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Prakash Chandran (Host): Everyone's joints goes through a normal cycle of damage and repair during their lifetime, but sometimes the body's process to repair our joints can cause changes in their shape or structure. When these changes happen in one or more of your joints, it's known as osteoarthritis and the knee is one of the most commonly affected joints.

We're going to talk about it today with Christian Schwartz, a Physician Assistant at Ridgecrest Regional Hospital. This is the Ridgecrest Regional Hospital Podcast. My name is Prakash Chandran. And so Christian, it's great to have you here today. You know, I obviously gave a high level summary of what osteoarthritis is, but I will leave the full description to the expert, being you. So, why don't you go ahead and give us a summary. What is osteoarthritis?

Christian Schwartz, PA (Guest): OKay, great. Thanks for having me. Osteoarthritis is basically, like you mentioned, is over time, a breakdown or deterioration of people's bones, specifically the ends of the bones where they meet, which is a joint, and with age and other things, over time, those do erode and develop osteoarthritis.

Host: Now is everyone subject to getting osteoarthritis? Or is this something that affects only certain types of people?

Christian: In general, everyone is susceptible to getting osteoarthritis to some degree. There's a lot of risk factors that can either increase your susceptibility or decrease them. Age, sex are one of the two most prevalent things. There's also a small degree of hereditary, genetics in there that, that can cause increased risk of osteoarthritis.

Host: Yeah. That makes sense. So, when you have osteoarthritis, let's talk about some of the most common symptoms that people experience.

Christian: I'm sure we've all kind of felt some pain in our body at some point. With osteoarthritis, a lot of times people generally feel some aching, some stiffness in the joints. This is actually affected by the temperature around us. You could also have intermittent swelling. Sometimes the joint just acts up and it swells up. Also again, frequently you get a popping or clicking, and that's just because of sometimes overgrowth, as far as osteophytes and bone spurs that can occur with osteoarthritis.

Host: Right. And as mentioned at the top of the episode, one of the most commonly affected joints is the knee. So, when you have osteoarthritis of the knees, what exactly are you experiencing then?

Christian: Yeah, a lot of times, again, it's some of those symptoms. We start getting up, moving around and may have some achiness, some tenderness in the knee joint. It can be located throughout the knee. Most common, it's toward the inside of the knees. You know, we'll be sitting at the movie theater or in a going for car ride and, and the knees start to ache. And when we get up from this prolonged sitting position, the knee's stiff, and it's painful and it does slowly loosen up most of the time. But pain is kind of hard to judge and it's different for everybody. So, it can be persistent or it can be intermittent depending on, you know, how, how bad the arthritis is.

Host: So, let's move on to how this is initially diagnosed. How does it first get recognized? And then what are some of the first-line treatments that people undergo?

Christian: Most of the time it is, you know, a clinic presentation is someone presents with pain in the joint, that again, over time has been getting worse. Maybe no specific injuries, such like a fall or a twist, but just this pain has been gradually getting worse. Most often we, we do take x-rays to diagnose osteoarthritis of a joint, and that will show us narrowing of the joint. Most often, bone spurs that do occur with arthritis.

And so treatment wise, there's a wide variety of treatments that are out there. First off, least conservative is treating the symptoms. So, using ice packs, heat packs, over the counter topical rubs, patches, things that are out there to help with joint pain.

We see commercials and all kinds of things on the shelf that can help with joint pains. Then there's, nonsteroidal anti-inflammatory medications, sometimes prescription strength medications that are a little stronger for bad flare ups. A little more invasive are our injections. Those are things that we could do in clinic. One being is a cortisone injection, very common. And for the knee, something new is, is a hyaluronic acid injection, and that's kind of, what's considered Viscosupplementation and it helps give us a little more cushion in between those two bones to help alleviate pain from osteoarthritis. And if all those things fail, sometimes you may end up talking to a orthopedic surgeon about possible knee replacement.

Host: Okay. So, just to be clear, a lot of the treatments that you mentioned were really just to reduce the pain and inflammation that you might be feeling, but there's no real fix for the condition itself. Is that correct?

Christian: Yeah, honestly. Yeah. That's that's, true. It's it's accumulation of, you know, life on our bones and so, no, there's no great cure. No great fix for that.

Host: So, you just touched on this briefly, but I'd love to unpack a little bit more. How does osteoarthritis progress in the body? And at what point does it start to worsen?

Christian: Yeah, osteoarthritis affects people at any age differently. Usually it is within the forties and older that we start to feel those symptoms of aching bones, pop and a click in a joint here and there. It does somewhat correlate too, with what we did earlier on in life. If we were, you know, very athletic, active, had a hard, work life then sometimes those do add up and, and our joints down the road will let us know. Also if there is some type of injury earlier on in life, that can also increase your risk of having arthritis at a joint down the road. And so it's just over time, how these things affected us, how we treated them and then pain will every once in a while rear its head.

That's really how arthritis develops is just, you'll start to notice a little more aches and pains here, stiffness here and there. And it's not just, we wake up one day with osteoarthritis. It's developed over time.

Host: So, let's say someone is listening to this like myself. I'm 40 years old. I'm starting to feel a little bit of pain in my knees and sometimes a little bit of like cricks and cracks and things of that nature. And I want to do everything that I can to prevent the onset of severe osteoarthritis. Like what are the recommendations or preventative measures that I should be thinking about to help me prevent it getting worse?

Christian: Again, staying active is a great way of doing it. Keeping the muscles around the joint strong and fit so that they could kind of offload the stress on the bone, that's a great way of doing it. We always recommend low impact cardiovascular activity, which means, getting on a bike and going for a bike ride.

You know, a treadmill is a good option. An elliptical is a good option too, cause there's no repetitive pounding. I'm not saying that you shouldn't jog, but sometimes if you're already having knee pain, jogging isn't the best. It may cause pain. So, finding alternatives to keeping the muscles around your joints strong. Stretching on a routine basis, again, a healthy diet. A supplement of glucosamine condroitin again, isn't harmful. It's one of the things that are out there that that may be beneficial, if you are starting to feel some aches and pains in the knees, you could start taking that to see if it's helpful at all.

Host: That is very informative. You know, I think a lot of people don't realize that conditioning and strengthening the muscles that support the bones is a great way to really reduce the workload that they have to undergo, for movement and for physical activity. Is that correct?

Christian: Yes, I'd have to agree with that. And that's where physical therapy sometimes comes into play. If, if you're not familiar with some of these activities, as a treatment option, we may send you to physical therapy so that you could learn these activities and kind of continue those through the rest of life.

Host: Now, you know, I'm sure you've seen so many patients, potentially hundreds of patients; if you had one piece of advice, one thing that people should take away from this conversation, before they came to see you, what might that be?

Christian: I guess I'd have to say is, is stay active and continuing to be active and, and have the ideal goal of, long-term goal of being at your ideal body weight so that there's less stress and wear and tear that are put on your joints throughout life. And then when you do have little aches here and there is, is listen to your body and treat those. So, put some, put an ice pack on there, use some heat, anything that helps kind of soothe an aching joint in the longterm is beneficial.

Host: Well, Christian, that is great advice. And the perfect place to end. Thank you so much for your time today. That's Christian Schwartz, a Physician Assistant at Ridgecrest Regional Hospital. Thanks for checking out this episode of the Ridgecrest Regional Hospital Podcast. To contact the Healthy Bone and Joint Center, please call 760-446- 8692. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks again for listening. My name is Prakash Chandran and we'll talk next time.