Transcription:
Arthritis and Osteoporosis

Melanie Cole, MS (Host): If you wake up in the morning and your stiff and hobbling around, you know how debilitating it can be for millions of Americans with arthritis. The pain can effect every part of your everyday life. Welcome to our health talk podcast. I'm Melanie Cole. We’re here today with Dr. Jordan Simon. He’s the director of the Joint Replacement Center at Montefiore Nyack Hospital. Dr. Simon, I'm so glad to have you with us today. Tell us about the different types of arthritis that you see. People have heard rheumatoid and osteo. What do they mean? What are the differences?

Jordan Simon, MD (Guest): So basically the different types of arthritis can be boiled down into two general topics. Osteoarthritis, which is the more common type, is the wear and tear type of arthritis. The type of arthritis that people get after injury or cumulative repetitive wear of joints from heavy activity. That’s the more common type. Rheumatoid arthritis, which is a type of inflammatory arthritis, is more of an autoimmune disorder, which is really a systemic disease. That is, again, one type of inflammatory arthritis. Other types of inflammatory arthritis such as gout or psoriatic arthritis as similar in that it’s an immune response that attacks the joints from within. So basically osteoarthritis, again, more common wear and tear. The rheumatoid arthritis is inflammatory and that’s an autoimmune disease. That’s usually managed medically whereas osteoarthritis has to be managed more symptomatically.

Host: Thank you for that good explanation. Today we’re going to concentrate a little bit more on osteoarthritis. You mentioned that it’s from wear and tear. What joints does it affect most often?

Dr. Simon: Well osteoarthritis can effect all joints in the body. Most often we see it in the knees, the hips, and the hands. Shoulders is not far behind either, but really the hips, knees, and the hands are the most common.

Host: So I’d like to discuss when you think it’s time for somebody to come to see an orthopedic surgeon or really a physician to assess that pain, and some non-surgical treatments that we might try once you’ve diagnosed what it is. When do you think is really the best time?

Dr. Simon: Well, I think that’s a difficult question to answer in a general sense. It’s obviously a very individual decision when it’s time to see your doctor. In general, if somebody has achy pain that’s really not getting in the way their activities but it’s just a nuisance and they're able to manage it with over the counter medications or just changing their activity, it’s probably not necessary to see a physician. But if somebody that has pain that’s severe enough to take medication on a regular basis or the over the counter medications just aren’t taking away the pain, or if the pain wakes them up at night or if it’s causing them to have a noticeable limp or curtail their activities, then it’s probably time to see a physician and get things checked out.

Host: That’s really good advice, Dr. Simon. So let’s speak about some of those things. Now exercise. Can exercise make arthritis worse or does it help? Also, speak a little bit for us about ice versus heat. Activity modification, bracing, physical therapy. Some of the things that we might try before the discussion of surgical intervention ever comes into play.

Dr. Simon: Sure. First off, I’ll address exercise. Moderate exercise is encouraged. If somebody is sitting in a chair all day and then they go to get up and they have a little arthritis, they're going to be sore, they're going to be stiff, and they're really going to have a tough time getting moving. If somebody exercises even moderately throughout the day, just keeps their limbs moving, they tend not to get that same degree of stiffness and their symptoms are less. So we definitely recommend moderate exercise and just general activity throughout the day. That being said, high impact exercises such as running, jumping, things like that can exacerbate the symptoms of arthritis. So all of the exercise you do has to be done in moderation.

Ice and heat is a common question that I get from patients. It’s basically one of those things that you have to try to see which works better for you. I usually recommend my patients to use heat before exercise to loosen up their joints and ice afterwards. However, some patients will say heat works better for me. Ice just makes my joints hurt more. Or vice versa. So there is a bit of a trial and error on the ice and heat aspect of the management, but they certainly have a role in symptomatic treatment.

Bracing can be helpful, especially for arthritis in the knees or arthritis in the wrists. Wear just an elastic support to give a sense of proprioceptive feedback. That can really help some patients. But, again, others find that it doesn’t work. So a lot of these different early treatments are a trial and error to see what works with one patient versus another.

Host: Dr. Simon, when does the discussion become about injection therapy with cortisone and viscosupplementation and PRP stem cell? There’s so many options today. What does that look like?

Dr. Simon: So usually when I see a patient with a diagnosis of osteoarthritis, I try them on simple things first as we just mentioned. Exercise, ice and heat, bracing, and oral medications. Usually I like patients to start with over the counter anti-inflammatories such as ibuprofen or naproxen, which is Advil and Aleve respectively. There are prescription strength anti-inflammatories that can be taken by mouth, but that have potential side effects. With the knee especially there are options such as steroid injection or viscosupplementation injections which are easily done in an office setting. It can be done in the hip as well, but it’s not quite as easy. In the shoulder it can be done. Basically these are reserved for patients that have failed early intervention such as exercise, physical therapy, and oral medication.

As far as the choice of what to inject, that’s a discussion unto itself. In general, I use steroid as a quick acting relief measure for somebody who’s had an acute flare up of arthritis. For somebody who has more chronic pain where it’s generally achy and becomes painful with activity, I might start with cortisone to calm it down and then follow that up with the viscosupplementation which are generically called lubricant injections. As far as platelet rich plasma goes, that’s a more controversial injectable that we can do in the office. Whether or not it’s really going to help is controversial. The current studies show that it may be equally as effective as viscosupplementation, but the jury is still out on that.

The final one that you mentioned is stem cells. My personal feeling on stem cells is it’s not ready for prime time. It sounds really good to imagine a world where we can harvest stem cells, inject them into the knee, and then magic stem cells will rebuild the cartilage and rebuild the joint. Today’s technology just isn’t there yet. The commercially available stem cell treatments really have not been proven to work well enough to recommend them for routine use. So I think under the stem cell category, it’s probably still… I don’t want to use the word experimental, but it’s certainly not mainstream.

Host: What about some of the alternative or complementary therapies and nutrition? Do they fit into this picture at all? Like glucosamine and chondroitin. Do any of these things—Can our diet help our joints in any way?

Dr. Simon: So the glucosamine and chondroitin supplements have been used for many years. That actually came out of veterinary medicine. They find that without a placebo effect, because animals frankly don’t know that they’re receiving medication, they do see and improvement in the symptoms of osteoarthritis with the glucosamine and chondroitin, especially in the canine model. So from that respect, I do recommend my patients try a glucosamine chondroitin supplement. Some will have very positive effects; some won't see any effect. But there really is no downside to trying it. It’s a safe and sometimes effective measure to help minimize symptoms.

As far as diet goes, there are currently diets out there—the Mediterranean diet comes to mind—that are considered to be anti-inflammatory. Getting rid of the red meat and the animal proteins is felt to be a way to minimize general inflammation in the body. At least anecdotally I've had patients who swear that their arthritic symptoms got better when they changed their diet to one of the so called anti-inflammatory diets. Essentially the cardiologists are now recommending an anti-inflammatory diet, Mediterranean diet, and some of those patients are coming to me and telling me that their arthritic pains have gotten better since they switched their diet. So it certainly is beneficial. Whether or not it’s going to take the place of active treatment is difficult to say, but certainly it’s an adjunct to our traditional treatments.

Host: What great information Dr. Simon. As we wrap up, please offer your best advice for keeping healthy joints and when you really want to have that discussion about surgery. What that looks like and what you want patients to take away from this segment on arthritis, and really your best advice.

Dr. Simon: Well, my best advice is to treat your joints if they're the only ones you're ever going to have because frankly they are. Cartilage does not repair itself well. That’s why osteoarthritis forms. It’s cumulative wear and tear over time. So the less we beat up on our joints early on in life, the fewer problems we’re going to have later on. That has to do with moderation of diet and exercise. Keeping your weight down to a reasonable level. Overloading a joint that has some arthritis is going to make it more symptomatic than if you aren’t overloading it. So weight loss is important.

As far as when to consider surgery, I think there’s certainly a role for surgery. As an orthopedic surgeon, I do a lot of joint replacements. But I reserve that for patients who have really failed non-operative treatment. Joint replacements are very good at relieving symptoms or arthritis and it really can restore somebody’s quality of life. However, they're not perfect operations and it’s not going to be exactly the same as the joint you were born with. So the best thing you can do is try to maintain the health of your joints throughout your life so that you don’t have to have a joint replacement. If you do have a joint replacement, make sure you're doing that for the right reason. That would be usually failure of all other methods to control your symptoms, and at the point where your quality of life has diminished to the point where the benefits of surgery outweigh the risks. It can certainly restore function and lead to a better quality of life, but the decision does need to be made in an informed fashion and after all other measures have failed.

Host: Great information. Dr. Simon, what a great educator you are. Thank you so much for coming on and sharing your expertise about something that so many millions of people suffer from, the pain of arthritis. Thank you again. Thank you for listening to this episode of our health talk podcast. Head on over to our website at montefiorenyack.org/joint-replacement to get connected with one of our providers. If you found this podcast enlightening, please share on your social media and be sure to check the entire podcast library for topics of interest to you. I'm Melanie Cole.