Management in patient with rheumatoid arthritis and tuberculous arthritis: a case report

Rheumatoid arthritis (RA) is mainly treated with immunosuppressive drugs, which affects the immunological system. Therefore, the risk of tuberculosis was increased two to ten times in RA patients. Moreover, immunosuppressant is contraindicated in patients with tuberculosis arthritis. A 51-year-old male was presented with pain in his left elbow after he slipped on the floor. He was diagnosed with RA for 16 years and only took prednisone for six years. Six months before, he came to a rheumatologist and was given corticosteroid for six months for RA. The left elbow radiograph and joint aspiration revealed a tuberculosis infection. The patient treated with chloroquine and oral antituberculosis for one year and showed good clinical outcomes. Other diseases should be suspected in RA with uncommon symptoms. Chloroquine is the drug of choice in RA patients with tuberculosis who are contraindicated in immunosuppressant therapy because chloroquine has no immunosuppressant effect.

Breast Surgery

Breast surgery is commonly performed under general anesthesia. Opioids are often utilized for pain management. Regional anesthesia is superior to opioids in many ways, and opioids are best avoided in patients with cancer due to their immunosuppressant effect. Regional anesthesia can be effectively utilized not only as postoperative pain management but also as intraoperative anesthesia. This chapter discusses anatomic considerations to analgesia in breast surgery, detailing the innervation of the breast and the chest wall. It also discusses techniques for providing surgical anesthesia and postoperative analgesia, focusing on the various regional nerve blocks that are available to achieve anesthesia and analgesia of the breast and the chest wall.

Immunosuppressant effect of Boswellia serrata extract on CFA induced arthritis in rats

Background: Rheumatoid arthritis (RA) is an immune-mediated arthropathy, so for the treatment disease modifying antirheumatoid drugs are required. In this study we are evaluating the immunomodulatory property of Boswellia serrata extract (BSE) as an alternative medicine.Methods: Complete Freund’s adjuvant (CFA), 0.1ml was injected intradermally in the footpad of left hind paw in 36 Wistar rats to induce RA. Animals were divided into 6 groups. BSE in the doses of 45mg/kg, 90mg/kg and 180mg/kg was administered and cyclophosphamide as standard drug. Various parameters as body weight, paw thickness, ankle diameter, paw volume, arthritis index, TNF- α and histopathological changes were analyzed.Results: Marked reduction in paw thickness, ankle diameter, paw volume, arthritis index and an improved body weight was found in high dose BSE (180mg/kg) group but the effect was lesser than standard drug Cyclophosphamide.Conclusions: BSE has significant potential as an alternative medicine for treatment of autoimmune diseases like rheumatoid arthritis.