explanation, due in part to multiple factors including our inability to detect the early phase of the disease, as well as the lack of appropriate procedures to replace the damaged cartilage. The cartilage injury appears during the early stages, however a complete cartilage loss occurs in the late stages of the disease and is the key element of the joint impairment with its subsequent necessity of joint replacement. If, we will be able to re-grow a normal healthy cartilage in an advanced osteoarthritic joint, the chances of a prolonged life and functionality of this joint may be expected, and eventually OA may be cured.
Orthopedic Surgery
Orthopedic surgery is the last resort in the treatment of OA. Arthroscopic surgery was not proven to be superior to the medical treatment unless a structural damage like ligament or meniscus tear is present. Total joint replacement may be a successful option if used in the right patient. The judgments and recommendation for this radical procedure belongs to specialized orthopedic surgeons who use their clinical skills and experience to predict the full success of the procedure. The age, the body weight, the patient’s mobility and compliance, as well as the type of joint and the amount of joint damage have to be taken into consideration when such a complex surgical procedure is decided.

Frostbite
RP is considered primary if it occurs alone or secondary if it occurs in the presence of a related illness (systemic lupus erythematosus, scleroderma, rheumatoid arthritis, Sjogren’s Syndrome, Polymiositis, vasculitis) or induced by a drug (beta-blockers, ergot alkaloids, cocaine), or by vibration in workers with a vibratory tool or if caused by an occlusive arterial disease (arteriosclerosis or antiphospholipid syndrome), vascular trauma or after frostbite.
Lesions
The terms spondyloarthritis or spondyloarthropathies are used to refer to a family of diseases that share a group of similar clinical features. The most distinguishing features are inflammation of axial joints (especially the sacroiliac joints), asymmetric oligoarthritis (especially of the lower extremities), dactylitis (sausage digits), and enthesitis (inflammation at sites of ligament or tendon attachment to bone). Additional features include genital and skin lesions, eye and bowel inflammation, an association with preceding or ongoing infectious disorders, positive family history, elevated acute phase reactants, and a strong association with the human leukocyte antigen (HLA)-B27.
Rashes
Psoriasis
Psoriasis is a chronic skin disease mediated by the immune system that appears as patches of thick, inflamed red, scaly silvery plaques. More than 40% of people with psoriasis also develop psoriatic arthritis. PSA is a type of arthritis that affects men and women equally and causes pain, swelling, and stiffness of the joints.

Physical Therapists

Physical Therapy
Nonpharmacologic therapies for OA - include exercise programs, weight loss, patient education, and physical therapy including a very useful aquatic therapy program. The nonpharmacologic interventions, other than surgical approaches, are generally recommended before the start of medication. Especially weight loss and moderate stretching/relaxing exercises with the recondition of the muscles and tendons strength may be very useful from the beginning of the therapy. Acupuncture and alternative and complementary therapies are also useful in different clinical conditions and for a limited group of patients.
Shoulder Pain
Back Pain
Aquatic Therapy
Exercise - home-based or supervised exercises by physical therapy programs, can help maintain the function and relief the symptoms, however cannot stop the progression of the disease. Exercises include postural training, range of motion stretching and recreational activities; swimming and other types of hydrotherapy (hot tub bath) or aquatic pool therapy, are highly recommended. In addition, pain relief measures such as local heat or cold can be given a trial. At a minimum, patients with AS should participate in an unsupervised home-based exercise program including stretching/relaxing movements of 10 to 15 minutes duration, twice a day, preferably in the morning and evening.

Plantar Fasciitis
As with any chronic inflammatory disease, patients with AS may have fatigue and malaise. Disturbed sleep, caused by back or joint pain at night, as well as an excess of cytokines release from the overactive immune cells may contribute to the fatigue. Fever is an infrequent but not absent manifestation of AS in adults. Low back pain in the vertebral area (cervical thoracic, lumbar) or SI joints are most frequently present, sometimes with an unbearable intensity. Chostochondritis (rib cage pain) with a limited chest expansion, hip, knee, ankle, shoulder pain, feet pain associated to plantar fasciitis and inflammation with pain in different tendons (tendonitis), muscle fascia (fasciitis) and periarticular bursa (bursitis) are also frequently present. Most of the patients are unable to bend down below the level of the knee because of the loss of spine mobility (Shober test); the Si joints and the lumbar spine are very sensitive at local compression or by legs bending (Patrick sign); in the advanced forms of disease, do to the loss of cervical spine mobility, the standing patient along the wall is unable to touch the wall with the head (“occiput to wall” test). The imaging techniques which have been used to assess the SI joints include scintigraphy, ultrasonography, plain radiography, conventional tomography, computed tomography and MRI. X-rays of the lumbar spine and SI joints are able to identify fibrosis, extra-bone formation or bony erosions only in the advanced forms of disease (Stages III and IV) when the joint mobility is already compromised. Therefore the initial imaging changes (Stage I of disease) are seen by MRI (bone marrow edema) or by Echo-Doppler ultrasonography (new vessel formation in the cortical bone) which are now highly recommended for an early detection of AS.

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