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    Defining Arthritis

    Dr. Mujtaba Tapal, MD Rheumatologist, Deaconess Clinic Downtown 05/13/2021

    Arthritis is a very common condition, affecting as many as half of all Americans in their lifetime. In my more than 20 years of practice, I’ve seen thousands of patients who are suffering from arthritis. It can be a painful and debilitating disease.

    However, arthritis is a broad term that describes one of several conditions. What they have in common is that they affect the bones/joints in a way that keeps them from moving properly. 

    Inflammatory and Non-Inflammatory Arthritis
    There are two main categories of arthritis:  inflammatory and non-inflammatory.
    Inflammatory arthritis can include many different conditions, such as rheumatoid arthritis, lupus, and gout.

    Non-inflammatory arthritis is also known as degenerative arthritis, or osteoarthritis. It’s sometimes called “wear and tear” arthritis, and is the more common variety. 
    Osteoarthritis most often affects the hands (most often the knuckles and base of thumbs), hips and knees. Other joints may be affected, but less commonly. There are several known causes of osteoarthritis. For the weight bearing joints (hips and knees), obesity is a significant contributing factor. But surprisingly, this is also a risk factor for osteoarthritis in the hands, for reasons that are not fully clear.

    Trauma (injuries) is also a risk factor for arthritis. Sometimes “old sports injuries” or motor vehicle accident injuries can later develop into arthritis. There are also problems that result from repetitive stress injuries. Typing, for example, can increase risk for hand arthritis. Beauticians can develop arthritis in the joints that control their scissors. 
    Osteoarthritis Treatment
    Osteoarthritis (OA) is treated in a variety of ways, depending on the severity of pain and limitation of movement in the joint. The simplest treatment is non-prescription pain relievers, such as ibuprofen, naproxen, and acetaminophen. (Brand names can include Advil, Aleve and Tylenol.) 

    There are some things that people can do to help keep their joints limber, including exercises to keep the joints moving and to strengthen the muscles around them. Ask your doctor what exercises may be best for your joints.

    For more moderately-severe OA, prescription pain medications, as well as joint injections, can be helpful in reducing symptoms of pain and stiffness. At this stage, I also consider sending a patient for therapy. For upper extremities, I send patients to occupational therapy; for lower extremities and arthritis in the back, physical therapy is most helpful.

    For severe OA, joint replacement, if feasible, is considered. Not all joints can be replaced, and not everyone is a candidate for joint replacement. However, replacing hips and knees can frequently help someone return to a better quality of life.

    I am often asked about different/alternative treatments for OA, such as taking glucosamine/chondroitin, shark cartilage, gin-soaked raisins, etc. In controlled studies, they have not indicated any effective treatment for OA. However, some patients report improved symptoms. Overall, they’re not likely to cause harm (*see note below), and if someone feels they’re getting a benefit, I am fine with that. In some cases it may be the placebo effect—they believe it’s working, and so therefore, their symptoms are improved. That’s fine! 

    *There are some reports of glucosamine/chondroitin affecting blood sugar, so it is best to let your physician(s) know you’re taking this medication. Recovering alcoholics should not try the gin-soaked raisins.  With everything, there is the potential for side effects, so again, be sure to tell your doctor about anything you take—prescription or over-the-counter.

    Inflammatory Arthritis - Rheumatoid
    Rheumatoid arthritis (RA) is diagnosed through several components, all of which are considered in making the diagnosis.

    These include:

    • Patient history
    • Physical exam
    • Lab tests (blood) 
    • X-ray and imaging

    Sometimes a patient will have a positive result on their blood test for rheumatoid factor, and this alone neither makes or breaks the RA diagnosis. A primary care physician can be suspicious of RA, and will provide a referral to a rheumatologist to confirm the diagnosis. Once the diagnosis is made, we move on toward treatment options. 
    Rheumatoid Arthritis Treatment
    In RA, treatment includes symptom management for joint pain and treatment to prevent future joint damage. The goal is to manage pain and keep the disease from progressing. For mild-to-moderate RA, oral medications are used. For more severe cases, oral and injectable medications are needed.

    Many people have heard the side effects for RA medications on TV commercials, or read them in magazine ads. These side effects may seem scary, but if medications are managed properly, these medications can be used safely. The good results far outweigh the potential bad side effects.

    As a rheumatologist, when my patients are on RA medications, I require lab tests on a regular basis to make sure that their bodies are handling the medication well, and that the medication is doing what it is supposed to. If the labs are not normal, I adjust the dose or try a different medication. 

    Rheumatoid arthritis is a systemic disease, and can affect more than your joints. Your eyes, lungs and other organs can be affected. So, even if someone isn’t experiencing joint pain, it’s best to discuss ongoing treatment with your doctor to prevent complications down the road.

    Inflammatory Arthritis - Lupus
    Another form of inflammatory arthritis is lupus. Lupus is another autoimmune disease (like RA), that is the result of the body’s immune system not functioning properly, and instead “attacking” parts of the body, rather than defending them.

    Not everyone with lupus will have joint pain. Those who do will use a combination of treatments with the goal of reducing symptoms and keeping the disease from getting worse.

    Lupus, overall, is treated in various ways, depending on the severity of the disease and the body systems that are involved.

    Inflammatory Arthritis - Gout
    Gout is a third common form of inflammatory arthritis. Gout is the result of excessive uric acid in the blood, which is a waste product of the body and is normally managed and excreted by the kidneys. If uric acid builds up in the body, it deposits in the joints, forming “crystals” of uric acid inside these joints, which causes severe pain. Gout most commonly affects the toes, making it difficult for people to walk during a gout “attack.” The toes can be so sensitive, it hurts to even touch them.

    Once the diagnosis of gout has been established, patients must always stay on treatments for gout. The treatments are for managing uric acid levels, and reducing pain from a gout attack. 

    There is one medicine that a patient must take daily to keep the body’s uric acid low. This medication does not treat gout attacks, but has the goal of preventing them. It must be taken indefinitely, as starting-stopping this medication can cause more frequent/severe gout attacks. 

    Acute gout, or a gout attack, is managed with a different set of medications which treat the episode and the related pain and swelling.

    The relationship between the diet and gout is somewhat limited. If someone is eating a normal everyday diet, then stay with that (although eating more fruits and vegetables is always a good thing!).

    High uric acid is often associated with hyperlipidemia (high cholesterol), so it’s really important to keep your cholesterol in check.

    There are some foods to avoid:

    • High fructose corn syrups, such as in sodas, and added to other foods.
    • Organ meat, such as liver and brain.
    • Certain fish, such as anchovies and shellfish

    Arthritis Prevention
    If you want to prevent arthritis in all its forms, you can’t go wrong with simply taking care of yourself. That means being at a healthy weight, eating nutritious food, regular exercising (rather than being a “weekend warrior”), and managing stress. It’s not 100% guaranteed, and these problems can happen to otherwise healthy people, but overall, by taking care of your health, you’re more likely to avoid all kinds of health problems, not just arthritis.

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