Some aspects of “ Pseudogout ” with homoepathic mode of treatment

Also known as Calcium pyrophosphate deposition (CPPD) disease, pseudogout is an arthrpathy due to deposition of calcium pyrophosphate dihydrate (CPPD) crystals in articular cartilage & periarticular tissue & has many similarities with gout. Pseudogout has been reported to occasionally coexist with gout. This means that the two types of crystals can sometimes be found in the same joint fluid.

Sex- It occurs slightly more commonly in men.

Age- It usually occurs after the age of 60 years. But those with familial chondrocalcinosis may be affected at younger ages.

Aetiology- Aetiology of pseudogout is unknown but there is an association with primary hyperparathyroidism, haemochromatosis, ochronosis, amyloidosis, & hypothyroidism

Risk factors-
(1) Older age- Chance of developing the disease increases with age.
(2) Joint trauma- Trauma to a joint such as a serious injury or a joint replacement surgery, increases the risk of deposition CPPD crystals in the joints.
(3) Family history -Chance of developing pseudogout increases in case of a family history of the disease.

Site of lesion - Larger joints are more affected. In a majority of patients the knee joints are involved. Other areas commonly involved are elbows, wrists, ankles, shoulder & hip.

Associated medical conditions- Hyperparathyroidism, haemochromatosis, amyloidosis, hypothyroidism, hypophosphatasia & true gout.

Clinical Features- The clinical presentation is similar to that of normal gout, however, the onset is much slower, & its course is much milder. The attack begins suddenly with pain & swelling. The affected joint is warm & swollen with a large effusion. The pain may last for days to weeks & can resolve spontaneously. Pseudogout tends to be polyarticular but symmetrical involvement of joints is usually unlikely. Occasionally pyrophosphate deposition may be totally asymptomatic.

Investigations-
(1) Blood test- Serum calcium is normal. ESR may be raised during an attack.
(2) Analysis of Joint fluid- Joint fluid from an affected joint examined under a polarizing microscope if reveals the presence of calcium pyrophosphate crystals, diagnosis is confirmed.
(3) X-ray & MRI - X-ray & MRI, though cannot provide diagnostic confirmation of the disease, may be advocated to rule out other causes of pain & presence of associated medical conditions. They are also helpful to evaluate the extent of the disease & to detect possible damage to bone & surrounding structures. X –ray may also show calcifications in cartilage of joints referred to as chondrocalcinosis.

Differential Diagnosis- Pseudogout is to be differentiated from rheumatoid arthritis, osteoarthritis, gout, psoriatic arthritis, septic arthritis etc।

Treatment-

[A] General measures to be taken are-

(1) Cold compresses on painful joints.
(2) Complete rest.
(3) Exercise after the pain subsides.

[B] Homeopathic medicines to be used – Of the different homeopathic medicines commonly used, Aconite, Benzoicum acidum, Bryonia, Calcarea phos, Colchicum, Formica rufa, Rhus toxicodendron (Rhus.tox),ledum pal, etc. need to be mentioned. The use of the medicines is more or less the same as that in gout. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual along with type of gout whether it is acute or chronic. Lower potency is to be used at the beginning. If response is not satisfactory a second dose should be used. If desired effect is still not noticed, it is better to switch over to a new medicine.

Prevention-It is not known how to prevent pseudogout. If the condition has developed because of some other medical conditions, such as haemochromatosis, treatment of that condition may prevent progression of other features of that potentially dangerous illness & may in some cases, slow the development of pseudogout.

Prognosis- Often the inflamed joints heal without any residual damage but in many people permanent damage may occur with severe destruction of some joints. Pseudogout often complicates osteoarthritis, particularly in the knees & hips.


In short, pseugout is manifested by intense joint pain & swelling involving a single or multiple joints, & is to be treated by Aconite, Benzoicum acidum, Bryonia, Calcarea phos, Colchicum, Formica rufa, Rhus.tox etc.

But in every case, a doctor should be consulted.

Some aspects of “Achilles tendonitis” with homoepathic mode of treatment

Achilles tendonitis is the inflammation (tendonitis) of the Achilles tendon which is the thickest & strongest tendon in the body connecting the heel to the calf muscles & thus enables a person to stand on the toes, to walk, to run or to jump. Achilles tendonitis is a frequent complaint in athletes, especially runners training under less than ideal conditions.

Causes- Lack of flexibility & overpronation are the two basic causes. Associated causes may be the following-

[A] Extrinsic-
(1) Repetitive stresses to the tendon.
(2) Overuse.
(3) Overtraining.
(4) Poor conditioning.
(5) Improper training surfaces.
(6) Improper stretching exercises.

[B] Intrinsic-
(1) Age.
(2) Tight Achilles tendon.
(3) Different congenital foot & knee deformities.
(4) Medical diseases affecting tendon tissue like diabetes mellitus.
(5) Use of long continued steroids.

Clinical features-
(1) Pain over & above the back of the heel which increases on participation in activities especially after a period of inactivity. Hence patients complain of pain after first walking in the morning & also on running or jumping.
(2) Tenderness over the Achilles tendon.
(3) Stiffness of the tendon in the morning which gradually lessens as the tendon warms up.
(4) Inability to stretch Achilles tendon without pain.
(5) Mild swelling on the tendon.
(6) Occasionally a cracking sensation when the tendon is under pressure.

Investigatins-
(1) Blood Tests- Routine Blood Tests for sugar estimation to exclude diabetes mellitus.
(2) X-rays- X-ray is not useful but should be done as a routine to find out other possible conditions.
(3) MRI- MRI is helpful in evaluating a patient for tears within the tendon. It also can provide useful information in refractory cases & helps in preoperative evaluation & planning in patients being considered for surgery.

Differential Diagnosis- Achilles tendonitis may sometimes be confused with Achilles tendon rupture, Ankle Sprain, Ankle fracture, Retrocalcaneal bursitis, Athletic foot injuries, Achilles bursitis, Deep venous thrombosis, etc

Treatment-

[A] General measures to be taken are-
(1) Rest.
(2) Wearing of a heel pad that slightly raises the heel.
(3) Exercises to strengthen the tendon.

[B] Homeopathic medicines to be used- Homeopathy can be very effective if properly used. Homeopathic medicines to be used depend on the clinical features & the causative factors. Ruta Graveolens (Ruta), Thuya, Benzoicum Acidum (Benz.ac) etc. may be used. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual

Prevention-
(1) Warming up & stretching before any sort of sport.
(2) Strict restriction of overdoing of any sport.
(3) Wearing of correct footwear.
(4) Designing of shoes according to the sport with adequate heel support.

Prognosis- Achilles tendon having a poor blood supply is slow to heal. But with proper treatment the affected tendon usually recovers completely, provided treatment is started in time. In case the starting of treatment is delayed, it may develop into a chronic one. With passage of time the inflammation may lead to degenerative changes within the tendon & may even lead to small tears within it which make it susceptible to rupture. Incomplete rehabilitation or a hasty return to activity should be strictly prohibited as it would hamper the healing process & may also lead to re-injury.

In short, Achilles tendonitis is the inflammation of the Achilles tendon which is manifested as pain, tenderness & stiffness of the tendon that increases on participation in activities especially after a period of inactivity & is treated Ruta, Thuya, Benz.ac etc.

But in every case, a doctor should be consulted.

Some aspects of Student’s elbow with homoepathic mode of treatment

Also referred to as Olecranon bursitis, it is a chronic inflammation of the olecranon bursa. It is so called as it is found in students who tend to keep their elbows repeatedly over the table, bench etc over long periods during writing, reading etc & the resulting chronic friction leads to its development.

Aetiology -
(1) Repetitive minor injuries or irritation.
(2) Microcrystalline deposition.

Clinical features-
(1) Usually a swelling on the bony bit at the back of the elbow.
(2) Associated pain if there is inflammation.
(3) Gradually pain at rest & during movement of elbow.
(4) Restriction of elbow movement.
(5) On bleeding into the bursa, the swelling as well as the pain increases.

Investigations-Aspiration & culture of the bursal fluid to exclude the possibility of an infectious aetiology.

Treatment-
(1) Rest & protecting the area from any kind of trauma.
(2) Application of ice.
(3) Immobilization of the arm.
(4) Homeopathic medicines to be used are usually Benzoicum acidum (Benz.ac), Bryonia or Belladonna (Bell) etc. The potency & frequency of dosage varies with the severity of the condition & the individual. Usually a lower potency like 30 C is to be used first for thrice daily & to be continued till the persistence of the symptoms.

Prevention-
(1) Wearing of elbow guards during playing a game in which there is a chance of getting hit on the elbows.
(2) Change of writing or reading habits so that leaning on the elbows for long periods of time can be avoided.

Prognosis- Microcrystalline-induced bursitis has a good prognosis & the symptoms usually resolve after a few days, whether treated or not. But bursitis due to repeated minor irritation is more difficult to treat.

In short, Student’s elbow is a chronic inflammation of the olecranon bursa which manifests as a painful swelling over the tip of the olecranon & is to be treated by Benzoicum acidum (Benz.ac), Bryonia or Belladonna (Bell).

But in every case, a doctor should be consulted.

Some aspects of External Hordeolum or Stye with homoeopathic mode of treatment -

External hordeolum or stye is a focal, acute inflammation of the follicle of an eyelash including the glands of Zeis or Moll, usually ending in suppuration.

Causative agent- Staphylococcus.

Associated Conditions- It may be associated with blepharitis, rosacea or seborrhoeic dermatitis.

Associated factors- It may be associated with uncorrected errors of refraction as well as some metabolic factors like diabetes mellitus, debility & excessive intake of carbohydrate.

Age- It may occur at any age, but more common in adults than in children.

Symptoms- Acute pain in the lid margin with a sense of heaviness & heat.

Signs-
(1) A single or multiple swellings at the margin of the affected lid pointing anteriorly through the skin.
(2) Marked tenderness at the point of inflammation on the lid margin.
(3) Swelling, redness & marked oedema of the affected lid as a whole.
(4) Congestion of the neighbouring conjunctiva which may be chemotic.
(5) Enlargement of the corresponding pre-auricular lymph glands.
(6) Finally appearance of a white pus point on the lid margin at the base of a cilium which indicates suppuration.

Course- If not treated, the pus point may burst outside & consequently the pain and swelling subsides.

Complications- Usually none but very rarely the inflammation may spread producing cellulitis of the orbital tissue.

Treatment-
(1) Lid hygiene should be properly maintained.
(2) Blood sugar should be controlled in case of diabetes mellitus.
(3) Refractive errors, if any, should be corrected with proper glasses (spectacles) or contact lens.
(4) General health of the patient should be improved with good nutrition and vitamins.
(5) Hot fomentation should be applied on the lid to hasten suppuration.
(6) If the pus points on the skin of the lid, the pus should be drained by pulling out the affected eyelash.
(7) Homoeopathy plays a good role in its treatment. Of the different medicines, constitutional medicine is Graph (Graphites) 200 for fair, fatty, flabby patients. General medicine is Staphysagria 200 twice daily. If there is severe pain, Hepar Sulph (Hepar Sulphuris Calcareum) 30 should be added with it till the pain persists in a dose of four times daily. If there is stitching pain, Silicea 200 should be added with the general medicine till the persistence of the pain. General medicine should be continued till the subsidence of stye and also for another two weeks.

Labels- Homoeopathy, Diabetes mellitus, Nutrition, Vitamins, Refractive errors, Glasses, Spectacles, Blepharitis, Rosacea, Seborrhoeic dermatitis, Swelling, Oedema, Lymph gland, Inflammation, Suppuration, Blood sugar, Health, Eyelash, Pus, Conjunctiva, Treatment, Staphylococcus, External Hordeolum, Stye, Graphites, Silicea, Hepar Sulph, Staphysagria.

IN SHORT- Stye is manifested as a single or multiple swellings at the margin of the eyelid with marked tenderness along with swelling, redness & oedema of the affected lid as a whole. Treatment is followed as mentioned above.

But in every case a doctor should be consulted.