Ashlee Williams, MD: Are everyday activities becoming harder because of joint pain? Maybe your knees ache after a walk or your fingers feel stiff after you wake up in the morning. Joint pain is incredibly common. And it can affect anyone at any age for a number of reasons. The good news is there are proven ways to manage it and to keep your joints healthy over time.

 Welcome to The Healthier You Podcast. I'm Dr. Ashlee Williams, and today I'm joined by Dr. Nora Taylor, a Board Certified Rheumatologist here at Kaiser Permanente about how to prevent and treat joint pain and to keep your joints healthy at any age. Dr. Nora Taylor, thank you so much for joining us today.

Nora Taylor, MD: Thanks Ashlee. I'm really excited to be here.

Host: I'm so excited to have you. Let's just start with the basics. Can you talk about the most common causes of joint pain?

Nora Taylor, MD: Yes, no problem. So the most common cause of joint pain, that a lot of our patients will experience throughout their lifespan is osteoarthritis, and that occurs in our middle age to older adults generally. Then there's rheumatoid arthritis, which is an autoimmune condition, and we see it here in rheumatology quite a bit.

There's diseases like gout, which are common in the general population. And then there are overuse injuries. There are injuries that occur to the joints from trauma or sports. And then there are conditions like bursitis, which are inflammation and some fluid-filled sacs around the joints. So there's a lot of different joint diseases out there, but osteoarthritis is the most common.

Host: It's so true. My patients are always coming in like, my shoulder hurts, my knee hurts, my elbow hurts. What do you think it is? And the differential diagnosis is just so large. And so it really takes coming in, examining the patient to determine what exactly is causing that joint pain. Can you talk a little bit about since there are so many different types of joint pains, specifically, how can we prevent joint pain from flaring?

Nora Taylor, MD: Well, we can't always prevent it depending on what's causing it. But for osteoarthritis, you need to be active. You need to actually make sure to stay active. Prolonged immobility, sitting still for too long or not moving around or staying strong enough can actually increase your joint pain. So we want our patients moving.

For patients with rheumatoid arthritis and gout, more of the inflammatory conditions, those are patients that need to follow up regularly with their doctor and really importantly, stay on their medications that help control their disease.

Host: Are there any dietary things that we can do? Are there like anti-inflammatory foods that we can try to eat to prevent flares of joint pain?

Nora Taylor, MD: Yes, this is all the rage, right? You'll hear about this in a lot of, uh, social media and online, and our patients ask about it frequently. And what we do know is that a Mediterranean diet, particularly for our patients with inflammatory arthritis, like rheumatoid arthritis is really the best diet and the one with the most evidence behind it.

So that's a diet that's going to contain a lot of plants, right? So vegetables, fruits, whole grains, nuts and seeds. And then fatty fish like salmon, anchovies, sardines, if you're willing to eat those, are great. So low in processed sugar, low in red meat, refined carbohydrates. So we really want our patients eating a really healthy diet, and this has benefits for not just patients with inflammatory arthritis, but those with osteoarthritis as well.

Host: Yeah. What are your thoughts on turmeric and glucosamine.

Nora Taylor, MD: You know, the data there is mixed and not robust. So what I would say is that, especially for glucosamine, the data is very mixed and chondroitin, and that's a over the counter supplement that you can get anywhere. But I would say it's helpful for some patients. If you're going to try it, go ahead and give it a limited try, and then, you know, if you're not feeling significant benefit, for osteoarthritis specifically, I would stop because these things are expensive and the data's not fantastic.

Host: I get a lot of patients that come in like, you know, Doc, I tried this glucosamine, it made me feel better. And I'll say to them, you know, it's not hurting you. And if you are getting some improvement from it, then go ahead and keep trying it. But if you try it and it doesn't work, I agree, just stop taking it. Why add something that's not helping?

Nora Taylor, MD: Right. Don't add if it's not going to provide benefit.

Host: Exactly. So I do have patients that come in, they've tried everything. They've tried the diets, they've tried the supplements, they've tried over the counter, nonsteroidal anti-inflammatory drugs such as ibuprofen or Motrin. They've tried the prescription. They get the x-ray, they have severe arthritis. What are your thoughts on steroid injections?

Nora Taylor, MD: Right. For osteoarthritis, it can provide short-term pain relief, right? So we're looking at weeks to sometimes months, because there is a mild amount of inflammation in the joint in patients with osteoarthritis. But if it's really severe bone on bone osteoarthritis and that patient is going to need a joint replacement, we want to hold off on injection because that may delay their time to surgery.

But if we know that they're going to need a long runway to surgery, these can be really helpful for some patients for pain relief in the short term. For our patients with inflammatory arthritis like rheumatoid arthritis, this can act as sort of a targeted treatment. We don't necessarily increase all of their medication for their rheumatoid arthritis, but we might be able to target just that one joint that's inflamed, and give them local treatment in the clinic.

We don't want to repeat these too often, so we do them maybe three to four times maximum per year because we don't want to weaken the cartilage, or tendons around the joint or, in the joints. So we are, are careful about how frequently we do it, but it can provide relief for a lot of our patients.

But there was one thing we didn't mention, Ashlee. So I just want to go back really quickly. You mentioned all these treatment modalities, like diet and over the counter medications, but the most important one is exercise, right? We want all of our patients to be exercising. I'm not picky about what kind of exercise you do as long as you like it, and you choose to do something. If you hate it, you're not going to do it. So, aerobic exercise, resistance training, we're fans of all of it in rheumatology. So I want my patients to make sure that they're exercising regularly.

Host: Yeah, and sometimes it's important to pull in a specialist, like a physical therapist to make sure we're doing the right exercises. Because sometimes people will have joint injuries in their knee and we want to make sure that we're actually strengthening the muscles around the knee instead of re-injuring the knee. Right?

Nora Taylor, MD: Exactly, exactly. And strengthening those muscles that support a joint can really reduce that patient's joint pain and increase their daily functional status. So they're able to do more in their daily life when they strengthen the muscles around those joints that are painful. And yes, a physical therapist and many of the resources we have online through Kaiser can really help a patient's treatment protocol.

Host: Right. So as a Rheumatologist, I know you see joint pain all the time. So when someone comes in with a shoulder pain or a knee pain, what kind of exams, blood testing are you doing to try to figure out the source of that pain?

Nora Taylor, MD: That's a great question. So as a Rheumatologist, the first thing I want to figure out is this primary inflammatory arthritis, like rheumatoid arthritis or gout, or some of our more rare forms of arthritis, like psoriatic arthritis, or is this non-inflammatory, which is really osteoarthritis, the more common form of arthritis.

And that's going to be primarily through history, physical exam, and sometimes blood testing and imaging. But patients with inflammatory arthritis will often have warm and visibly swollen joints. They may have a different pattern of joint involvement versus osteoarthritis, and it may be more acute in onset for patients with inflammatory arthritis.

 We will often take fluid off the joint in the clinic if they're really inflamed to help us make a diagnosis. Osteoarthritis patients aren't going to tend to have warm joints. They may have some swelling in their joints, but they're not going to have warm joints to touch, and they're goning to feel a little bit different to a trained hand.

X-rays will also show different findings depending on whether it's inflammatory arthritis or osteoarthritis. And from a blood test standpoint, there are more specific markers in the blood for some forms of inflammatory arthritis. So we use all of these to help us make a diagnosis. But most important really is history and physical examination. Those are key.

Host: Yes, the history and physical is very key, so it's so important for you to check in with your primary care doctor when you are having symptoms of joint pain that aren't resolving, because there's so many resources we have from physical exam to blood tests to imaging. And we want to make sure that we're doing what's necessary to treat our members.

Thanks so much for this great information, Dr. Taylor. There's so much to learn about joint pain and how to treat it. To recap, one: Joint pain can be caused by arthritis, injury or inflammation. Prevention can include exercise, a healthy weight, and posture or anti-inflammatory medications. Two: Steroid injections can often offer relief during flareups. Three: Regular low impact exercise is key to joint health. And four: Accurate diagnosis helps guide effective treatment. For more information about joint health from our experts and other health advice, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast.

If you enjoyed this episode, be sure to share it with others who may find it helpful. Thank you, and from all of us at Kaiser Permanente, be well.