Transcription:
Get the Facts on Arthritis

Melanie Cole (Host):  It is true that arthritis can be painful, but there are a lot of things that you can do to feel better and manage your symptoms. My guest today is Dr. Deanne Eccles. She’s a sports medicine physician with Dean Clinic Stoughton. Welcome to the show, Dr. Eccles. Tell us about the types of arthritis. And really, what does that mean for someone suffering from one of these types? 

Dr. Deanne Eccles (Guest):  The two main types of arthritis are osteoarthritis, which is just wear and tear arthritis, and then inflammatory arthritis, which will be rheumatoid arthritis or lupus arthritis or those types of things. Those are the two main categories, and each one is treated with different medications and different type of provider, sometimes, even. 

Melanie:  How do you know if what you’re having is just normal wear and tear and aches and pains or if it’s truly arthritis? How does someone find out? 

Dr. Eccles:  Well, sometimes the inflammatory arthritis has more swelling and more joints stiffness in the morning, and it kind of improves through the day or it can come on rather quickly, whereas wear and tear arthritis is more gradual loss of motion or stiffness, and then maybe some swelling. Sometimes it can be related to having a prior surgery or injury to the joint that would predispose you to having the actual wear and tear arthritis. 

Melanie:  Dr. Eccles, I think people are most concerned when they do have arthritis, whether it’s in their knees or their hips or some kind of arthritis in their lower spine or their hands. What can they do to manage and live with these symptoms? If someone was to come to you, what would be your very first line of defense? What do you recommend they do just right away? 

Dr. Eccles:  Well, first we try to determine how much pain and activity limits they have on the arthritis or presumed arthritis. Then we’ll take an x-ray to see if there is a lot of narrowing in the joints base, a little narrowing, are there signs that it could be inflammatory with erosions in the bone, or is it more showing a tear. And between taking the history and then looking at x-rays, you kind of see what severity you have, and then you can determine how aggressively to treat it. Or if they’ve already tried some things on their own, they may have already tried Tylenol or Advil for pain, or they may have tried glucosamine, which is an over-the-counter natural supplement for joint pain. And that can be helpful for people. Those are kind of the initial things along with just x-ray, exercise, and activities for strengthening of the muscles around the joints affected. And then after that, you would get into more injection medicines such as cortisone injections or sometimes, for the knee joint, you can do viscosupplementation, which is like… Synvisc or Hyalgan are two brands that we’ve used here for the arthritis pain. And then obviously, the last option is surgical intervention with either a joint replacement or something. For hands and joints, sometimes they fuse the joints, or use a tendon for a cushion in the joint. 

Melanie:  Let’s start with some of the medications and cortisone injections, because people do always have questions about cortisone injections. If it’s shoulder arthritis, wear and tear, knees, what do cortisone injections really do? How long do they last? When is the time to stop doing them? 

Dr. Eccles:  The cortisone injection is basically an anti-inflammatory that you’re putting into the joint to decrease pain and swelling. The steroid will stay in the joint for about three months to four months, and then the effect of the steroid will last somewhere between three months or longer. Some people had years of improvement, whereas other people, if their arthritis is more severe, the steroid may only last three to six months. And then it can be repeated until it’s not helping the pain, and then it’s to the point, well, if you want to consider a surgical intervention at that time or if you’re not a surgical candidate, maybe other medications for pain control. 

Melanie:  Let’s talk about some of the medications. They come on and off the market: Voltaren, Celebrex, Vioxx. People hear about these medications. They hear about them on TV at 2:00 in the morning, they’re worried about all those side effects. How long can you be on anti-inflammatory—NSAIDs, or even ones that contain some steroids to manage your arthritis? How long, generally? 

Dr. Eccles:  There’s not a limit to how long you can be on those medications. You can be on them chronically. The main issue would be it does affect the protective chemistry that is involved for your stomach lining. So by blocking one of the [arms] of the reaction for the anti-inflammatory, it all affects some of the protection to your stomach lining. If you’re on them for a long time, sometimes people will have bleeding, like a stomach ulcer. And in that case, you probably have to stop it. But if you don’t have any stomach irritation, you could stay on it unless your doctor recommends that you’re not on those medications for either issues with your kidneys or your liver. Tylenol is an alternative pain medication which does not cause any problems with the stomach, and that’s another option, although some people don’t think that the Tylenol controls the pain for arthritis as well as an anti-inflammatory. 

Melanie:  I tend to agree with them. I always like ibuprofen better or naproxen, one of those, because of that anti-inflammatory effect. Now, what do you think about external anti-inflammatories, Dr. Eccles, such as topical creams, Bengay, or even ice? 

Dr. Eccles:  Ice is the best anti-inflammatory, actually. The reason behind that is because it causes vasoconstriction on the soft tissues or the vessels for decreasing swelling on the soft tissue. That’s probably the best type of way to get swelling down other than maybe a steroid injection. Anti-inflammatories over the counter only block one side of the inflammatory reaction, so you’re still probably going to get some swelling even with the over-the-counter anti-inflammatories or prescription anti-inflammatories. The topical anti-inflammatories are better for pain probably than for swelling. Those can be helpful if you are sensitive with your stomach and can do a topical better. That is an option. 

Melanie:  Where does activity and exercise play a role? If you have an arthritic joint, Dr. Eccles, do you brace that joint while you’re exercising? Do you wrap it or brace it, or do you just let it exercise and move it and try and get it as strong as possible? Where do you stand on that? 

Dr. Eccles:  I’m a big proponent of exercise. I think exercise is very good for arthritis because it helps the joints to start moving better and loosens it up. Sometimes, you have to find your threshold for how much exercise makes it feel better, whereas going too far will make it irritated. Usually, non-impact exercise, although it’s better for your bones, the impact is probably better for an arthritis. Do just range of motion and non-impact things, especially for lower extremity arthritis or a bicycle. Pool exercise is excellent for arthritis. Then obviously, strengthening the muscle groups around the joints can help protect the joint. 

Melanie:  What about heat? Does that play a role in soothing joints? Does that make inflammation worse? Sometimes people like to use moist heat on these really bad joints after exercise or before. Where do you stand on heat? 

Dr. Eccles:  Well, heat is good for stiffness. If you feel like you’re having trouble with joint stiffness, I would recommend heat. Usually it would be good to use it before an activity and then ice after an activity to limit swelling. So they’re kind of working in opposition. The heat will cause swelling, to some degree, but it loosens the joint if it’s stiff, whereas the ice will help with swelling and sometimes can be a better pain reliever. 

Melanie:  Now, when does surgery come into the picture, whether it’s joint replacement if you’ve got no cartilage left, if you’re just so severely arthritic that it’s very, very painful to walk or move around? When does surgery come into it? 

Dr. Eccles:  Well, surgery would depend on when you’ve lost function with the joints. Say you have knee arthritis, I always tell patients that when your knees start to control your life and the conservative treatments are no longer effective, that’s when you consider a surgical treatment. 

Melanie:  Surgery for arthritis, what is the end goal? 

Dr. Eccles:  End goal with a joint replacement type surgery would be to restore range of motion, function, and reduce pain. 

Melanie:  Okay. So in just the last minute, Dr. Eccles, please give the listeners your very, very best advice on living with and managing the symptoms of arthritis and why they should come see you at Dean Clinic Stoughton. 

Dr. Eccles:  Well, my main advice for arthritis is to try to use over-the-counter remedies and exercise on a regular basis for the initial stages of arthritis. If this is not effective in controlling the symptoms, then come see myself or some provider that has a similar background to consider other options to manage your symptoms and get evaluated to determine how severe your arthritis is and what the next step would be. 

Melanie:  Thank you so much. You are listening to Stoughton Hospital Health Talk. For more information, you can go to stoughtonhospital.com. That’s stoughtonhospital.com. This is Melanie Cole. Thanks so much for listening.