Transcription:
Knee Osteoarthritis

Scott Webb: Osteoarthritis is the result of wear and tear on our joints over the years. And for many of us, our knees get it the worst. And joining me today for a conversation about knee arthritis, both the symptoms and treatment options, is Dr. Alan Kawaguchi. He's a board-certified orthopedic surgeon specializing in the surgical treatment of the knee.

This is Hello Healthy from Dignity Health. I'm Scott Webb. Doctor, thanks so much for your time today. I was just saying to you that, at 54, I probably have osteoarthritis, certainly some sore knees. And I'm sure lots of folks are nodding their heads because they also suffer from this. So before we get to knee arthritis specifically, maybe you can just kind of set the stage here. What is arthritis, especially osteoarthritis?

Dr. Alan Kawaguchi: Arthritis is the word that comes from two roots. Arthro- means joint, and -itis means inflammation. So, arthritis is a condition where the tissue called cartilage that covers the end of the bone basically wear away, and this causes pain and swelling and so forth. That's a process called inflammation.

Now, there are various types of arthritis that are out there, but we're going to concentrate today on osteoarthritis, which is basically the most common type of arthritis and is due to wear and tear on your joint. That could happen in any particular joint in your body, but knees are very common to have osteoarthritis.

Scott Webb: Yeah, they definitely are. And that's definitely been my experience. And as you say, there's other types of arthritis like rheumatoid, but that's for a separate podcast. So, sticking with the wear and tear osteoarthritis, what are some of the risk factors? I know wear and tear by definition sounds like it just happens. You're a human and you live and you wear and you tear and you begin to get osteoarthritis. But is there anything else? Smoking, family history, anything else that contributes?

Dr. Alan Kawaguchi: Arthritis is definitely a wear and tear phenomenon. Every single injury that you've had growing up can potentially injure a joint, whether large or small. Now, most people don't think about stumbling and causing a little bit of damage. But if you keep doing these similar activities where you may injure your joints, that can start causing more profound wear and injuries to your joints that can cause pain.

Other factors include being overweight, certainly that makes sense from a mechanical standpoint. If you're heavy, you're putting much more pressure on a particular joint specifically the knees, and that can certainly lead to wear and tear. In some people, genetics can play a factor. Some patients will say, "Oh, yeah, my grandmother had arthritis and so did my mother and my aunt," and that could happen also. That pretty much covers the gist of the causes of arthritis, of osteoarthritis, I think.

Scott Webb: Yeah. So, genetics, family history, some lifestyle, behavior, cumulative effect of wear and tear and injuries over the years. So doctor, how do we know that it's arthritis versus just some other knee thing or some sort of acute thing? How do we differentiate or how do you do that in terms of meeting with patients in the office and diagnosis and so forth?

Dr. Alan Kawaguchi: Most of the time when you start getting arthritis-type pain, you're usually, let's say, in your mid to late 40s or older and people complaining of knee pain with swelling. So, those are the most common complaints that people have regarding arthritic knees. And I do an examination and after I talk to them for a while about what makes the pain worse and so on, commonly they're described as a dull, achy or throbbing pain. And the more you're active, the more you use that particular joint for various activities, it tends to get worse. And certainly, it could be remedied by resting or taking some medications, which we can cover in a little bit later. But yeah, those are the main factors or the symptoms that you get. And then, I get an x-ray in the office to see what the joint looks like. And from there, I could see if you have arthritis, to what degree the arthritis is.

Scott Webb: Yeah. And for some folks, it may just be, as you say, that dull nagging thing. For others, it may be debilitating and definitely affecting their quality of life. So, let's talk about the treatment options. Whether it's just the standard sort of OTCs, physical therapy, surgery, take us through that.

Dr. Alan Kawaguchi: So, the best thing to start off with if someone comes to see me, I ask them, "What have you taken?" Majority of people have tried over-the-counter remedies, whether they be salves, rubs, various things you could find over-the-counter. But when it comes to taking medications, Tylenol is a reasonable pain medication. But more effective are the medicines we call NSAIDs or non-steroidal anti-inflammatory drugs. They include over-the-counter ibuprofen, which in a brand form is called Advil or Motrin. And there's the other one called naproxen, and the brand form is called Aleve. So if you take that medication, a lot of people do get relief. A lot of people have tried that before they come to see me. So, that's a good start there. There's also a topical medication that's out on the market that you don't need a prescription for, and that's called diclofenac gel. It's a cream you rub on it. It's an anti-inflammatory cream, and it's supposed to work in the local area.

So, those are some of the things you can do to help with the symptoms of osteoarthritis. Otherwise, icing, it will be a good option. A lot of people think of heating it up, but that usually goes against inflammation. Inflammation, if you think about it, is basically like a fire burning in your knee and you want to cool it down, so you want to ice it down and not to heat it. And certainly, rest and taking it easy will help also.

Scott Webb: So yeah, by the time folks are in the office with you, they've probably tried over-the-counter things, some cream, some ice and whatever. What other options are available? Is surgery even on the table? Is that, I'm assuming, the last resort for most folks?

Dr. Alan Kawaguchi: Sure, yes. Surgery is a very last resort for all folks, in my opinion. And that depends on failing other what we call conservative management too. So once you come to the doctor's office, we could potentially prescribe you a little stronger anti-inflammatory medication that you should probably try to take for five to seven days straight. Some people take one over-the-counter ibuprofen and think, "Oh. I took it one time. It didn't help me, so I stopped taking it." Sometimes you have to keep it in your system for several days to allow the medicine to really work. So, I will tell my patients, "Yeah, we'll either try that or I will prescribe you something similar and you could take this on a regular basis for five to seven days to see if that calms it down."

If that doesn't work, physical therapy can help in some arthritic conditions. And people may think, "Oh, how does therapy make it better?" There's a thought that because you have pain in the knee, that you definitely are using that particular part of the body less. Now, you may not feel actual weakness in the leg, but compared to how it was, let's say, six months before where you were using it more, that leg has in a sense become weaker theoretically. And what the therapist can do is teach you exercises specific to the muscles around the knee to help strengthen the muscles to help to support the knee better and, hence, that helps to decrease the pain. So, that could be helpful.

If that doesn't work or that's not your cup of tea, then we do have injections. That'll be the next level up. And the mainstay is cortisone injections, which can be given. There are a lot of people out there who may not feel comfortable with cortisone injections for various reasons. And there are some myths out there that they harm the joint and do other things. But by and large, cortisone is a very safe medication to give as long as you give it in a specific way, specific time interval. Now, you shouldn't get a cortisone injection no more than once every maybe three to four months in that particular part or same joint. The body has to recover from some of the other side effects.

There are other injections that can be tried, somewhat controversial, but we call them hyaluronic acid injections. Originally, they originated from the rooster comb. Now, they make them synthetically and they are a series of injections up to three that are spread one week apart and it helps to lubricate the knee joint. The interesting issue is that no one really knows how it works, but it tends to reduce the pain and inflammation. So, the science hasn't told us how this works, but seems to work in many people, although it is still somewhat controversial even in the orthopedic research literature where some research studies have said that this doesn't really work and it's no different than squirting water in your knee. But then, there are other research studies that have shown that this can be beneficial. So, it's somewhat controversial from that point of view.

So, that's what we have available from the office. Now, there are a lot of fancy things that people may have heard of called platelets of plasma or stem cells and so on. That's more cutting edge, I call it, on the research end because it hasn't been proven well to help with arthritis, although there are plenty of anecdotal reports that have shown decrease in pain and increase in function, that people are interested in that treatment. A lot of athletes have gotten it. It does cost quite a bit of money because insurances do not pay for such treatments. It could cost you in the thousands of dollars. And the worse the arthritis is, the less likely that it'll be effective, and that's based on looking at the x-ray and, again, the assessment of how the arthritis appears on the x-ray. If someone has really bad arthritis where the bone's already rubbing against the bone, chances of that kind of treatment working is very low.

There's one actual method of helping the pain of arthritis that's been shown many times in research and that happens to be probably the hardest for patients to do, that's called weight loss, especially the majority of people that have osteoarthritis are overweight to various degrees. And weight loss has been shown to help decrease the pain and actually slow down the arthritic process, which makes sense. You're putting less pressure on the joint as you lose weight, so therefore, the pain should improve and may potentially slow down the arthritic process.

Scott Webb: Yeah. I always like, as a patient, and I know doctors and nurses are patients too, but I like as a patient knowing that diagnosis is fairly easy and there's lots of treatment options from simply walking to your local drugstore and getting some OTCs and then working your way up depending on how severe it is, how debilitating it is, and maybe surgery would be an option down the line, but it sure seems like there's a lot of things we should try and do first before we ever have that conversation. So doctor, this has been really educational today. Thanks so much. You stay well.

Dr. Alan Kawaguchi: Okay. Thank you very much.

Scott Webb: Need a doctor? We can help. Visit dignityhealth.org/ourdoctors to get started. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full library for topics of interest to you. This is Hello Healthy, a Dignity Health podcast. I'm Scott Webb. Stay well.