Joey Wahler (Host): It's a common, often very debilitating condition among adults. So, we're discussing arthritis and how it's treated. Our guest, Laura Grantham. She's a physician assistant in Rheumatology at Skagit Regional Health. This is Be Well with Skagit Regional Health. Thanks for listening. I'm Joey Wahler. So first in a nutshell, what does a rheumatologist do exactly?

Laura Grantham, PA-C: A rheumatologist diagnoses and treats musculoskeletal disease and systemic autoimmune conditions. Rheumatologists treat joint diseases similar to orthopedists but do not perform surgeries. Common conditions treated in rheumatology are rheumatoid arthritis, gout, lupus and psoriatic arthritis.

Joey Wahler (Host): So we're focusing on arthritis, as mentioned, and there are a few different types. Can you tell us what they are and what's the difference between them?

Laura Grantham, PA-C: It's important to know that arthritis is not a single disease. It's an informal way of referring to joint pain or joint disease. There are many different types. There is osteoarthritis, which is a more degenerative condition, and then there are a variety of inflammatory arthritides.

Joey Wahler (Host): Let's try and narrow it down, for instance, to rheumatoid arthritis and osteoarthritis. What's the difference between those?

Laura Grantham, PA-C: Osteoarthritis is localized inflammation, and it is the most common arthritis. It affects most adults over the age of 50, and it is the result of wear and tear over time. Rheumatoid arthritis is the most common inflammatory arthritis, and it's caused by the immune system.

Joey Wahler (Host): And so what you're saying there is that one basically comes from age and usage over time, and the other one is being caused by other factors. So what about the symptoms? How do those differ between the two?

Laura Grantham, PA-C: So the symptoms of osteoarthritis are usually based on mechanical pain. The more you use the joint, typically the more pain that you will have. Whereas rheumatoid arthritis can also hurt with activity, but one of the hallmarks of this condition is prolonged morning stiffness. And then some people actually feel better the more they use the joint.

Joey Wahler (Host): So how about treatment for both? What are the similarities or differences there?

Laura Grantham, PA-C: Certainly. So the treatments for osteoarthritis are pretty broad. Weight loss can really improve pain associated with osteoarthritis. Exercise, done the proper way, can also improve pain in the long run. Support devices can be used to support the joints. And heat and cold therapy can also be employed. There are some complementary medicine like chiropractic care and acupuncture, which can be helpful, and there's some other options, medication wise too.

There's some topical medications like capsaicin cream, lidocaine and diclofenac gel, which can be used to relieve pain. Acetaminophen, which is Tylenol, can also be taken to help with sore joints. Some people also employ non-steroidal anti-inflammatory drugs, which are called NSAIDs. Some common over-the-counter examples would be ibuprofen and naproxen.

Another drug that has been approved for pain in osteoarthritis is called Cymbalta or duloxetine. That would be requiring a prescription from your physician. We also perform joint injections for osteoarthritis. There are some newer modalities available for osteoarthritis as well, like platelet-rich plasma injection, stem cell use, anti-inflammatory diets and CBD products. If all of these modalities fail, there also are surgical options. Some of them are arthroscopic, requiring small incisions, and then there's big surgeries like joint replacement.

Rheumatoid arthritis, on the other hand, is treated completely with medications. We use medications that are called DMARDs or disease modifying anti-rheumatic drugs. These medications make changes in the immune system to help treat the disease. There is no cure for either of these arthritides, so it's important to know about their management, which a rheumatologist can help you to navigate.

Joey Wahler (Host): So if someone thinks they may have arthritis, be it one type or the other, when should they see a doctor? How do they know the time is right?

Laura Grantham, PA-C: You should discuss this with your primary care provider and they can help you to know when you should seek out specialist care.

Joey Wahler (Host): How about the way in which professionals like yourself go about diagnosing initially which type of arthritis the patient has in the first place? What's done there?

Laura Grantham, PA-C: There is no one test to diagnose patients with arthritis. Typically, your rheumatologist is going to look at blood test results, examine joints and organs and review X-rays or ultrasound images.

Joey Wahler (Host): In addition to treatment, you touched on this earlier, but let's maybe expand on it a bit, please. What are some of the ways a patient can manage their own arthritis? Because we're talking about weight control and some other things, right?

Laura Grantham, PA-C: So other things that you would consider, especially with osteoarthritis, is properly learning position and support of your neck and back while sitting or sleeping. You could also learn how to adjust furniture such as raising a chair or toilet seat to become in a more ergonomic position. You want to avoid repeated motions with the joint, especially frequent bending. Losing weight, if you're overweight or obese, which can reduce pain and slow progression of osteoarthritis.

It's recommended that you exercise each day to help get the joint moving. You could also use adaptive devices that will help you do daily activities. You may want to work with a physical therapist or occupational therapist to learn the best exercises and to choose arthritis assisted devices.

Joey Wahler (Host): Let's maybe just talk a little bit more about maintaining a healthy weight and exercising regularly. Explain if you would please, why is it exactly that heavier people have more problems with arthritis?

Laura Grantham, PA-C: Carrying more weight, puts more stress on the joint with each repetitive motion. For example, walking. If you're carrying 10 pounds extra and you're walking daily, every time you take a step, that's an additional 10 pounds that your joint is having to support. So over a period of one day, you could see how this would really add up.

Joey Wahler (Host): Sure. In summary here, for those with arthritis, what would you say your message is about the chances of improving your quality of life?

Laura Grantham, PA-C: With proper treatment, guidance and support, patients can minimize pain and have a more productive and pain-free life.

Joey Wahler (Host): All right. Well folks, we trust you are now more familiar with the treatment of arthritis. Laura Grantham, thanks so much again.

Laura Grantham, PA-C: Thank you. Have a great day.

Joey Wahler (Host): And for more information, please visit SkagitRegionalHealth.org. Again, that's SkagitRegionalHealth.org. If you found this podcast helpful, please do share it on your social media, and thanks for listening to Be Well with Skagit Regional Health. Hoping your health is good health. I'm Joey Wahler.