Transcription:
Arthritis and Joint Health

Caitlin Whyte (Host): Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This podcast is sponsored by the University of Maryland Joint Network.

Pain, stiffness, swelling, redness, and decreased range of motion are some of the telltale signs of arthritis. It is a common condition, especially in older adults and athletes. Learn today from joint expert, Keona Holliday, what arthritis is and what the treatment options are including at-home joint care. Well, Keona, let's start with that first question. What is arthritis?

Keona Holliday, PA-C (Guest): So arthritis is really a generic term, which refers to joint inflammation. But the vast majority of time, people are actually referring to osteoarthritis, which is what I specialize in treating.

Caitlin Whyte (Host): And who is likely to get arthritis? And on that note, can it be prevented?

Keona Holliday, PA-C (Guest): So the top risk factors for osteoarthritis are age, gender, obesity, and genetics, which unfortunately the only real modifiable risk is obesity. And it's actually more common in women than men, especially after the age of 50.

Caitlin Whyte (Host): Gotcha. And what are the different kinds of arthritis that can happen?

Keona Holliday, PA-C (Guest): So there are several different types of arthritis, but the three most common are osteoarthritis, rheumatoid arthritis and psoriatic arthritis. Again, I mainly specialize in treating osteoarthritis, but the patients that I do see who have painful joints with little to no breakdown of their cartilage, I end up referring them to a rheumatologist for further workup.

Caitlin Whyte (Host): Can you just quickly break down what those three types are and what the difference is?

Keona Holliday, PA-C (Guest): Again, osteoarthritis is inflammation that's caused by the cartilage at the end of your bone wearing out. So if you've ever pulled apart like a chicken bone and you see that shiny white stuff at the end of the bone, that's the cartilage that we're referring to when we're talking about osteoarthritis. It's called articular cartilage in which some joints like your knees also have a meniscus cartilage in them. But that's a different function. But the articular cartilage is the smooth weight-bearing joint. Weight-bearing surface of your joint, that is, and it covers the ends of your bones. So it generally starts off as being like the shiny white pearl color. But as it starts to break down, it develops arthritis, that cartilage loses its shine, becomes kind of dull, if you will. It even gets a little irregularities and cracks in it. So that's usually when people start to take a little Tylenol and doing a little more sitting, because that's when they start to feel pain. And the end result of severe osteoarthritis is when there's no cartilage, the cartilage is completely gone.

So I try to associate osteoarthritis with things that people can relate to. Like, if you look at like a pavement or like a road top, if you see that there's a lot of potholes, more potholes than asphalt, that's kind of like what it is with arthritis. Your cartilage ends up with a lot of potholes in it, something like that. But it particularly becomes painful because once you wear your cartilage down, the nerves for the joint are actually located at the end of the bone, right on the other side of cartilage. That's when people are feeling that pain. So that's osteoarthritis.

The other ones that I mentioned, rheumatoid arthritis, that's basically when your system kind of is attacking itself. It's an auto-immune type thing or an inflammatory type thing, which labs and stuff are done to break that down. Sometimes rheumatoid arthritis can also lead to osteoarthritis. And the same thing with psoriatic arthritis. Patients see that when they have psoriasis, sometimes they have pain in their joints, again, slowly but surely turning that into an osteoarthritis. Osteoarthritis is just the breakdown of the cartilage.

Caitlin Whyte (Host): All right. And then when it comes to arthritis, what are some treatment options that are available to us?

Keona Holliday, PA-C (Guest): A lot of people will jump right to the conclusion of needing surgery when they have arthritis, but surgery should absolutely be the last resort. It's really only a small part of treatment for arthritic patients. So what I like to do a lot of times, the first thing I have my patients do is basically switch their footwear to an athletic style shoe. The more cushion, the better. Because you have to remember every time you take a step, your joint is essentially absorbing whatever impact you have on it. If you have more cushion in your shoes, that cushion can absorb that shock that you're giving the joint.

The next thing is over-the-counter medications like Tylenol or ibuprofen, which a lot of people I think know that there are dangers in of course taking any medication, especially with high doses. Anti-inflammatories such as ibuprofen should always be used short-term. They are great short-term medications, but long-term affect your liver, kidneys and other parts of your body, including some people will get like some GI upset, which over time can lead to ulcers and things like that because it increases your stomach acid. But Tylenol is the best and safe medication actually for osteoarthritis. Our patients, which I don't necessarily like to state exactly what the dosage is for everybody, because everybody is different. If you have any effects of your liver, that's something that you have to talk to your primary care doctor about, but it is still better than ibuprofen because ibuprofen can affect your liver as well.

So those are the main two treatment options, I will say. There are other things that you could do, but treatment-wise, as far as what we recommend, things that, you know, you should consult with your doctor with would be for sure those medications. Also, physical therapy, weight loss. I know a lot of people will be like, "You want me to lose weight, but I can't exercise." Exercise is only a small part of, you know, losing weight. It's more so what you're feeding yourself. Again, that's a whole 'nother thing to get into. But the best options as far as exercise and/or with therapy is you want to do what you can that will take the weight bearing off of your joints in which I recommend walking in waist-deep water, which you don't need a physical therapist for that. The YMCA, aquatic centers, I know we have those types of options in our area. Not everybody has that, but for those that do, utilize it.. Walking briskly in waist-deep water, the water makes you practically weightless from the buoyancy. So you're taking the weight off of those joints and you're strengthening the muscles around them at the same time.

Caitlin Whyte (Host): Well, that leads me into my next question. You just mentioned a bunch, but what are some of the best at-home ways to care for your joints?

Keona Holliday, PA-C (Guest): So, yeah, increasing your physical activity, hence that walking briskly in waist-deep water. Walking in water is the best exercise. Next, following after that would be riding a recumbent bike. You're not standing on it. You know, most of the time, the recumbent bikes kind of leave you in a reclined position. You're just doing the motion with your legs. I specifically mentioned recumbent bike because some people are like, "Oh, I have a stationary bike," but they tend to stand up and ride. That's not good for your knees, for sure. After the recumbent bike would be the elliptical, because again, you're kind of doing that round motion, even though you're standing, it's still is less than walking on dry land. The next thing would be then walking on a treadmill because all treadmills have a little bit of cushion to it, hence taking off that shock from your joints when you take a step down. And lastly, will be walking on land.

Caitlin Whyte (Host): Well, wrapping up here, are there any other thoughts you would like to leave with the audience? We covered a lot today, but is there anything we missed?

Keona Holliday, PA-C (Guest): Don't be afraid of supportive devices. I have a lot of patients that come and you're like, "Oh, I'm never going to use a cane" or "I don't want to use that because it makes me look old." If you feel that way, get trekking poles. You ever see somebody who is out hiking on dry land and you think they look really cool they had trekking poles. Those are our fashionable canes, but it looks good. So you use those instead.

And another thing, I think a lot of people will say, you know, they're worried about running. If you are an avid runner and you don't have our arthritis, keep running, because research has shown that recreational runners had a less chance of developing knee and hip arthritis compared to non-runners or people that are sedentary. However, competitive running though, because a lot of times they do quick stops, those people actually increase their risk. So if you're a runner, keep running. If you start to develop arthritis, then you have to slow things down. But as long as you don't, keep up with your running. It's great for your joints.

Caitlin Whyte (Host): Well, Keona, just some great information covered today. Thank you so much for joining. This episode is sponsored by the University of Maryland Joint Network. UM Joint Network Surgeons are experts in total hip and knee replacements. Held to the highest standards of care, UM Joint Network Surgeons produce better outcomes for patients compared to national averages, including lower infection rates and faster recovery times. The UM Joint Network, home to Maryland's leading joint replacement surgeons.

Keona Holliday, PA-C (Guest): Find more shows just like this one at umms.org/podcast. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.