Dear Dr. Roach: I am a 75-year-old woman in generally good health. A couple of weeks ago, I woke up with an awful pain in my hand. Then I noticed hard bumps on my knuckles. Shortly thereafter, I was diagnosed with a UTI. Just as my antibiotics were finished, I came down with some kind of infection that caused a fever, headaches and body aches. One morning, I vomited bile.
As the fever subsided, I began experiencing pain in my neck, shoulders and back, which felt very much like arthritis. Can infections bring on a sudden flare-up of osteoarthritis (OA)?
P.T.
It sure sounds like the infections caused the flare-ups in your case, but the published data I could find on triggers of OA did not include infections. The most common cause of a flare-up is a higher-than-usual amount of exercise. Overdoing exercise caused flare-ups that were defined with elevated pain scores, but some studies also saw worsened swelling, stiffness and psychological effects, including sleep, mood and overall functioning.
Other causes that can trigger flare-ups of OA include worsening mental health, knee or hip injuries, high-heeled shoes, and temperature changes in the environment.
Although OA is the most common cause of joint pain in older adults, there is a condition that can look just like OA, except it is much more likely to flare up. This is called calcium pyrophosphate deposition disease, or pseudogout. Flare-ups are caused by increased crystals inside the joint, and infections have clearly been indicated as a potential cause of a pseudogout flare-up.
A plain X-ray usually makes the diagnosis of pseudogout. This is one reason I make sure to get at least one set of X-rays in a person I suspect to have OA.
The “hard bumps” on your knuckles sound like Heberden’s nodes, which are benign, bony abnormalities that are found with OA. However, it’s certainly possible to have both OA and pseudogout, so a visit to your regular doctor or an expert (such as a rheumatologist, orthopedic surgeon or physiatrist) might be reasonable to confirm the diagnosis, as the treatment for pseudogout includes some additional treatments that aren’t used for OA.
Dear Dr. Roach: My spouse is 73 years old. He is planning on having a penile implant performed shortly. He is tired of giving himself penile shots for eight years since his prostate cancer surgery in 2016. Are there any significant concerns with this type of surgery?
J.S.
Even with the best experts, sexual problems after prostate cancer treatment, especially surgery, are common. Erectile dysfunction is probably the most common problem, but men may also have changes in ejaculatory function, orgasm, libido, and even the size and shape of their penis after surgery.
Many surgeons use medications like sildenafil (Viagra) to try to prevent irreversible changes to the penis after surgery. Unfortunately, this isn’t 100% effective, and if oral treatments don’t work, injections are often highly effective. This can be with one medicine (such as alprostadil) or a combination of them. Vacuum devices are another option.
If injections don’t work (or, as your husband found, a man doesn’t want to keep doing them), then a prosthesis is a very good option. The major concern with this surgery are infections, and current data show that the risk of infection is about 1%. The device can fail mechanically, with surgical revision needed in 5% to 15% of people over a seven-year span. The newest devices are more reliable than earlier models. Patient satisfaction rates are above 90%.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
