Rheumatoid arthritis (RA) is a “rheumatic disease”, that can affect the organs and systems of the whole body. It is a serious, long-term, and progressive condition, but one in which there are often periods in which the disease does not cause any symptoms. Fortunately, modern treatment can prolong these symptoms-free periods and slow the disease process.

Rheumatoid arthritis is an autoimmune condition, in which the body’s defense mechanism attacks its own tissues. It affects about three times more women than men. It can strike at any stage of life, but it usually becomes apparent between ages 40 and 60.


In RA, joints lubricated by synovial fluid become inflamed – and a large number of the joints in your body, including the facet joints of the vertebrae, are synovial. This inflammation leads to a reduction in mobility and damage to bones and cartilage. In the spine, the cervical (neck) vertebrae are most commonly affected by this condition.

The symptoms of RA tend to come and go, often being inactive for months or even years. This makes the condition difficult to diagnose early. The hands and wrists are often the first to be affected, leading over time to severe deformities.

The disease often affects the cervical vertebrae, leading to pain at the base of the neck as the vertebrae become unable to support the weight of the skull, and so slip bit, leading to deformities and the serious risk of spinal cord compression at the base of the skull.

Compression in other areas of the spine may first become apparent if your gait starts to change. You may also experience weakness and problems in keeping your balance. When the condition is active, there is muscle and joint stiffness, frequently accompanied by tiredness, a raised temperature, and a loss of appetite.

RA can also affect other organs and systems of the body, such as the lungs, kidneys, heart, liver (“Felty’s syndrome), and the eyes (“Sjogren’s syndrome), which often become dry and inflamed.

Rheumatoid Arthritis

What Causes Rheumatoid Arthritis?

Nobody knows for sure. What is clear is that a family history of RA predisposes to it, and there is strong evidence that cigarette smoking, stress, and obesity are all risk factors.

It is thought that, especially when risk factors are present, a viral or bacterial infection may trigger an autoimmune response in which your body’s defensive immune system starts to target your body’s own tissues.

Figuring Out What’s Wrong

A doctor may first suspect RA after looking at your joints to see whether they are swollen, twisted in any way, or tender; stiffness (characteristically in the morning) and decreasing mobility are also key indicators. The relative numbers of small and large joints affected are an important part of the diagnosis. Blood samples are also taken. In about 80 percent of people who have RA, an antibody – that is, a protein that destroys material identified as foreign – called “rheumatic factor” is found, but some people who have this antibody in their blood do no have RA.

Fixing Rheumatoid Arthritis

The earlier a diagnosis is made and treatment can start the better in order to reduce the risk of irreversible joint damage.

The pain of RA can be relieved by oral medication, physiotherapy or injection.

Call +65 64712674 for an appointment to treat Rheumatoid Arthritis today. Same day appointment.

There are three types of spinal curvature: kyphosis, in which the spine of the upper back tilts forwar; scoliosis, in which the spine curves either to the left or right; and lordosis, when the lower back arches outward. Such problems can either be present at birth or develop later.


Many people have a small amount of forward rounding of their upper back, but doctors don’t usually consider the problem to be kyphosis unless the degree of rounding is greater than 40 degrees. If the cause of kyphosis is long-standing poor posture or an underlying disease process, the degree of rounding is likely to increase and may cause painful symptoms.


When kyphosis is severe, symptoms may include not just a rounded back but also backache and some breathing difficulties. This last symptom is because the forward tilt of the spine pushes the ribs in toward the lungs and constricts their ability to expand.

What Causes Kyphosis?

When a curvature is present at birth, it’s likely that it’s been caused by a rare developmental problem that fused or distorted the baby’s vertebrae. Kyphosis may also develop during adolescence, especially in girls, when slouching posture stretches the ligaments that support the spine. Scheuermann’s  disease, a condition of unknown cause that runs in families and affects more boys than girls, may have the same effect. When kyphosis develops in adulthood, it is usually due to another condition, through poor posture also plays a part. The culprits may be osteoporosis, which sometimes leads to a dowager’s hump; osteoarthritis; rheumatoid arthritis; and ankylosing spondylitis. Occasionally, disorders that affect muscles and connective tissue or tumours may also be responsible.


Good posture is vitally important, especially during late childhood and adolescence, so encourage your children to adopt a correct posture. For adults, physiotherapy may be useful. If you think you’re developing kyphosis, consult a doctor.


Scoliosis Bending Down

While kyphosis is an outward and upward curve of the thoracic spine, scoliosis is a spinal curve in a different plane – either right or left of a normal spine, as seen from behind. In the classic manifestation of scoliosis, the spine comes to adopt either C or S shape.

Scoliosis affects about twice as many girls as boys, and is most likely to develop any time from early childhood through to adolescence.


Other than the curvature of the spine – and sometimes a difference in the apparent height of the shoulders or the hips – there are often no symptoms, though there may be some back pain. In severe cases, the curvature of the spine may affect the movement of the ribs and even the heart, causing shortness of breath and chest pain.

What Causes Scoliosis?

In about 80% pf cases, the cause of scoliosis is unknown, though the condition often runs in families. However, an apparent scoliosis can also result from muscular imbalances caused by poor posture, a discrepancy in leg length or overdevelopment of the muscles on one side of the spine, as is seen in some professional tennis players. Another type of scoliosis – generally referred to as functional scoliosis – can develop as a response to a painful stimulus, such as herniated disc. Or sometimes a severe form of the problem results from a defect in a way that the spinal bones develop in the womb (congenital scoliosis).

Osteoarthritis and osteoporosis can also cause scoliosis if the damage they cause mostly affects one side of the spine.


Scoliosis can generally be prevented only when it is caused by muscular imbalances that are created, and then worsened, by poor posture. In those instances, paying attention to your posture can help stave off the problem. Physiotherapy may help in this situation.

Figuring Out What’s Wrong

X-ray of the spine will be helpful to see the severity of the scoliosis.

Fixing The Problem

Functional scoliosis is treated by addressing the problem causing the muscular imbalance, often by means of physiotherapy. When scoliosis is idiopathic in a young person, a brace may be fitted to stop the curvature from becoming worse as growth continues. Surgery is generally advised for a young person if there are additional symptoms such as pain, breathing difficulty, or heart problems. Depending on the cause, this may involve the realignment of vertebrae followed by spinal fusion to fix them in place, or the removal of osteophytes – bony outgrowths from the vertebrae – formed as a result of osteoarthritis.



The left hand side of the picture shows a natural inward curve of the vertebral column in the lower back. In some people this becomes exaggerated, and in these cases the condition is known as lordosis.

Lordosis can cause pain and limit movement. It also reduces the spine’s efficiency as a shock absorber. As a result, even minor injury can cause damage to muscles, ligament, and vertebrae.

What Causes Lordosis?

Although lordosis tends to run in families, and in some cases can be present at birth as a result of developmental problems in the womb, most cases are caused by bad posture. The problem can also arise in later life as a result of a number of other conditions that cause degeneration of the spinal column, such as osteoarthritis and osteoporosis. Injury to the neck and back can also be a contributory factor.

What Are The Symptoms?

Apart from an unnatural and ungainly posture, neither cervical nor lumbar lordosis usually cause any symptoms, other than mild limitation in movement and sometimes mild discomfort. On rare occasions, severe lordosis may cause pressure on nerves as they leave the spinal cord, causing problems at the nerve’s root.


The most important preventive measure you can take is to be vigilant about maintaining good postures at all times, and to be ready to make necessary adjustments throughout the day.

Figuring Out What’s Wrong

Lordosis is diagnosed by observation and confirmed by X-rays. The doctor will also check on the range of movement of your spine to see if it has become limited in any way.

Fixing The Problem

Often mild lordosis does not require specific treatment. But if the condition is causing pain, you may be advised to take medication or injection. A physical therapy program may be suggested, with the aim of improving your range of movement.

The emphasis of treatment is on correcting your posture and maintaining the improvement by constant vigilance.

Call +65 64712674 for an appointment to check your spine today.

A harmless but painful bony enlargement on the outer posterior heel is called a Haglund’s deformity, named for the doctor who first described it. This condition is commonly referred to as a “pump bump”, because women’s pump-style shoes, with rigid heel counters, contribute to its symptoms. Given this common name, it isn’t surprising that Haglund’s deformity occurs most frequently in women who spend a lot of time wearing dressing shoes

Haglund's Deformity

What Causes Haglund’s Deformity?

Most people with Haglund’s deformity have inherited a foot structure with this bony enlargement present at birth. With pressure and rubbing on the heel over time, a bursa forms and becomes inflamed and painful (bursitis). High-arched feet, in particular, tend to supinate when walking (inward movement of the heel causing a person to walk on the outside of the heel), causing the back of the heel to rub repetitively against the shoe’s heel counter. A tight or shortened Achilles tendon also contributes to the condition by compressing another bursa (the retrocalcaneal bursa, which everybody has) against the heel bone.

Symptoms of Haglund’s Deformity

Symptoms of Haglund’s deformity include pain, redness, and swelling at the back of the heel. Often, a callus also develops over the affected area.

Treatment of Haglund’s Deformity

Treatment of Haglud’s deformity begins with

If the above conservative treatments are not helpful, you may want to consider surgery. The procedure usually involves removing both the prominent bony enlargement on the back of the heel bone and the inflamed bursa.

Please call +65 64712674 for an appointment for treating Haglund’s deformity.

Key Points

  • If conservative treatments have not been successful and you experience pain and limited motion then surgery may be a therapeutic option for your osteoarthritis.
  • The posoperative rehabilitation process is often lengthy, and complications are possible – please give the decision to have surgery appropriate consideration.
  • A discussion with your doctor and then an informed decision aware of the potential risks and benefits of surgery should be made.

While most people with osteoarthritis won’t need surgery, it might be an option for you if you experience severe joint damage, extreme pain, or very limited motion as a result of your OA and other more conservative treatments have been unsuccessful. The decision to use surgery depends on several things including your level of disability, the intensity of pain, the interference with your lifestyle, your age, other health problems, and your occupation. Currently, more than 80 per cent of the surgeries performed for osteoarthritis involve replacing the hip or knee joint. An orthopaedic surgeon can assist you in determining if surgery is an option for you to relieve the pain from osteoarthritis.

Surgery may be performed to:

  • remove loose pieces of bone and cartilage from the joint if they are causing pain or symptoms of buckling or locking
  • resurface (smooth out) articular cartilage and bones
  • reposition bones (osteotomy)
  • replace joints

The benefits of surgery may include improved movement, pain relief, and improved joint alignment.

When should I have surgery?

Surgery should be resisted when symptoms can be managed by other treatment modalities. If your function and mobility remains compromised despite maximal conservative treatment, and/or if your joint is structurally unstable, you should be considered for surgical intervention. If your pain has progressed to unacceptable levels – that is, pain at rest and/or night-time pain – you should also be considered a surgical candidate. Thus the typical indications for surgery are debilitating pain and major limitation of functions such as walking and daily activities, or impaired ability to sleep or work despite other therapy.

What surgical options are there?

There are several different types of joint surgery.

Arthroplasty / joint replacement

Surgery may be used to replace a damaged joint with an artificial joint. Arthroplasty, or joint replacement surgery, is most often done to repair hips and knees, but also is used to repair shoulders, elbows, fingers, ankles and toes. Currently the most common indication for knee and hip replacement is osteoarthritis.

Joint replacement is one of the most successful procedures available in modern medicine, but still has its risks and potential complications.

Please call +65 64712674 for an appointment to see our orthopaedic surgeon to discuss possible surgery intervention to treat osteoarthritis today.

Injections are used to help in the management of osteoarthritis, but they are not a cure for the condition. They act by reducing symptoms such s pain and discomfort with the aim of improving function once more. As with other medicines, they should be used as a package, for example, alongside exercising or physiotherapy. The injections that we will cover in this article are called intra-articular injections – injections directly into the joint itself. They are therefore very different to the usual intramuscular injections (e.g. the flu jab) or subcutaneous injections (e.g. those used to administer insulin). There are two intra-articular injections commonly used in the management of osteoarthritis:

  • Corticosteroid injections
  • Hyaluronic acid

We will discuss these two injections and look at how effective they are, who they are suitable for, and potential side effects.

Corticosteroid intra-articular injections

Corticosteroids are hormones that are either produced naturally by the adrenal gland (found above the kidney) or produced synthetically. Most injection preparations are synthetic. They have various metabolic functions, but are used in osteoarthritis because of their potent ability to reduce inflammation. They were first used in the 1950s and to date most studies have concentrated on the knee joint, although there are some indications that it may also be beneficial for the hips. The vast majority of the research conducted with the knee joints confirms that corticosteroid injections are beneficial when compared to a placebo treatment. Today approximately 53% of doctors use these injections to help alleviate pain caused by osteoarthritis.

As mentioned earlier, the corticosteroid injection is not a cure for osteoarthritis but it can help relieve the pain and inflammation. The onset of pain reduction is usually rapid (between 24-48 hours) with the maximum effect being reached within a few days. Studies have shown that the benefits last up to 4 weeks in most subjects and up to 3 months in some patients who have effusions of the knee. They can be repeated up to four times per year for the knee joint although usually less often for hand joints. Research to date has not shown repeated injections to cause any deterioration of osteoarthritis in humans.

It is not uncommon following the injection to have a temporary, mild flare-up of knee pain occasionally accompanied by some inflammation. This is due to a natural reaction of the synovial fluid in the joint to the crystal steroid solution of the injection. It is usually an immediate side effect but it is not permanent, and the treatment for this is a cold compress.

Hyaluronic acid

Hyaluronic acid is a naturally occurring component of the synovial fluid and is also found in the cartilage. It is highly viscous and acts as a shock absorber within the joint. It also stores energy that can be released when there is rapid joint movement and acts as a lubricant when there is slower movement. It is thought it has a role in maintaining a healthy cartilage. In the osteoarthritic joint there is less naturally occurring hyalronic acid and it can be less viscous.

By injecting hyaluronic acid directly into the joint the depleted levels are replenished and hence ease the pain and improve function of the joint.

Hyaluronic acid injections are not a cure for osteoarthritis,but they are used to help reduce the symptoms  (pain, swelling, stiffness). The benefits are usually noticed between 2 to 5 weeks, although this can vary. The benefits usually last about 6 months.

Please call +65 64712674 for an appointment to see our orthopaedic surgeon to treat osteoarthritis today.