Transcription:
Living With Arthritis: Help for This Painful Condition

Melanie Cole (Host): For millions of Americans with arthritis, the pain can affect every part of their everyday lives. My guest today is Dr. Mark Kelley, he's a board-certified orthopaedic surgeon at Aspirus Keweenaw. Welcome to the show, Dr. Kelley. Tell us a little bit about arthritis. What is the definition? There are so many types, and people don't really understand.

Dr. Mark Kelley Guest): Thank you. Good morning. Arthritis is a term and a diagnosis that we use to describe inflammation of the joint. It's a broad category of diseases and there are really over 100 types of arthritis and related conditions. It affects about 50 million adults in the United States and about 300,000 children, so it's really very prevalent. In fact, it's the number one cause of disability in our country. It tends to affect women more than men and older people more than younger. As you mentioned, there are a number of different varieties, some of them from just plain life and wear and tear; some from, perhaps, a genetic and familial disease that can cause different types of joint disease and different types of disability.

Melanie: So when we speak about causes, do you see as one of the more common causes a genetic predisposition, wear and tear on the joints, or something like an injury that then causes this arthritic condition to pop up?

Dr. Kelley: We're starting to learn a lot more about the genetics and, as with at a lot of things in medicine, it's an area of very active study. So, even in degenerative or wear and tear arthritis, we are seeing familial patterns and things that like grandma and grandpa had arthritis, so the generation may skip or it may be pervasive through a family. Same thing with some of the inflammatory diseases. Those are much more strongly linked to genetics threads and genetic conditions. And then, there are a lot of other things that are associated with autoimmune disease that we're starting to see and identify some of the genetic characteristics. And then, of course, there's the post-traumatic. Somebody has an injury as a child and 20 years later, they can develop arthritis. Or, as a result of something that's very traumatic, right away it becomes a very bad arthritic condition. So, there are a variety of things associated--degenerative arthritis or the wear and tear arthritis are the most common form of arthritis that we see.

Melanie: So, because of all these different types—and it’s in movable joints and in some non-movable joints, how do you diagnose it? People feel pain in their spine or it could be a lot of different things--their hands, whatever it is, the knees, the hips--I mean, in every joint possible. So, what do you do and what is the first line of defense when you discover that somebody has one of these types of arthritis?

Dr. Kelley: Well, arthritis primarily is a joint pain, joint swelling and joint deformity disease, so most people will come to you, say, "My hand hurts. My finger hurts. My knee hurts. My shoulder hurts." Whatever they're identifying. Or, multiples of those hurt. “I get swelling”, or “I'm stiff in the morning”, or “When I exercise and later in the day I get pain or swelling”. Identifying factors can be very important, as far as morning stiffness can be associated more with rheumatoid arthritis and later in the day pain and swelling can be associated more with degenerative arthritis. So, the patient’s story is very important. And then, of course, just visualizing the patients, sometimes you can see some quite obvious changes that occur--the knobby fingers or the bow-leggedness, or the knock-kneedness that people have or sometimes the curvature of the spine that can create some various changes in people. So, without even getting too far into knowing somebody in the office, you have a pretty clear idea by their description and then just some general observation what you may be up against, whether that's a degenerative versus an inflammatory type of thing based on family history and things like that.

Melanie: So, there are so many ads in the media for various anti-inflammatories and NSAIDS. What do you tell people, Dr. Kelley, every day to do for their arthritis? Do you like ice? Do you like bracing? What do you tell them?

Dr. Kelley: I think we as a population tend to forget about the simple things and the easy things. When we look at treatment programs, we look at risk and benefit. Many of the low risk things like you mentioned--ice, heat, some wraps--those are easy things to do and everybody's a little different. So, I just tell people, “Try and identify what works for you.” If you're an ice person, use ice or use a combination of ice and heat. Sometimes just a light ace bandage on a joint for part of a day can make a dramatic difference in swelling and pain and allow somebody to do what they need to do. Some activity modifications, figuring out if moving around is helpful or actually resting and then maybe in the morning you stretch a little bit. You loosen up before you start your day or even before you get out of bed. Simple, low risk things can be very, very effective. Regular physical activity, maintaining a healthy body weight. Sometimes, if you're out for a walk and there’s some uneven ground, using a walking stick can be very, very effective. So, these are all things which are just available to us without much risk but very high reward. And then, we get into the over-the-counter anti-inflammatories that come into two categories and those are the non-steroidal anti-inflammatories--the Motrins and the Naprosyn. Some of them you can get over-the-counter and some you can get through prescription. There's also Tylenol, which is not a very good anti-inflammatory but it's a good pain reliever. So, we try and get people into a safe, low risk, high reward. So, Tylenol is a good place to start and the lowest dose is you can go to about 3 grams a day. You can safely take Tylenol. Ibuprofen, Voltaren, Motrin, Naprosyn, over the counter, again, people kind of indiscriminately will take those but I think they're best taken for two or three days in a row to get a little bit of a level in their system and see how they feel and not get into the habit of just throwing a bunch of those into your system because they have definite risk as far as gastrointestinal side effects particularly. Anybody who's taking any kind of blood thinner other medications for blood pressure or heart disease can really have problems if they're not careful. So, everybody really needs to be cautious about asking their doctor about that. The steroid medications, primarily cortisone--and cortisones are very effective medicines that I think has gotten a bad rap out there because people hear about all the side effects of cortisone and there are in fact side effects if cortisone is misused. But, there are people that really have to take cortisone almost every day to survive and be able to get around. For me, I use cortisone fairly discriminately as far as injections and I separate the injections by four months or longer. We can use cortisone topical cream sometimes for the hands and fingers. We can use cortisone tablets for a brief burst of anti-inflammatory, particularly for somebody who's had problems with some of the non-steroidal anti-inflammatories. So, there are very effective ways of using both of these types of medicines as far as just being cautious and not just saying, "Go ahead and take this for the rest of your life," or “Do this for this period of time,” without judging whether it's working or not.

Melanie: What a great explanation, Dr. Kelley. What about some of the other things that people can try? You mentioned, ice and heat and bracing and wrapping and all those things, besides the NSAIDs and cortisone injections. What about some of the complementary things--paraffin wax for the hands or exercise? Some people are very confused as to whether exercise helps or hurts arthritis.

Dr. Kelley: There are definitely modalities, and also, just to go back, I think there are some other products that people read about--glucosamine and chondroitin being one of the more common ones. I think, looking at the scientific data, there is enough data to support taking that as an over-the-counter medicine as long as you know what you're buying and what you're getting. So, you have to be very selective as far as the product goes, but those can be very effective if you take it over the course of a 6 week period time and you notice an effect, it's probably helping you. If not, just stop taking it. That's just a little caveat about glucosamine and chondroitin. The modality-based treatments, for example, the paraffin, can be very effective. Even just moist heat can be very effective in the hands, particularly--a moist heating pad. I'm a huge proponent of stretching. I think a lot of the joint forces, the joints gets squeezed by tight muscles. The muscles are the motors that make these joints move and if the muscles are tight, they're squeezing the cartilage together. So, the more flexibility we have, the less compression there's going to be along that diseased cartilage. I try and get people to stretch and then move slowly and to a point where they can tolerate it at a pace that they can tolerate. Many people don't realize that if you have an inflamed joint and you take 2 or 3 days off from your regular exercise program, that really takes a lot out of you. To go back and try and do that 10 mile bike ride after you've been off for 3 days is really detrimental. You really need to slowly get back into the program. So, being cautious and listening to your joints with the realization that sometimes exercise is better than rest.

Melanie: What a great way to put it, and so understandable for people, Dr. Kelley. In just the last few minutes, give your best advice for arthritis sufferers. What do you want them to know about living with it, managing it, when it requires intervention and why they should come to Aspirus Keweenaw for their care?

Dr. Kelley: Well, obviously, there are many things about arthritis that require education. The first thing I would say is try and educate yourself about all of this. The internet can be a vast subject and it can take you a lot of places, but going to, for example, the Arthritis Foundation, can be a very effective way of getting a general overview of what this is all about. There are a lot of ways of preserving the joints that, again, we mentioned earlier. There are some very simple lifestyle modifications that can be done. I try and tell people that what you need to do is seriously look at how this is impacting your life and how it's impacting your day-to-day ability to do the activities of daily living you need to do as well as your overall happiness, because pain, obviously, creates mood and people aren't happy. So, if you're starting to feel an impact on day-to-day life that you can't manage through some of these simpler things, then it's time to sit down and talk with a doctor, a physician, who treats arthritis. Oftentimes, some of the primary care doctors are very familiar with it and can get you to the proper place, whether they feel a rheumatologist needs to do some diagnostic testing or whether they feel like just some plain x-rays may be able to be a place to start, and then going to a specialist. I'm an orthopaedic surgeon but I also conservatively manage arthritis as well. We try and work with the patient and say, "How is this affecting your life?" Ultimately, a lot of treatment decisions are patient-based: “These are the risks, these are the benefits, here's where you have to be careful and we'll walk you through this, and as it starts to affect your life more and more, we can be a little more aggressive with our treatments including injections and perhaps arthroscopic surgery in some cases and joint replacement surgery, as needed.” But, again, those are patient decisions that should be made in conjunction with the surgeon.

Melanie: Thank you so much for being with us today. What great information. You're listening to Aspirus Health Talk. For more information, you can go to Aspirus.org. That’s Aspirus.org. This is Melanie Cole. Thanks so much for listening.