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Dear Dr. Roach: Can exposure to infectious mononucleosis trigger or cause rheumatoid arthritis to flare up and become active?

I would appreciate your comments. Thank you.

J.C.

Dear J.C.: The Epstein-Barr virus — the cause of infectious mononucleosis (although there are other germs that can cause a similar picture) — has been associated with rheumatoid arthritis, and there is some evidence that EBV may be a trigger that causes RA and possibly other autoimmune diseases, such as lupus, to become active in a person who is genetically susceptible.

However, this evidence is only speculative at this point, since an alternative explanation for the association is that the immune deficiencies in RA and other autoimmune diseases allow for abnormal persistent replication of EBV.

What is more important is that nearly all adults (90-95 percent) have had EBV infection, and re-exposure to the virus does not cause clinical infection and almost certainly will not trigger new onset or a flare-up of RA in people who already have been exposed to EBV.

Dear Dr. Roach: In your recent column on Achilles tendinopathy, you discuss treatment, but please also make sure that the patient does not have a spondyloarthropathy.

Dr. Irene Blanco, M.D.

Dear Doctor: The spondyloarthropathies are a group of related conditions, including ankylosing spondylitis, psoriatic arthritis and reactive arthritis (formerly called Reiter’s syndrome).

These all increase the risk of Achilles tendinopathy, due to inflammation at the insertion of tendons to bone.

Similarly, these conditions also increase the risk of plantar fasciitis. Achilles tendinopathy and recurrent plantar fasciitis should prompt your doctor to consider the possibility of one of the spondyloarthropathies. X-rays and blood tests are able to help confirm the clinical diagnosis.

I thank Dr. Blanco for writing.

Dear Dr. Roach: We care for our elderly dad, who has early stages of dementia. When church friends and acquaintances greet him, at least half of them ask him, “Do you remember me?” or “What’s my name?”

Please, people, no one enjoys being put on the spot! Greet the person, and tell them your name and maybe someone they can associate with you.

A.D.

Dear A.D.: This is great advice. Being constantly reminded that your memory is failing can be very painful for people with dementia and for their families.

A friendly introduction to remind the person of your name can make social events much smoother and less painful for everybody.

Email questions to ToYourGoodHealth@med.cornell.edu.

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