American Medical Association Family Medical Guide - American Medical Association [706]
Diagnosis
See your doctor if you have symptoms of gout, even if the symptoms subside. Your doctor will examine the affected joint and may withdraw a sample of fluid from the joint to determine if the pain is caused by an accumulation of uric acid or of calcium pyrophosphate dihydrate crystals.
Treatment
If you have had only one attack of gout, your doctor will recommend taking a nonsteroidal anti-inflammatory drug other than aspirin, such as ibuprofen or naproxen. Aspirin is not used to treat gout because it can interfere with the excretion of uric acid crystals in urine. However, aspirin can be used to treat pseudogout. Your doctor may prescribe colchicine to reduce inflammation and relieve pain. He or she may also inject a corticosteroid drug into the affected joint to reduce inflammation. No other treatment is usually necessary.
If you have frequent attacks of gout, your doctor may prescribe drugs such as allopurinol, probenecid, or sulfinpyrazone to help prevent attacks. He or she will also recommend that you drink more water to dilute your urine and that you stop drinking alcohol, which can inhibit the body’s ability to eliminate uric acid. Avoid eating protein-rich foods, especially organ meats such as liver or kidneys, because protein can increase the uric acid level in the blood. In rare cases, a doctor may recommend surgical removal of the uric acid crystals that have accumulated in a joint.
Temporomandibular Disorder
Temporomandibular disorder, or TMD (formerly called temporomandibular joint syndrome), is a disorder that affects the jaw muscles and the joints on either side of the jaw (the temporomandibular joints). TMD affects twice as many women as men.
Temporomandibular joint
The temporomandibular joint is a hinged joint on each side of the head where the lower jawbone (mandible) connects with the temporal bone of the skull.
Symptoms and Diagnosis
In TMD, the joints or, more often, the jaw muscles cause pain. In some cases, the pain can extend to the ear or even as far as the shoulder. It may be difficult to open the jaw fully, and your jaw may make clicking or snapping noises.
If you have symptoms of TMD, your doctor will examine your face and jaw. He or she may recommend X-rays and laboratory tests to rule out other disorders, but tests performed on people with TMD often reveal no physical abnormality.
Treatment
To treat TMD and relieve painful spasms, your doctor may recommend massage, heat therapy or ice packs, anesthetic injections or sprays, and pain relievers. He or she will tell you to eat soft foods and avoid extreme movements of your jaw, such as yawning widely or opening your mouth wide to eat, or clenching or grinding your teeth. Ask your doctor or dentist if you should use a nightguard (see page 1111) to reduce clenching or grinding of the teeth. Using a nightguard may also help ease muscle tension around the jaw and prevent damage to the teeth.
Back and Neck Problems
The spine, also called the spinal column or backbone, stretches from the base of the skull to the bottom of the buttocks. The spine consists of more than 30 separate bones called vertebrae. Strong ligaments link the vertebrae, and flexible, flattened disks lie between them. Each disk is constructed of a tough, fibrous outer covering wrapped around a jellylike inner substance, which provides enough elasticity to permit some movement over the entire spine. However, this construction also limits flexibility. For this reason, if you twist the wrong way or strain any part of your spine, it can cause pain in the vertebrae and the muscles and ligaments that connect the vertebrae.
The back is also especially susceptible to pain because the spinal cord, which is a major part of the central nervous system, is in a channel that runs the length of the spine. Peripheral nerves pass through narrow side channels of the spine on their way to and from the rest of the body. As a result, any problem with a