University Health System Blog

Dr. John Pixley answers the question: “What tests determine whether a person has arthritis or osteoarthritis?”

Arthritis is a general term that identifies the area that is diseased or is painful. More often than not pains are not a reflection of arthritis at all and reflect muscle spasm, tendonitis, bursitis (a sac outside of a joint) or even disease in the abdomen or chest. A history, physical examination, laboratory and X-ray evaluation allow for establishing both the presence of arthritis and the proper diagnosis.

Once the clinical evaluation identifies that arthritis is present, the physician then determines whether it is part of a larger disease process or not.

Osteoarthritis is in essence a disease where the cartilage degenerates. Causes include genetics, obesity, deconditioning, previous injury and certain metabolic conditions, such as iron overload or thyroid disease. There is no specific test.

Treatment of osteoarthritis is directed at the underlying cause, as well as, minimizing further cartilage deterioration. Osteoarthritis of the knee is best studied and understood. Here, weight reduction, walking, medications to relieve pain, such as acetaminophen, and therapeutic exercises directed by a physical therapist have been shown to improve patient functioning.

The role of glucosamine is controversial. The best studied is DONA (glucosamine sulfate), which has received approval in Europe as a medication. Unfortunately, many of the preparations in commercial pharmacies, health food stores and Web sites have not been studied in a randomized controlled fashion to establish their effectiveness. Other therapies include joint injections with glucocorticoids and viscosupplements, which may provide benefit, and are approved by the U.S. Food and Drug Administration. Finally, total or partial joint replacement may be required if the cartilage deterioration is far advanced.

John Pixley, M.D. is an internist and rheumatologist in Reno, Nevada, with more than 30 years of medical experience. He practices with University Health System in Reno.

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Dr. Mary Beth Hogan answers the question: “When should I have allergy testing?”

Any age group can be tested and we have seen newborns already allergic to cow’s milk. However, testing should be limited to those allergens likely to be present in that age group. For instance, children less than a year old may be allergic to pets and dust mites, but are very unlikely to become allergic to pollens. Up to 70 percent of children and adults may have allergies which trigger their recurrent wheezing or asthma.

Individuals requiring asthma hospitalizations or have difficult to control asthma should be tested. Infants, children or adults with asthma in the absence of viral infections should also be allergy tested. Anyone with a history of a significant reaction to a food, bee stings or chronic eczema should be tested. Likewise, people with nasal problems and hay fever who respond poorly to antihistamines and topical nasal steroids should be tested.

Going to a physician specifically board certified in allergy will help ensure the proper tests are done. Your primary care physician can help you decide whether allergy testing would be helpful for you or your child.

Mary Beth Hogan, M.D. is professor of pediatrics and section chief  of pediatric allergy, immunology and pulmonary medicine at University Health System, the clinical practice of the University of Nevada School of Medicine. Dr. Hogan is based out of Reno, Nevada.

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Dr. Scott Hall answers the question: “When should I use a hot pack or cold pack to treat a sports injury?”

Generally cold packs should be used after an acute, or sudden, injury.

Cold acts to reduce pain and swelling. Good results are often seen when cold is applied directly over the injured area shortly after the occurrence. Ice is generally used, but there are other good substitutes, including frozen vegetables and cold packs.

One should remember not to apply the cold pack too long as frostbite may occur. I recommend keeping the pack on the injury 20 minutes on and then removal for 20 minutes before re-application.

Heat may be used after the acute injury to promote increased blood flow and decrease residual stiffness.  Individual comfort should guide the duration and intensity of heat.

Heat packs are commonly used and various types are available at pharmacies and shopping malls.

Scott Hall, M.D. is an assistant professor and director of sports medicine at the University of Nevada School of Medicine Department of Family and Community Medicine in Reno. Dr. Hall is board-certified and holds a Certificate of Added Qualifications in Sports Medicine. He has served as a team physician for several professional and scholastic sports teams. He currently serves as team physician for Damonte Ranch High School in Reno.

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Dr. Kami Larsen answers the question: “I’ve heard fruit juice is bad for kids because it contributes to obesity. But it’s a good source of vitamins. What should I do?”

The amount of fruit juice consumed by children is definitely a contributing factor in our battle against childhood obesity. While in some cases it may be a good source of vitamins, typically the carbohydrate (sugar) content is far too high.

If parents want to ensure their children get vitamins in the diet, they should be focused on whole fruits and vegetables, not solely on juice.

In moderation (four to six ounces per day), juice can be acceptable, even helpful.

Parents should check the label to look at vitamin content and go for those that offer the most bang for the buck. Simply pumping 32 ounces a day of apple juice into a child is typically just giving them empty calories.

Kami Larsen, M.D. is a pediatrician at University Health System in Las Vegas, Nevada. Dr. Larsen is assistant professor of pediatrics at the University of Nevada School of Medicine and medical director of Kids Healthcare Clinic.

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