REDUCTION IN CHRONIC ARTHRALGIA IN MULTIPLE JOINTS OF THE LOWER EXTREMITIES IN A 13 YEAR OLD MALE WITH POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME FOLLOWING A PROGRAM OF MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION.
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Brain, Spine & Sport, United States
Background: A 13 year old male presented to a private clinic with a chief complaint of chronic lower extremity joint pain and stiffness in multiple joints that has persisted for a year. The pain caused the individual to withdraw from all organized sports activity. There is a family history of rheumatoid arthritis with the maternal grandfather. The patient had consultations at the local children’s hospital in the rheumatology and sports medicine departments. Treatment with physical therapy and medications failed to reduce the patient’s symptoms.
Methods: Orthopedic and neurological examination revealed the following: Tilt table testing demonstrated abnormal elevation of heart rate (HR) from supine to standing with a 40 beats per minute (BPM) increase revealing postural orthostatic tachycardia syndrome (POTS). Systolic blood pressure (BP) on the left dropped 7 points. Examination of the lower extremities revealed signs of inflammation with the presence of calor and dolor in both ankle mortise joints. Limits in joint mobility were noted in both ankle mortise joints. Right sided finger to nose testing was dysmetric. Fakuda’s test was positive with abnormal rotation to the right. Saccadic intrusions were noted in vertical pursuits. Optokinetic nystagmus testing (OPK) revealed a reduced reflexive response downward. Computerized Dynamic Posturography (CDP) revealed paradoxical findings with more stability with the eyes closed than open on a firm surface and abnormal fatigue ratios on firm surface testing. Saccadometry revealed a heteroscedastic distribution of 100 saccades in terms of velocity and accuracy. There was reduced velocity and hypometria bilaterally. The patient was placed on an anti-inflammatory diet and supplement protocol featuring turmeric, iron and vitamin D addressing blood chemistry findings. A neurological rehabilitation program was initiated that included vestibular rehabilitation (VR), spinal manipulative therapy (SMT), extremity manipulation, low level laser therapy (LLLT) and neuromuscular re-education. VR included gaze stability exercises, eye movement exercises, balance and proprioceptive training.
Results: There was a patient reported improvement of 75% by 4 weeks into the program. By 12 weeks there was a self reported improvement of 90% of joint pain and the patient is planning to return to organized sports participation. Tilt table testing revealed normalization of POTS findings. BP on the left did not drop upon standing posture. CDP improved with normal patterns between eyes open and closed on a firm surface. Saccadometry revealed an improvement in accuracy and an improved pattern trending towards homoscedastic readings. Pursuits and OPK testing improved. Signs of inflammation in the ankle mortise joints resolved.
Conclusion: this author recommends further investigation into the role of neurological rehabilitation and clinical nutrition interventions in the treatment of chronic arthralgia and POTS.
Keywords:
Arthralgia,
Postural Orthostatic Tachycardia Syndrome,
POTS,
Low level laser Therapy,
Clinical Nutrition,
Inflammation,
saccadometry,
computerized dynamic posturography,
turmeric,
Vestibular Rehabilitation,
Spinal manipulative therapy,
Autoimmune Diseases,
rheumatoid arthritis (RA)
Conference:
International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.
Presentation Type:
Poster
Topic:
Clinical Applications in health, disease, and injury to the nervous system
Citation:
Schiller
D
(2018). REDUCTION IN CHRONIC ARTHRALGIA IN MULTIPLE JOINTS OF THE LOWER EXTREMITIES IN A 13 YEAR OLD MALE WITH POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME FOLLOWING A PROGRAM OF MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION..
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00093
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Received:
01 Apr 2018;
Published Online:
14 Dec 2018.
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Correspondence:
Dr. David Schiller, Brain, Spine & Sport, Avon, Connecticut, 06001, United States, drschiller@comcast.net