Q. I have always led an active lifestyle and enjoy jogging to keep fit. Recently I have begun to have very bad pains in my hip when I get up in the morning and when I rest at night.
I am only 56 I am worried I might have arthritis.
A. Osteoarthritis is inflammation of the joints often caused by overuse or wear and tear. It is the most common form of arthritis and its frequency increases with age.
Over time and with repeated stress on a joint, the bone and cartilage of the joint become damaged leading to pain and swelling. Pain and stiffness are common first symptoms associated with arthritis and these may worsen over time. Your GP may order an X-ray to help in the diagnosis however this is not always necessary. This may show a narrowed joint space or changes of the bone around the joint.
Initially the management of the condition will involve symptom control and lifestyle modification. Keeping as active as possible to strengthen the muscles around the joint is useful and physiotherapy may be helpful also in the management of the condition.
Painkillers may also be used in a step-wise fashion to relieve pain. Initially paracetamol alone or a combination of paracetamol and ibuprofen may be sufficient to control symptoms. Running on a treadmill or grass/sand is preferable to running on a road to limit stress on the joint as well as making sure to wear footwear with good support and cushioning.
If these measures fail, your GP may prescribe stronger medications. These may be stronger anti-inflammatories or combination medications.
Joint injections containing a steroid to reduce inflammation and pain may also be appropriate for pain relief; however, these would more commonly be appropriate for the knee or shoulder. There is some evidence for the use of food supplements especially glucosamine and chondroitin, however this is controversial.
If these measures fail, it may be appropriate to get a referral to an orthopaedic specialist who may discuss the option of joint replacement but this is not needed in the majority of people who will not be severely affected by the condition.
Q. My husband has been diagnosed with mumps. He is 43 and presented generally unwell with very large facial swelling. I am concerned as I thought this was a very uncommon illness in Ireland.
A. Widespread use of the MMR (measles, mumps and rubella) vaccination has significantly reduced the likelihood of developing mumps. However, it has not been completely eradicated.
It is an important condition as it can be infectious. It is spread by contact with affected individuals (who are infectious a week before they present with facial swelling) and it can have serious complications including infertility and meningitis in affected individuals as well as inflammation of the pancreas or the joints.
Developing mumps in the first trimester of pregnancy may be associated with an increased risk of miscarriage, however, it will not cause harm to the development of the baby. Management of the condition remains within symptom control. Paracetamol and ibuprofen may be given for pain, fever and swelling as well as encouraging adequate fluid intake.
Mumps is caused by a virus and so can be prevented with vaccination. People who present with mumps should be excluded from work or school for five days after they present with the condition and they should be encouraged to complete their course of MMR (If this has not been done), this is generally two doses of MMR vaccine.
Vaccination causes a certain amount of population immunity, however, if insufficient numbers of people in the community are vaccinated, outbreaks of illness may occur. It is important that children are up to date with their immunisation programme.
The first dose of MMR should be given as part of the routine childhood immunisation schedule at 12 months old, with a booster in school at 4-5 years. This should provide immunity against measles, mumps and rubella.
Vaccination itself is generally simple and administered in your GP’s surgery.
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