Transcription:
Arthritis of the Knees and Hips

Sean O’Connor (Host): Hello. Welcome to Health Currents. My name is Sean O’Conner and I am a marketing communications rep with Riverside Healthcare. I'm joined today with Dr. Josh Miller, who is an MD and PhD, correct, in general orthopedics?

Joshua Miller, MD, PhD (Guest): Correct.

Host: Alright. Welcome. Today we’re going to be talking about arthritis and some kind of general signs and treatment options available. But first, let’s get to know you a little better. So give us kind of your background and what brings you to Riverside?

Dr. Miller: My background is that I have been working at the University of Michigan for the last 20/25 years. I've been doing general orthopedics at the VA hospital there. Seeing a fairly wide variety of problems relating to the shoulder and hip and knee and some ankle as well. I had a friend of mine tell me about a really great opportunity down here at Riverside. I came down and met everybody and really loved it and saw a chance to do something great with building up an orthopedic program here and try to really provide great service to the community and practice some general orthopedic care.

Host: Excellent. Well, that’s great to hear. We’re glad to have you. You and the entire team have just been fantastic from the beginning. So what brings us today to discuss things is arthritis. So kind of give us an idea of what arthritis is. So what is it that really…? What are patients feeling with they have arthritis?

Dr. Miller: That’s a really good question. Arthritis is really when there’s some degeneration within the joints itself. The human joints are a remarkable structure. The bones that support our body weight and allow motion and function are really amazing structures as well, but they're loaded with nerves. If they are to rub against each other, it would be very, very painful. So our body has a cap, basically, on the ends of the bones. It’s a very smooth perfect white shiny surface like the white stuff on the end of a chicken bone. I basically tell all of my patients the same thing. So it may be a little redundant.

It gives you a really good, smooth gliding joint. That surface is called articular cartilage. It is very good at absorbing shock and loads, but it’s very fragile. When it’s in good operating condition, it is also bathed in joint fluid that the lining of the joint produces. It’s really amazing, but the two joint surfaces on each other with that thin cushion of joint fluid in there is 1,000 times slipperier than water on ice.

Host: Wow, incredible.

Dr. Miller: It’s an incredible, incredible surface. It also has another amazing property called being thixotropic, which is at very low speeds it’s very thick—like a heavy motor oil—and it’s very cushioning. So if you're doing like really heavy lifting, it really spreads the loads out across the joint and really protects. Whereas if you're moving, like running, at high speeds, it becomes a very thin and very much less viscous so that it has very little resistance and can allow the joint to move really, really quickly.

Unfortunately, over time the joint can deteriorate. This can happen naturally, really in everybody as we get older. That cartilage surface can start to break down a little bit. That’s really what we call arthritis. Now another amazing thing about that articular cartilage on the end of the bone is that it doesn’t have any nerve endings. So it can take a pretty heavy load and not cause pain. When it gets damaged, it’s still probably not the source of pain, but it fragments. Little fragments from the cartilage can float out and get lodged in the lining of the joint, and that can cause irritation of the lining joint, which generally causes it to produce more fluid. Therefore, we get the swelling in the joint and it also creates a lot of inflammation and inflammation causes pain.

It’s generally—Arthritis pain is generally a dull, achy throbbing. It’s like your world’s worst toothache. It’s a very nagging pain. It is often worst in the morning when you get up, but as you start moving around, it kind of loosens up and it gets better as you go.

That fluid gets moving, the joint get less stiff, the pain is actually usually a little bit better. But over time, as you're starting to put a lot of wear on it, a lot of pressure on it, the pain usually will get back. So in early arthritis, it’s getting bad sort of towards the end of the day. As the joint wears down, the arthritis becomes more pronounced and then it can become painful pretty much all of the time. When our patients are really, really struggling with it, it can be every step. So it can become very, very problematic for people as it progresses.

Host: So what are some common joints? Obviously, some joints are more susceptible to arthritis than others. What do we see?

Dr. Miller: Yeah. I think really all of the joints are susceptible to it. I think we see hip and knee probably the most, but certainly the shoulder is very susceptible to it. Our hand surgeon, Dr. Crawford, probably sees a lot of arthritis in the small joints in the hand and also in the wrist it can be a big problem. We think about it less in the elbow, but it is definitely a condition that can occur in the elbow as well. Interestingly in the foot, there are a number of joints that don’t have a lot of motion in them naturally. Other joints in the foot have a lot of motion. Those are the ones where we’re more worried about the arthritis. Because the joints that normally don’t have a lot of motion, they can get arthritic, but they're already pretty stiff and we tend to see less issues with pain there.

Host: Gotcha. How does that old adage…? Is it a true adage that weather can effect symptoms or is it just kind of a misnomer that weather…?

Dr. Miller: People seem to really notice that, yeah. When the weather’s changing or when it’s going to change. I don’t know why that happens, but it’s for sure. I think people’s arthritis is even worse in the cold in general, so in the winter. I know some people really have a hard time in the winter, and then things get better as the weather warms up. So they can tolerate living with that joint for a little bit longer.

Host: So as far as with the spring warming up, is it better to get it taken care of even though it’s not nagging as much now in the spring? Or is it something that if you can tolerate, you should go ahead and just keep going with it until it becomes a real problem for you?

Dr. Miller: Yeah. Great question and I think it’s very patient dependent, you know? How they sort of feel about how they can manage with it. Maybe even what sort of plans and activities they have coming up. Just a little bit about the natural history of arthritis. It’s something that when the damage is done, and our best way of detecting that is an x-ray, a regular old x-ray. Once we see arthritis there, even if it’s mild or moderate or more severe, it just tells us that that’s what the diagnosis is. It doesn’t really tell us what the patient’s feeling. That level of pain that they're having—You're going to have your good days; you're going to have your bad days. Over time, sometimes it kind of gets better for a while. It will get worse; it will get better. So it can be sort of an undulating pattern. It doesn’t generally go away. Sometimes over time it will worsen. That can happen suddenly, or it can just be very, very steady. So we don’t really have a good way to tell people how is this going to effect you over the next three months, over the next six months.

For many of the joints, really for all arthritis, we’ve got good medications. So just your over the counter anti-inflammatory type medicines have a profound effect. Because, like we said, it’s arthritis. Arthral means joint, itis means inflammation. It probably is a lot of inflammation of the joint that’s causing the pain. So those anti-inflammatory medicines can make a really big difference for people. Tylenol was also really effective. Then there are a lot of more of your nutraceutical kinds of things like glucosamine and chondroitin sulfate where evidence is in is good for those, but I see a lot of people that get some relief from that. So those things are really helpful.

In a lot of joints, physical therapy can be really helpful. A really key example is the knee joint. There’s many, many studies that show if we do a good, low impact arthritis program—which basically is get the leg strong in a way that doesn’t make it hurt—it can make a tremendous difference. There’s bracing. Injections can be very useful. So all of those things are things that can just be done at any time. So if somebody is getting ready for the warmer weather and being more active, I would say if you’re feeling it less then let’s just see how it goes. If they said, “Well I've got a big event coming up or I really like a certain activity and I'm having trouble doing that.” Then we can see what sort of things haven’t been tried and try to do those things that they think that they have the time for and will work well in their schedule to try to not hold them back too much.

I think you might have been referring to treatment like an operation. Those things, I think, really need to be thought about long and hard. Because many of them are fairly predictable, but there are bad things that can happen and those can really change the course of what’s going to happen. So if somebody has a big even coming up and they're like I really need to be able to do this and I need some pain relief for that, surgery isn’t necessarily a great way to go. Because if they have a problem, they may not be able to make that event whereas if we try and injection or something like that, that might get them through. That might get them by until they're at a point where they can see a surgical thing through its entire course.

Host: I think that’s a very good point is that you and the rest of the team have always strive to take a conservative approach towards medicine first before we go to those extremes right out the gate. So exhaust all of our other resources first before we start to look at kind of last case scenarios.

Dr. Miller: I think we all have a pretty similar philosophy on that.

Host: Yeah. I think that’s very important. So, obviously, if somebody’s experiencing pain or symptoms, coming to see Riverside orthopedic specialists is a great first step. Talking to their doctor as well. So, obviously, if someone is experiencing symptoms, they should see Riverside orthopedic specialists or talk to their primary care provider before starting any type of regimen of treatment. But, as always, fantastic. Glad to have you here. Glad we could get your insight for some great thoughts on arthritis, no bones about it. Fantastic job. We hope to have you on another time. So thank you very much.

Dr. Miller: Thanks Sean. My pleasure.