What are your business hours?

Our practice hours are from Monday – Thursday: 8:00 AM to 4:00 PM, Lunch Break: 12:30 PM to 1:00 PM. Friday: 8:00 AM to 3:00 PM, Lunch Break: 12:30 PM to 1:00 PM. Appointments can be made by telephoning our practice at (858) 312-1717.

What is arthritis

Arthritis is often referred to as a single disease. In fact, it is an umbrella term for more than 100 medical conditions that affect the musculoskeletal system, specifically joints where two or more bones meet.

Arthritis-related problems include pain, stiffness, inflammation and damage to joint cartilage (the tissue that covers the ends of bones, enabling them to move against each another) and surrounding structures. This can result in joint weakness, instability and deformities that can interfere with the most basic daily tasks such as walking, driving a car and preparing food.

Arthritis is the major cause of disability and chronic pain in Australia, with 3.85million Australians affected at a cost to our economy of more than $23.9 billion each year in medical care and indirect costs such as loss of earnings and lost production

• As the population ages, the number of people with arthritis is growing. According to leading researcher Access Economics, current trends suggest that, by 2050, 7 million Australians will suffer from some form of arthritis
• There is a widely held belief that arthritis is simply a consequence of age, the pain of growing old. But it is not a natural part of ageing. In fact 2.4 million of all people suffering from the disease are of working age
• Research suggests that early intervention can delay the onset of the disease and may reduce the number of cases of osteoarthritis by about 500,000 within 15 years

While there are about 100 forms of arthritis, the three most significant – osteoarthritis, rheumatoid arthritis and gout – account for more than 95 per cent of cases in Australia.

Arthritis is not yet curable. While the condition is usually manageable, it invariably impacts on a patient's quality of life and includes varying degrees of discomfort and pain.

The most common forms of arthritis are:

• Osteoarthritis
• Rheumatoid arthritis
• Gout
• Ankylosing spondylitis
• Juvenile arthritis
• Systemic lupus erythematosus (lupus)
• Scleroderma

Why is arthroscopy necessary?

Diagnosing injuries and disease begins with a thorough medical history, physical examination, and usually X-rays. Additional tests such as an MRI, or CT scan also may be needed. Through the arthroscope, a final diagnosis is made which may be more accurate than through "open" surgery or from X-ray studies.

What are the joints that can be viewed with an Arthroscope?

Although the inside of nearly all joints can be viewed with an arthroscope, six joints are most frequently examined with this instrument. These include the knee, shoulder, elbow, ankle, hip, and wrist. As engineers make advances in electronic technology and orthopaedic surgeons develop new techniques, other joints may be treated more frequently in the future.

What is a Rheumatologist?

A rheumatologist is a doctor who is qualified by additional training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones. Many rheumatologists conduct research to determine the cause and better treatments for these disabling and sometimes fatal diseases.

What kind of training do Rheumatologists have?

After four – six years of medical school and three years of training in either internal medicine or pediatrics, rheumatologists devote an additional two to three years in specialized rheumatology training. Upon completion of their training Rheumatologists are recognised by the Royal Australian College of Physicians (FRACP) and the Australian Rheumatology Association.

What do Rheumatologists treat?

Rheumatologists treat arthritis, certain autoimmune diseases, musculoskeletal pain disorders and osteoporosis. There are more than 100 types of these diseases, including rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, fibromyalgia and tendonitis. Some of these are very serious diseases that can be difficult to diagnose and treat.

When should you see a Rheumatologist?

If musculoskeletal pains are not severe or disabling and last just a few days, it makes sense to give the problem a reasonable chance to be resolved. But sometimes, pain in the joints, muscles or bones is severe or persists for more than a few days. At that point, you should see your physician.

Many types of rheumatic diseases are not easily identified in the early stages.

Rheumatologists are specially trained to do the detective work necessary to discover the cause of swelling and pain. It's important to determine a correct diagnosis early so that appropriate treatment can begin early. Some musculoskeletal disorders respond best to treatment in the early stages of the disease.

Because some rheumatic diseases are complex, one visit to a rheumatologist may not be enough to determine a diagnosis and course of treatment. These diseases often change or evolve over time. Rheumatologists work closely with patients to identify the problem and design an individualized treatment program.

How does the Rheumatologist work with other health care professionals?

The role the rheumatologist plays in health care depends on several factors and needs. Typically the rheumatologist works with other physicians, sometimes acting as a consultant to advise another physician about a specific diagnosis and treatment plan. In other situations, the rheumatologist acts as a a manager, relying upon the help of many skilled professionals including nurses, physical and occupational therapists, psychologists and social workers. Team work is important, since musculoskeletal disorders are chronic. Health care professionals can help people with musculoskeletal diseases and their families cope with the changes the diseases cause in their lives.

What is done during a Joint Aspiration/Injection?

Joint injections or aspirations (taking fluid out of a joint) usually are performed with a cold spray or other local anesthesia in the office or hospital setting. After the skin surface is thoroughly cleaned, the joint is entered with a needle attached to a syringe. At this point, either joint fluid can be obtained (aspirated) and used for appropriate laboratory testing or medications can be injected into the joint space. This technique also applies to injections into a bursa or tendon sheath to treat bursitis and tendonitis, respectively.

What benefit is derived from a Joint Aspiration?

Joint aspiration usually is done for help with diagnosis or treatment. Fluid obtained from a joint aspiration can be examined by the physician or sent for laboratory analysis, which may include a cell count (the number of white or red blood cells), crystal analysis (to confirm the presence of gout or pseudogout), and/or culture (to determine if an infection is present inside the joint). Drainage of a large joint effusion can provide pain relief and improved mobility. Injection of a drug into the joint may yield complete or short-term relief of symptoms.

What benefit is derived from a Joint Injection?

Joint injections may decrease the accumulation of fluid and cells in the joint and may temporarily decrease pain and stiffness. They may be given to treat inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendonitis, bursitis and, occasionally, osteoarthritis.

What usually is injected into the joint space?

Corticosteroids (such as methylprednisolone and triamcinolone formulated to stay primarily in the joint) frequently are used. They are anti-inflammatory agents that slow down the accumulation of cells responsible for producing inflammation and pain within the joint space. Although corticosteroids may also be successfully used in osteoarthritis, their mode of action is less clear. Hyaluronic acid (Hyalgan®, Synvisc®, Orthovisc®) is a viscous lubricating substance that may relieve the symptoms of osteoarthritis of the knee for periods up to 6–12 months. Mode of action is not clear.

Which joints are commonly injected?

Commonly injected joints include the knee, shoulder, ankle, elbow, wrist, base of the thumb and small joints of the hands and feet. Hip joint injection may require the aid of an ultrasound or X-ray called fluoroscopy for guidance. Some small joints may be more easily aspirated or injected with aid of ultrasound.

What are the risks of Joint Injections and Aspirations?

Occasional side effects include allergic reactions to the medicines injected into joints, to tape or the betadine used to clean the skin. Infections are extremely rare complications of joint injections and occur less than 1 time per 15,000 corticosteroid injections. Another uncommon complication is post-injection flare—joint swelling and pain several hours after the corticosteroid or hyaluronic acid injection—which occurs in approximately 1 out of 50 patients and usually subsides within several days. It is not known if joint damage may be related to too-frequent corticosteroid injections. Generally, repeated and numerous injections into the same joint/site should be discouraged. Other complications, though infrequent, include depigmentation (a whitening of the skin), local fat atrophy (thinning of the skin) at the injection site and rupture of a tendon located in the path of the injection.

Will physical therapy be required after surgery?

Getting a full range of motion, strength and flexibility back after surgery usually takes time. That's where pre-operative exercise and education and post-operative physical therapy programs come in - to ensure you're physically and emotionally prepared for surgery and to maximize your recovery after surgery.

What should I bring with me when I come for an appointment?

When you come for your appointment remember to bring the following:

• Referral letter from GP, family physician or other doctor
• Medicare card, DVA card, pension card
• Have your Private Hospital Insurance information with you
• Reports, X-rays, MRI's, CT scans etc and any other relevant information