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Bob Lewis (Host): And good afternoon. I'm Bob Lewis. I'm welcoming you back to another in our series of conversations with the doctors with the Summa Health System here in Akron. Our doctor today is Daniel Jackson. He's a rheumatologist with Summa Health. Good afternoon, Dr. Jackson.

Dr. Daniel Jackson: Hi there. How are you?

Host: Doing very well. We're going to talk today, obviously, about Rheumatology and rheumatologists. First of all, let's take a look at that word, and the root word seems to be rheumatism, but what kind of conditions do rheumatologists actually treat?

Dr. Daniel Jackson: Well, we treat all sorts of arthritis and causes of inflammation and autoimmune disease. So, it's kind of a little bit of different kinds of things, but I know we a lot of times get referrals from people's family docs or their primary care providers about anything that kind of is something that they think that there's something where there's inflammation as a source, but a lot of it's things like rheumatoid arthritis, lupus, gout, and sometimes the arthritis that comes with psoriasis, like psoriatic arthritis. But there's a couple of hundred type of conditions that fall under rheumatism. Those are the probably most common things that we see when we're referred to.

Host: That is a very, very, very broad category that you have to take care of. Let's talk about, again, some of these terms. Everybody tosses around the term arthritis. Now, breaking that down, what does that mean, arthritis?

Dr. Daniel Jackson: I think when people say arthritis, I know it's something that, most of the time when people talk about arthritis in general, it's usually osteoarthritis, which is something where when people have kind of wear and tear in their knees or their hips or their back, sometimes their fingers. It's something that can happen. About 15-20% of the population has some kind of symptoms of it at some point, and probably the majority of people get some degree of osteoarthritis over time. But the kinds of treatment for that can be something that we do can treat that. But it's also something that a lot of people, you know, use these kinds of things as far as over-the-counter type of medications or sometimes seeing orthopedic surgeons or sports medicine people.

But we focus on more of the-- they're less common, but they're still definitely out there-- like rheumatoid arthritis, which is different than osteoarthritis, is something where there's an underlying inflammation and the joints kind of swell, and get stiff in the morning. And they're usually worse after resting more so than after using them. So, about 1% of the population has rheumatoid arthritis. And sometimes, in some groups, it can be higher. But that's something that when you start to notice there's kind of the warmth in areas or there's inflammation and you feel flu-like, it's kind of a little different than regular osteoarthritis.

Host: Now, these other kinds of arthritis, you talked about rheumatoid arthritis not caused by simple wear and tear or age. Is there a cause for that, that they were aware of? A virus or some other activity? Well, what causes that?

Dr. Daniel Jackson: With rheumatoid arthritis and a lot of the other autoimmune conditions, it's something where there's probably, in most cases, a little bit of genetic parts to things. A lot of times there is a family history, but not all the time. So sometimes, there's other kind of inherited things that people have, where you have a little bit of a tendency towards something. Then when you have that, sometimes either having an illness like the flu or COVID or things can kind of trigger it to come on too. But sometimes there's no illness. It just happens itself. There's not a single kind of point of cause that they know of. But I think it can be either an infection or sometimes it can be pregnancy. It can be kind of all sorts of things that turn on the immune system to be kind of autoimmune and cause inflammation.

Host: You mentioned the word autoimmune in the immune system. Tell us how that works and what we mean while we're saying it's an autoimmune disease.

Dr. Daniel Jackson: It's something where normally your immune system's focused on treating bacteria, viruses, and kind of infections. And when you talk about autoimmune, the same things that your body does to fight infections is something where either a switch gets turned on or sometimes your body gets sensitive to its own materials. So, people that have rheumatoid arthritis or lupus or psoriasis, there's something that your body's-- its immune system-- that's usually used to fight outside problems is turned itself into being inflamed from your own self. It's something where the immune system's turned in the wrong direction basically.

Host: So in other words, your body kind of gets mad at itself and tries to hurt itself for some reason.

Dr. Daniel Jackson: That's exactly it. The kind of things where we treat it, it's something where we want to make sure that whatever we do, if there's an autoimmune condition, that we don't cause the immune system-- because we definitely don't want the immune system to shut off. But it's something where we wanted to try to aim in the better direction. So, sometimes when people have autoimmune diseases, a lot of times, the immune system itself is overactive. So, if we try some different kind of treatments that help to control the immune system or turn it in the right direction, it's something where we want to make sure that it's not making it too low. But a lot of times, when people who have autoimmune disease, their immune system is really active. So even when we're treating it, a lot of the times, it's something where the people who have it can still fight infections well.

Host: Now, let's ask some questions about what causes the actual pain, what we consider any type of arthritis. The degenerative type of arthritis, people talk about things like there's not as much fluid in between the joints as they used to be, or sometimes even use the phrase bone-on-bone. What do those phrases mean?

Dr. Daniel Jackson: When people have, like say you have a knee that has a lot of arthritis. Knee arthritis is the number one reason in the world for having a joint surgery. So, people who have knee arthritis, there's normally this cartilage and some fluid, between, you know, your thigh bone and your shin bone. And when it gets down to the point where there's more wear and tear, that cartilage, which is kind of really cushiony, but it's something where it's a pretty shock-absorbing area that, with osteoarthritis, gradually thins. There's also some fluid in the knee that also helps to cushion the two joints.

But when people have osteoarthritis, that process where they talk about being bone-on-bone on an x-ray, that's something which is a sign of that cartilage over time, kind of narrowing to the point where the two edges of the bones are meeting. And the pain that comes with that is from the two sides of bone if they lose the cushioning, they kind of get a little bit of a bruised feeling. So, it's something where if you are normally able to walk, say, 20 minutes or so because there's no cushioning there, you can only walk for a few minutes. So, you can still usually bear weight on them. But it's something where when you lose that cartilage cushion over time, that's something that can cause a lot of the source for the pain.

Host: Now, rheumatoid arthritis, you said, it causes inflammation. Where is the inflammation and what the cause of the pain and what's being inflamed?

Dr. Daniel Jackson: Yeah. With rheumatoid arthritis, and it can be a lot of times in your hands and sometimes shoulders and knees and feet, it's something where when that pain comes, it's something where the cartilage could be fine, and it still has a lot of the fluid in there. It gets inflamed in the area around the fluid. It's called the synovium, which normally it's not that thick. But when you have inflammation, it gets kind of thick, almost like a sponge that has a lot of the same inflammation that's all around your body when you have a virus or something where you, feel like that kind of flu-like feelinf everywhere.

That same chemistry of that inflammation is all in the area around the joint. So, it's kind of a different location and a different source of pain. And that's something, when you have it, it's painful, but it's also something that causes a lot of stiffness, which osteoarthritis can also cause, but it's almost like there's kind of warmth and fever to it rather than just the bone pain.

Host: Now, how do you diagnose which kind of arthritis it would be when someone just comes in complaining of pain?

Dr. Daniel Jackson: Yeah. First thing we do is we get a good idea of what you're experiencing. Like something where, you know, kind of how long it's been going on, what time of the day is the worst, what kind of things you've tried for it. And there are blood tests that are usually very helpful. But sometimes someone who has signs of rheumatoid arthritis and they don't have the blood tests that show it, there's a test called a rheumatoid factor. That's usually elevated when you have rheumatoid arthritis, but not all the time.

And there's other kind of blood tests we do to specify, you know, to kind of demonstrate what kind of arthritis it is. Sometimes those other things like x-rays and occasionally MRIs, we use sometimes also to diagnose it, but a lot of the most important things are just talking to you and seeing what you're going through and then looking at the joints themselves. Those are the most important things to do when we make the diagnosis.

Host: Now for the osteoarthritis, I'd imagine that, again, in addition to asking the patient the symptoms and the like, those x-rays, those CAT scans would probably be the most helpful in showing what's going on in the joint.

Dr. Daniel Jackson: It definitely has to do with the whole picture of everything too. So, sometimes we can talk to somebody and look at them and say, "Well, you know, it's something where we're pretty sure about what it is, but sometimes when you have the other things, as far as the CAT scans or labs and things, that sometimes makes us look more closely or look at it again. So, it's something where we try to be as good as we can, but there's always reasons to go back and reconsider things. And that's true when we see people with autoimmune disease particularly, it's something where we get an idea when we see the first time we see the patient. But a lot of times it takes a few follow-ups to get the right course of things and the right evaluation as well.

Host: Now, you mentioned you also treat lupus, which is another autoimmune disease, but not the same as a rheumatoid arthritis. What kind of a disease process is lupus?

Dr. Daniel Jackson: Lupus is something that can come out as an arthritis, but it also has a lot of other things that it can affect. It can affect the skin with more rashes. Sometimes it affects the kidneys or the blood count. It can make people have problems with mouth sores or sometimes lose their hair. So, it's a different autoimmune problem than rheumatoid arthritis. And it's something that could affect kind of a wide age range. But it's something that tends to be a little bit different in that it has more symptoms and areas outside the joints as well. So, it's kind of something that sometimes you'll get a little pain around your ribs when you cough, or other kind of things. The symptoms are more widespread than rheumatoid arthritis.

Host: At what age do the symptoms of lupus usually manifest themselves?

Dr. Daniel Jackson: Usually, lupus, there's a large start of symptoms in people in their 20s and 30s. And then, there's a second peak of people that come out with symptoms in their 50s and 60s too. So, it's kind of something where it's a pretty wide age range. I mean, I've had patients where it came on when they were teenagers, and then I've had patients where it came on in their 70s. It's not as common as rheumatoid arthritis. It's probably about less than a 10th as common as rheumatoid arthritis. But it's something where it's definitely something that's out there, but it's definitely less common than rheumatoid arthritis.

Host: I understand that more women are affected by lupus than men. Is that true?

Dr. Daniel Jackson: Yep. I think that's true for almost all the autoimmune diseases as far as women, just because of hormonal effects and because of some of the immune changes that happen with pregnancy. It's something that, a lot of times, a lot of autoimmune diseases are more common in women. There are a few exceptions. I know in people who have a different condition called ankylosing spondylitis. It's more common in men. But I think as they find out, that's something that happens in both, but it's more severe in men. But it's something where overall that's one condition where men tend to get it more than women.

Host: Now, do these tend to be hereditary?

Dr. Daniel Jackson: With lupus, that tends to be something that's definitely hereditary, like rheumatoid arthritis where some of the background genetic conditions probably run in families, but not everyone in the family gets it. It's usually something where if there's a family of five siblings, one or two usually will get it. But it's something where there are times when it really skips generations too. So, it's not always predictable.

Host: We're talking to rheumatologist, Dr. Daniel Jackson, who is with the Summa Health System, talking about arthritis, lupus, rheumatoid arthritis, other inflammatory and autoimmune diseases that they treat. Now, in treating an autoimmune disease, like we talk lupus or rheumatoid arthritis, we are looking at mostly some sort of medications for that.

Dr. Daniel Jackson: Nowadays, compared to even 10 years ago, there's been an explosion of different types of medicines, which it's good to have a choice, but it makes it difficult to find the right path all the time. But I think when you see a rheumatologist, they're going to be going with the things that they've used before and find to have the best effect with the best safety profile. So, there are kind of general guidelines or paths that people take. But a lot of times, it's up to the individual person as far as what's worked. But we all try to follow what's going to work the best and try to be the safest as far as the fewest side effects we can find.

Host: Now, have there been advances in treating autoimmune diseases in recent years?

Dr. Daniel Jackson: Yes, there's a lot of new types of medicines that we have for both rheumatoid arthritis, lupus, and others like psoriatic arthritis where there's been a lot of new medications. They call them biologics that are medicines that are engineered to really focus specifically on the sources of the inflammation. They're very strong medicines for the most part. And they're things that, unfortunately, a lot of them are newer, so they tend to be more expensive. But there are all sorts of ways. I know the specialty pharmacy that we have at Summa is excellent as far as finding ways to get things covered so that there's a reasonable cost or very low cost as far as having the coverage for them so that we have a lot of resources for making things when we need them to be available. But there's still medications that we use that we really try to use in the case where we think they're going to offer the most benefit. So, we don't use them in everybody, but I'd say probably almost half or maybe a little bit more than that of people that use them at some point during the course of their arthritis.

Host: Now, if those types of cases continue untreated, can the disease spread to other parts of the body and other vital organs?

Dr. Daniel Jackson: Absolutely. The rheumatoid arthritis and lupus, they are things that if they're not treated, they are something that can affect, for sure, the joints and they can cause, you know, problems with loss of use of the hands or the other joints that it involves. The inflammation that comes with it can cause other issues as far as the higher risk for heart disease, strength-wise as far as having your muscle strength. You can lose that when you have a lot of inflammation in arthritis. And I know, the kind of inflammation that comes with ongoing lupus can sometimes affect the kidneys and the heart as well. So when we call them arthritides, it's something where that's a lot of times what they affect. But really, the other parts of them, when the inflammation's uncontrolled, it can affect a lot more things than just the joint.

Host: So getting back to the osteoarthritis, the more common form of arthritis that people suffer, talk about the different joints. Let's talk about the knees, for example. And what the treatments are? As you discover, first of all, there may be some arthritis, how do you determine that there may be some arthritis? What are some of the modes of treatment that you would do on an arthritic knee?

Dr. Daniel Jackson: With knees, when you have a lot of knee osteoarthritis, it's something that I know from the beginning through, even when people have surgeries, a lot of times, the biggest, best treatment is going to be something where you're trying to maintain or bolster the muscles around the knee. So, I know in the areas of the thigh, like that front muscle in there, and then the rest of the muscles in the lower leg, when those are stronger, you're going to do better, both short term and long term with arthritis. So if you have something where either with physical therapy or sometimes people's own exercise routines, the better the strength in the leg is, the better the joint's going to do.

So first, if someone has some weakness in their leg at the beginning, that's something that a lot of times early on physical therapy is very good. We try to use different sometimes anti-inflammatories, but sometimes Tylenol. And if they don't work, we use other things that can help the joint pain, like sometimes injections, like steroid injections or cortisone injections. Or sometimes, we refer to Sports Medicine doctors or orthopedic doctors that use they call them gel injections, it's a liquid that's trying to emulate the fluid that's already in the knee, which can sometimes be helpful too. When it gets to be the point where nothing like that is working, then sometimes we refer to orthopedic surgeons that sometimes will look at doing knee surgeries and things like that.

Host: That would include, what, knee replacements if needed?

Dr. Daniel Jackson: Yep. Sometimes when it's early and it's something where there's problems with the parts of the cartilage and the knee, like the meniscus or the other ligaments in there, sometimes the less invasive surgeries, like the arthroscopy, if there's a problem with the knee stability or the way it moves, sometimes those can be very helpful. But a lot of times, when the knee is getting to the point where nothing else is working, the knee replacement is still, I think, a very good option even though it's difficult to go through of course because of their knee surgery and recovery. But when people do it, it's a very effective treatment when you have severe knee arthritis.

Host: Now, you mentioned for knee arthritis, osteoarthritis, that exercise can actually make it better. So, the question I would have is that, so yeah, my knee hurts. But do you mean it won't hurt it anymore if I exercise it? I may be concerned that, "Boy, if I try to, say, you know, ride a bike or jog or something, will that make it worse, even though it may cause me some pain when I start to do it?"

Dr. Daniel Jackson: Yeah. That's a hard point about when you have something that's going to make a knee strong, but not make it hurt too much when you do it. And that's something where a lot of times when we have some either guidance from physical therapist to find the right exercise for you, it's hard to say one exercise is really the right one for each person. But usually, there's something that can be done that gives the muscles some exercise to keep them strong that can be done. If it isn't completely pain-free, it's minimal pain. So, it's something where there's almost always some method of exercise that can be found that'll help. But it can be different for each person. Sometimes it's walking, sometimes it can be a stationary cycle. Sometimes it's a different aerobic machine or sometimes the different kind of things you can do at home. So, that's part of the difficulty of trying to do it, is trying to find the right thing for each person, which it's definitely different in each case.

Host: Now, let's move up the body. Let's go to the hip joints. Arthritis of the hip, is that common?

Dr. Daniel Jackson: It's common. It's not as common as osteoarthritis of the knee, but it's a little more difficult to do the things like exercises that help the muscles, because there's a lot more, muscles that are closer in the body and it's hard to get those always to the point where it can help. But I think, sometimes, the same medications we use like Tylenol or other anti-inflammatories are good. And sometimes similar kind of injections like cortisone injections can be used and they do it under x-rays, if it's a deeper joint. But I know that referring to an orthopedist or having a possible surgery is also something that's there for the hip too. The good thing about the treatment for that is usually recovery from the hip replacement is usually a lot quicker than the knee for different reasons.

Host: Going back up the body to the shoulder. Bursitis. Is bursitis a form of arthritis?

Dr. Daniel Jackson: Yeah, bursitis in the shoulder. Usually, it's a sign of the problem with the tendons around the shoulder. And it can cause a bursitis around the edge of the shoulder there. Things we do around the knee is also true of the shoulder as far as keeping the muscles around there strong. I know, injections for that bursitis and sometimes cold and other kinds of treatments can be very good for that, for the shoulder. I know that the kind of surgeries they do, and I can't speak because I'm not an orthopedic surgeon exactly, but they're making a lot of advancements with the kind of things that are helpful for really bad shoulder arthritis. But a lot of the times, things like physical therapy can be very helpful for that too.

Host: Now, talking about the treatment for this kind of osteoarthritis, of course, obviously, over-the-counter painkillers, we can snap on the TV anytime of the day or night and see advertisements or all types of those products, salves, creams, all those types of modalities. Are they effective?

Dr. Daniel Jackson: There's different kind of things you can get. The ones that are, you know, menthol-ey, as they have kind of a good Effect on there, or capsaicin ones or Salonpas. I think those are definitely all worth trying. If they help the pain in the meantime so you can sleep better or, you know, have some less intensity pain during the day, I think they're good.

I know, in some cases when people have arthritis in their knee or their hand, there's a topical anti-inflammatory called Voltaren gel or diclofenac gel, and sometimes that's helpful. But be careful that it's not something that would interact if you're on other medications, such as blood thinners or things too. But it's available over-the-counter and it's something that can be tried with those too. But overall, I think the topical ones that you see in the store or tried from different areas as long as something that's at a reasonable cost. I think most of them are effective and worth trying.

Host: Now, what about the alternative methods for arthritis that people talk about? Copper bracelets, electrostimulation, different type of things, do they have worth?

Dr. Daniel Jackson: As far as copper bracelets or the copper fit gloves or things like that, we don't have a lot of evidence on papers. And I've had a lot of patients where they really can be helpful. I think particularly with hand arthritis or knee arthritis, sometimes the compression that they have with using those can be something to try. I think it's certainly something where, if you can get it and it's not too expensive, I think it's definitely worth trying that way too.

Host: What about these other like electric stimulation, other things like that? What about those?

Dr. Daniel Jackson: When people would have a lot of either knee or back and sometimes shoulder pain, there's these other things called TENS units and they're kind of like a surface stimulation where it gives you like a little feeling like someone's tapping their fingers on your skin. And sometimes in cases when the pain-- you know, nothing else is working, I think those are things that can be helpful for local pain relief. Those are getting a lot more available and affordable than they used to be. So, there are things that I think they're worth trying when there's a kind of an area where there's a pain in that area. It's similar to using a topical pain medicine, but it's something where in some cases it works a little better or in between the times when you use those topical solutions too.

Host: Once again, Dr. Daniel Jackson, a rheumatologist with Summa Health. If you'd like more information or to schedule an appointment at one of the three convenient locations that Summa Health Rheumatologists have their offices, you can go to the website to find out the one nearest you summahealth.org/rheumatology or call them at 234-312-5331. That's 234-312-5331. Again, Dr. Daniel Jackson, thanks for talking with us this evening and continued good luck with your career. Thank you very much. I'm Mr. Sunday, Bob Lewis.