This month we will talk about arthritis which is a term that describes aching joints.
By: Dr. Brian Byrd
What is Arthritis?
There are over a hundred forms of arthritis but the most common are osteoarthritis, rheumatoid and gout. By far, the most common is osteoarthritis.
Osteoarthritis: Most joints contain cartilage that provide a softer cushion between two bones. In osteoarthritis, the affected joint that no longer possesses cartilage, or has worn down the cartilage a significant amount.
Rheumatoid arthritis: Sometimes our own bodies attack our joints which is the case in rheumatoid arthritis.
Gout: gouty joints flare up when a natural chemical called uric acid increases in our system and deposits in our joints, particularly cooler joints like the great toe. The uric acid forms crystals which our immune system attacks. Gout is characterized by pain out of proportion to the presentation. In other words, it hurts worse than it looks. Ouch!
Some Characteristics of Osteoarthritis
Osteoarthritis most often shows up in our fingers, hips, knees and shoulders. My patients typically describe finger pain as achy and they often rub their fingers. The condition lessens their ability to do things like open a can of pickles and worsens when they work in the yard.
Arthritic hip and knee pain worsen with weight bearing activity. The pain worsens over time and can be accompanied by a grinding sensation. Folks with shoulder arthritis have pain when the move their arms, particularly lifting their arms above their heads. As a result, they use their arms less and weaken their shoulder muscles. Sadly, weak shoulder muscles cause the shoulder arthritis to hurt more and deteriorate more quickly.
How Does Rheumatoid Arthritis Compare to Osteoarthritis?
Think of osteoarthritis (OA) as a worn down joint that we see in folks aged 50 and above. It is exacerbated by overuse and being overweight. Joints can become mis-aligned which is why OA can cause bow-legged knees when the wear and tear occurs on the inside portion of the knee joints. Knock-kneed deformity happens when the outside of the joint wears down more quickly than the inside.
Rheumatoid arthritis (RA) is unrelated to age, activity, or weight. In people who suffer from RA their immune systems attack the cartilage and joint capsule cells (synovial cells). Rather quickly, the cartilage breaks down and thins out, and joints lose their normal alignments. Patients experience an hour or so remarkable joint stiffness in the mornings and the joint distribution is almost always symmetrical.
RA can affect other organs such as the lungs, eyes, skin, heart and salivary glands. Patients often experience generalized fatigue, loss of appetite, and fever. RA puts the patient at increased risk for osteopenia and osteoporosis which are thinning of the bones. Osteoporosis patients are more likely to break a bone if they fall or overuse a weight bearing joint.
How does my doctor treat arthritis?
OA treatment requires weight loss, muscle strengthening through physical therapy, and wearing correct footwear. First line medication therapy is Tylenol for pain control. Non-steroidal anti-inflammatories (NSAIDS) such as ibuprofen and naprosyn also relieve pain and control inflammation but they cause stomach lining problems and kidney strain, so we prefer Tylenol. Glucosamine at 500m twice daily may have benefit for knee arthritis.
When pain continues to elevate, your physician may prescribe oral narcotic such as hydrocodone to use as needed. Joint injections with steroids are effective for a week to a few months. Eventually and sometimes, pain can be relieved only with joint replacement surgery.
RA requires specialized medications that blunt the body’s immune activity in the joint. Methotrexate is usually first-line and is an old medication that is safe when used correctly and preserves joint function. The newer medications are quite effective in moderating the immune activity but when not used in close partnership with a rheumatologist, their side effects can be severe (infection).
Your doctor will prescribe oral steroids and a medication called colchicine or a NSAID if you have gout pain. Long term treatment requires the patient to eat a diet low in meat and to take a medication called allopurinol which lowers the body’s uric acid level.
What can I do to keep from getting arthritis?
Outside of quitting smoking, there isn’t much you can do to prevent RA which is genetic, you can limit your OA risk by losing weight and keeping your joint muscles strong by doing non-weight bearing exercises. A stationary bike is excellent for your knees and hips. Gentle resistance exercises are helpful for shoulder joints.
Gout attacks can be prevented by losing weight and a diet low in meat. Meats have a high concentration of nucleic acids which are precursors for uric acid.
Brian Byrd, MD