August 6, 2023 • 25 mins
The Healthy Matters Podcast
S02_E17 - Arthritis - It's a Pain in the Joint!
Arthritis. It's a huge topic. But what is it exactly? Well, it turns out that's kind of a loaded question and it's pretty complicated when you get into it. Thankfully, on Episode 17 of the podcast, we've got an expert, Dr. Rawad Nasr, the Director of Rheumatology at Hennepin Healthcare to help us get a handle on it.
In this episode, we'll explain the 2 types of arthritis, the root causes of each type, when to be seen, current available treatments, and possible preventive measures. Around 80% of us are likely to experience just one of the types of arthritis at some point in our lives, so it's definitely worth getting the basics down. Join us!
Oh, yeah. And the plural of arthritis is arthritides...
Got a question for the doc? Or an idea for a show? Contact us!
Email - healthymatters@hcmed.org
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Speaker 2 (00:04):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Hilden .
Speaker 3 (00:21):
Hey everybody, it's Dr. David Hilden, your host of
the Healthy Matters podcast.
And welcome to episode 17.
Today, I am going to be joinedby an old friend and colleague,
Dr. Rahad Nasser , to talkabout arthritis. We've all
heard there's lots of kinds ofarthritis, everybody's joints
hurt. We're gonna break allthat down and find out what's
(00:41):
the real scoop on your jointsand keeping them healthy. Rahad
great to have you on the show.
Great.
Speaker 4 (00:46):
Uh , to be here, David, it's always a pleasure
to join , uh, your podcast oryour radio show,.
Speaker 3 (00:51):
So, so Rahad , you are the director of
rheumatology, and I'm gonnajust go right out there and say
nobody knows what that is,, but, but it is a
doctor that deals withconnective tissues in joint
care and systemic problems thatare related to that. But today
we're gonna talk aboutarthritis. So I'm gonna ask you
just straight up what isarthritis? Uh,
Speaker 4 (01:12):
Arthritis , uh, is a term used to describe
conditions that cause jointpain , uh, swelling and
stiffness and other jointsymptoms sometimes like redness
and warmth over the joint. Soit's a broad term to describe
the conditions that cause thesesymptoms in the joints.
Speaker 3 (01:27):
And there's lots of kinds of it. Yes,
Speaker 4 (01:29):
There's many types of arthritis. The main two
types we think about in ageneral manner is whether the
arthritis is inflammatory, it'scaused by inflammation, or
whether the arthritis isnon-inflammatory caused by wear
and tear and damage to thejoints.
Speaker 3 (01:44):
Are those , uh, which is more common, I guess
is what I'm trying
Speaker 4 (01:47):
To say. The most common arthritis , uh, we see
in clinic and in the UnitedStates is o osteoarthritis. So
osteoarthritis is wear and teararthritis. It comes as we age
and use our joints. Main riskfactors for this type of
arthritis is aging genetics.
There is genetic componentdamage to the joint obesity.
Mm-hmm . . And soo osteoarthritis, what causes
(02:09):
it? If you, if you're in a jobthat requires you to do a
repetitive motion to a certainjoint that predisposes that
joint to get osteoarthritis. Ifyou're an athlete and you get
an injury in a joint thatpredisposes it to get
osteoarthritis. We mentionedobesity, aging also, and
genetics. That's why you seearthritis has become more
common or more diagnosedbecause we've done so well in
(02:31):
healthcare over the years thatwe've prolonged people's age.
And so as they age, theydevelop osteoarthritis.
Speaker 3 (02:37):
So is it inevitable that as we get older that our
joints are gonna wear down?
Because I, I'm gonna guessthere are loads of people out
there and those listening tothis are thinking, yep , that's
me. My joints hurt.
Speaker 4 (02:48):
Absolutely. So in the United States, there are
about 33 million people whowere diagnosed with arthritis.
So about 25% of thepopulations, one out of four
people will be diagnosed witharthritis. 80% of people as
their age will getosteoarthritis. 60% of them
will have symptoms
Speaker 3 (03:05):
Okay.
Speaker 4 (03:05):
From it. That's
Speaker 3 (03:06):
Almost everybody though. That's almost
Speaker 4 (03:07):
Everybody. Almost everybody.
Speaker 3 (03:09):
And so what is going on in a person's body , um,
when they have osteoarthritis,say more about what's actually
going on in your joints.
Speaker 4 (03:17):
So the joint, you know, is usually two bones and
then there's cartilage inbetween. And the cartilage is
like the cushion between thebones and the joint when it
moves. So what happens is thatcartilage wears and tears and
becomes thinner and thinner andthe bones become closer to each
other. And so as that cartilagebecome thinner, when you move
the joint, the bone hits thebone 'cause it lacks that
cushion and that's when ithurts. So it's really wear and
(03:40):
tear of the cartilage betweenthe bones or also when that
cartilage thins, some of itcalcified and you start to have
calcifications in the joint.
And also the ligaments, whichare the tissues around the
joint, they become also moreprone to injury. 'cause they're
losing that thickness of thejoint.
Speaker 3 (03:57):
It sounds like the brake pads in your car, they're
wearing down. Exactly,
Speaker 4 (04:01):
Exactly.
Speaker 3 (04:02):
What symptoms would people first start to, to
notice that , what are theearly signs of arthritis?
Speaker 4 (04:08):
Yep . The early signs of arthritis is joint
pain, pain in the joint,sometimes stiffness in the
joint, and sometimes they willnotice swelling in the joint.
Now the , the first symptom ispain. If you look at the
arthritis foundation and theirrecommendations for people when
to watch for arthritis is ifyou develop joint pain that is
lasting more than three days.
And if you're having more thanthree episodes per month, so if
(04:29):
it's a prolonged joint pain andit's episodic and starting to
become more persistent, itmeans the patient is developing
arthritis.
Speaker 3 (04:36):
So those are the early symptoms. You get joint
pain here and there. First Iwanna ask you a two part
question. What happens as itprogresses? And then the second
question I want to ask you,which joints are affected?
Speaker 4 (04:46):
Yeah , great questions, David. So as, as
the, as the cartilage wears andtears become thinner as the
arthritis progresses, whathappens is you start to lose
range of motion of the joint.
Because when you bend the jointor extend the joint, it hurts.
We tend not to bend them andextend them as we should. And
so with time, we lose range ofmotion if we don't address
that. The other thing thatcould happen is the pain could
(05:09):
become so severe that it'spresent at rest even so it, it
wakes up the patient from sleepor it hurts even with sitting.
And that's when it becomesreally advanced when you have
persistent pain, regardless ofthe motion of the joint. And
also when you start to noticeloss of range of motion with
the joint.
Speaker 3 (05:25):
So at the beginning it's mostly the pain is when
you're trying to move thejoint. Correct. It's amazing
what the human body can do. Allof the joints of your body that
can move in all these differentdirections, from your hands to
your knees to your spine,there's joint , there's uh ,
uh, more joints than peoplerealize. Where are the common
places in your body whichjoints are most commonly
affected? You
Speaker 4 (05:44):
Know, it depends again on the type of arthritis.
You know, we discussed there'swear and tear arthritis and
there's inflammatory arthritis.
So we're kind of focusing onthe wear and tear arthritis in
the wear and tear arthritis.
The most common joints are thethumbs, the distal knuckles,
the knuckles that are close toyour nails in the hands.
Speaker 3 (06:00):
Distal, the ones closest to your fingernails.
Speaker 4 (06:02):
Exactly. Mm-hmm.
, um, the knees ,um, the big toes, big toe. Yes.
, the big toes .
Um, and um, uh, and the hips.
Um, however, in inflammatoryarthritis, it's a different
distribution of jointinvolvement. And I wanna
mention also that ininflammatory arthritis, when it
starts, the pain could happenat rest. It doesn't have to be
(06:25):
with motion. Also, there's moreswelling, more redness, more
warmth , uh, more pain withinflammatory arthritis. And the
joints involved are different.
They're more with the knucklesthat are more closer to your
wrist. Uh, the small knucklesin the, in the hands that are
more closer to the wrists. It'susually the wrists, elbows,
shoulders, all the toes insteadof just the big toes.
Speaker 3 (06:45):
So say more about , um, so just so to be clear for
people about the otherinflammatory or threads , I've
learned that right? Uh , uh,what are the other types of
inflammatory arthritisconditions?
Speaker 4 (06:55):
So for inflammatory arthritis conditions, the
common one is rheumatoidarthritis, which is , uh,
autoimmune inflammationaffecting the joints. But it
has a lot of cousins if youwant. There's psoriatic
arthritis when patients havepsoriasis and develop
inflammation, the joints, thereis a form of arthritis called
crystal arthritis. Probablypeople have heard of gout,
which is triggered by uric acidcrystals in the joints that
(07:16):
cause inflammation. And there'sa lot of different of
inflammatory arthritis. Uh, wecan go over, for example,
there's inflammatory arthritisdue to connective tissue
disease like lupus for example.
There's inflammatory arthritisthat affect the back, the spine
and the sacro iliac joints inthe back and the hips, it's
called ankylosing spondylitis.
So with the years go by, wewere able to sub classify if
(07:40):
you want inflammation in thejoints or inflammatory
arthritis to many differentforms. In the past it was
mostly rheumatoid arthritis,but now we have rheumatoid
arthritis, psoriatic arthritis,ankylosing spondylitis, gout,
et cetera.
Speaker 3 (07:51):
Lots of 'em . And they're all treated
differently. What is on therise? Um, oh , and what is on
the decline are , are all ofthese conditions getting more
common, less common? Where,where , where does that sit?
The
Speaker 4 (08:01):
Arthritis that is on the rise is osteo arthritis
because the
Speaker 3 (08:03):
Wear and tear. Yeah.
Because
Speaker 4 (08:05):
Patients are living longer. And if you look at
arthritis in general, between1990 and now, the diagnosis has
increased by about 111%. As Isaid, most probably. 'cause
people are living longer.
They're living longer. Yeah.
And you know, the inflammatoryarthritis usually occurs in
younger age. Um ,osteoarthritis occurs usually
at a older age. And
Speaker 3 (08:23):
So what would be an average , um, time of onset
for, we're going back toosteoarthritis. The wear and
tear arthritis,
Speaker 4 (08:29):
Osteoarthritis is more common. Patients are 50
years and above. Inflammatoryarthritis is more common
between 20 and 40. Althoughsome of them, we call them
biphasic, which means can occurin two stages of life, you
know, early, which is 20 to 40in older age.
Speaker 3 (08:43):
So I'm on a certain side of age 50. Um , ,
Speaker 4 (08:46):
I'm behind you. Yeah .
Speaker 3 (08:47):
one day. You
too . But so, and that's simply
because of the passing of theyears and the wear and tear and
the use of your, your body,right? Correct.
Speaker 4 (08:57):
It's , uh, wear and tear use of the body. Obesity
is a risk factor.
Speaker 3 (09:00):
Why is obesity a risk factor?
Speaker 4 (09:02):
It's a great question. So there's two things
about obesity that we know.
One, when we have more weight,the weight bearing joints have
to handle this weight. So thatput more strain on our ankles,
knees, and hips. However,interestingly, studies have
shown that obesity also isassociated with osteoarthritis
in our hands. Um, right.
Speaker 3 (09:19):
And you're not putting weight on your hands .
Speaker 4 (09:21):
Exactly. So I think there's two components. There's
the weight bearing, you know,we're putting more weight,
which causing more stress onthe weight bearing joints. But
also there is a signal thatthere is some mild inflammation
that happens in the body as wegain weight. And that can cause
wear and tear arthritis in thehands. Now you'll tell me, well
wear and tear arthritis is wearand tear. Right. Overuse.
However, you know, recentstudies have shown that even in
(09:43):
wear tear arthritis, some mildinflammation happens in the
joints. Mm-hmm . It's not theinflammation of inflammatory
arthritis like rheumatoidarthritis, but it's a mild
inflammation that's triggeredby that wear and tear. And that
is being studied moreextensively because the
challenge in wear and teararthritis, we don't have a
medicine that reverses theprocess or stops the process.
(10:03):
Our treatments or interventionsare to help with the symptoms,
the pain. However, if we can domore research on that mild
inflammation, we can probablytry more, more medications that
could help reverse the process.
Speaker 3 (10:15):
What that'd be the ultimate goal there would be
ultimate . After our break, weare gonna talk about what
treatments , um, are availablefor these various types of
arthritis on osteoarthritis. Isit more common in certain , uh,
patient populationsspecifically? Is it more common
in men or women?
Speaker 4 (10:29):
Yeah , so osteoarthritis and rheumatoid
arthritis are more common infemales , uh, than males.
Mm-hmm . gout ismore common in males than
females. So there is adifference. Um, actually female
being female is a higher riskfor osteoarthritis. It's a risk
factor for osteoarthritis aswell as rheumatoid arthritis,
while male is a risk factor forgout, for example.
Speaker 3 (10:47):
Okay. So how do you diagnose it? Do you, do you
simply just listen to a patientand and say, yep , that's what
you got? Or, or what do you do?
Um, when someone comes into youwith joint pain,
Speaker 4 (10:57):
It brings the question, what do
rheumatologists do?
Speaker 3 (11:00):
Exactly. I was kidding at the beginning when I
said, nobody knows what you dofor a living. I know what you
do for a living. And, and it ,it is one of the most
fascinating areas of medicine,if I would say.
Speaker 4 (11:08):
Absolutely.
Rheumatology.
Speaker 3 (11:09):
You've got your hands in all kinds of parts of
people's lives, you know.
Speaker 4 (11:11):
Exactly. And to correctly diagnose a disease in
rheumatology, you have to dothree, four things. One, you
have to listen to the patient,you have to listen to the
patient, you have to take verygood detailed history. Then you
have to examine them,particularly the joints on
physical exam, signs ofinflammation or we talking
about signs of wear and tear.
We order labs, blood tests,sometimes a connective tissue
(11:33):
disease, urine test . Butusually for arthritis, they're
mostly blood tests and thenx-rays. Sometimes we perform
ultrasound over the joint orMRIs of the joints. And to
diagnose it, you have to havethe full picture, the history
of the patient, the examinationand the test all have to point
to where the diagnosis toconfirm a diagnosis or get a
diagnosis. When
Speaker 3 (11:53):
Should they come to see you as opposed to their,
their primary care doctor?
Speaker 4 (11:56):
You know, we mentioned when the patient
start to develop pain in thejoint that is persistent and
very frequent and episodic ,uh, they need to see us to, to
examine them because the earlywe diagnose inflammatory
arthritis, the early weintervene, the better it is
because we can calm theinflammation earlier and
prevent damage in the future.
So it's very important to seeus early in the stage to see if
(12:19):
this is where arthritis orinflammation, inflammatory
arthritis. 'cause there is abig difference in treatment and
outcome because of the earlyintervention , early treatment
we can do in inflammatoryarthritis.
Speaker 3 (12:29):
Makes sense. So we're gonna take a short break
and when we come back we'regonna discuss treatments,
available medications, and ifthere are any preventive
measures you can take toprevent the development of
arthritis. So stay with us.
We'll be right back.
Speaker 2 (12:42):
You are listening to the Healthy Matters podcast
with Dr. David Hilden. Got aquestion or comment for the
doc, email us at Healthymatters@hcme.org or give us a
call at six one two eight seventhree talk. That's 6 1 2 8 7 3
8 2 5 5 . And now let's getback to more healthy
(13:02):
conversation.
Speaker 3 (13:05):
And we're back.
We're talking to Dr. RahadNasser. He's the director of
rheumatology at HennepinHealthcare and a friend and
colleague of mine here indowntown Minneapolis. Uh, I
have heard it said just thispast week, a person said to me
in the hallway, Dr. Nasser isthe best rheumatologist in the
state of Minnesota. That was anunsolicited comment from
(13:25):
another physician colleague.
And so we are absolutelyprivileged to hear Rahad give
us his wisdom about arthritis.
We're gonna move now into whatcan be done about it. We've all
seen that commercials on the tvask your rheumatologist if X,
y, Z is right for you. Sothere's a lot of stuff out
there. So I wanna ask you thebasic question. Is arthritis
(13:48):
curable?
Speaker 4 (13:49):
So for osteoarthritis, there is no
medication right now thatreverses the process or
prevents it from happening. Uh,currently with the evide , with
the current evidence , um, wehave, for those osteoarthritis,
we have medications orinterventions that help with
the symptoms. Now forinflammatory arthritis, what I
tell patients, we don't haveactually a cure per se. What we
(14:10):
have are medications thatsuppress the immune system to
stop the inflammation, to stopthe immune system from
attacking the joints to stopthe inflammation so you don't
have damage to the joints. Sowe have medications that temper
down the immune system, temperdown the inflammation, so we
don't get symptoms and we don'tget damage to joints. So
whether you consider that acure or not, yeah , it's not
clear. You know. Um , maybe inthe future the cure would be
(14:34):
gene therapy or I don't know.
Um , but right now this is what, where we are in terms of
treatments. Yeah.
Speaker 3 (14:40):
And when doctors talk about treatments, it's
sometimes a little bitdifferent from , uh, uh, what
the public might alwaysconsider. Are there treatments?
Yes, there's treatments totreat your symptoms. We do our
best to treat your symptoms,but are there treatments to
reverse the course of thedisease? And that's a different
kind of a treatment. And that'swhat you're talking about is
that there are some for theinflammatory arthritis and then
(15:00):
people wanna know, is therejust a cure? Stop it, make it
go away forever. And , and sothere's different forms of
treatments. Let's dive intothat just a little bit. How do
we treat the symptoms, the painof osteoarthritis?
Speaker 4 (15:14):
Yeah , so for osteoarthritis , uh, what we do
, uh, first we , uh, recommend, uh, physical therapy , uh,
basically a program tostrengthen the muscles around
the joints to preserve as much,strengthen the joint. And that
decreases usually pain improvesrange of motion , uh, improves
stability of the joint. Sophysical therapy is very
important , uh, individualizedto the joint and to the
(15:36):
patient.
Speaker 3 (15:36):
But doctor, it hurts to move the joint. Yes . You're
telling me to go move it more.
Uh , can I tell you how manytimes I've heard that? I don't
even know zillions of times. Soin
Speaker 4 (15:43):
Order to help patients with the pain in
physical therapy or in general,there are many , uh,
medications we prescribe orrecommend. One, you know,
acetaminophen or Tylenol forpain, of course with a dose
that is not too much, you know,a , a controlled dose. Second
are what we call NSAIDs ,nonsteroidal anti-inflammatory
drugs. Like I ibuprofen, Aleve, um, meloxicam . There is also
(16:05):
, um, a medication that is acousin of nsaid like Celebrex
for example. Uh, there's alsogels and uh , creams. For
example, diclofenac gel, whichis volar and gel. It's like
ibuprofen and gel that you rubover the you
Speaker 3 (16:17):
Rub your
Speaker 4 (16:17):
Skin. Yeah, exactly.
Or there's new medications thatare like, for example,
duloxetine. It's anantidepressant, but it works on
pain. And there's some studiesthat showed help with pain. Uh,
for example, arthritis of theknees. Uh, so that's a new
medication we use in , in casethere is contraindication to
give somebody the othermedications. Tylenol and
non-steroidal anti-inflammatorydrugs.
Speaker 3 (16:36):
In your experience, you've just listed of half a
dozen classes of medications,you've listed physical therapy,
you have not listed controlledsubstances such as opioids and
those things that, you know,people are asking about. How
effective are these things thatyou've just mentioned? Not even
opioids, but everything. Well,and opioids, I guess we
Speaker 4 (16:56):
Usually start with, as I said, Tylenol, nonsteroid,
antiinflammatory drugs, youknow, duloxetine opioids might
have a role in treating painfrom osteoarthritis in , in
patients who cannot tolerate orhave contraindications for the
medications we mentioned. Um,obviously with opioids there
have to be a discussion withthe patient. There's risks with
opioid intake from dependence ,uh, to many things. And they
(17:16):
have to be, usually we have todo it through a pain clinic
setting where everything is ,um, monitored for the patient's
safety. Nothing
Speaker 3 (17:24):
Else . Certainly not the first line choice. Is it
not
Speaker 4 (17:26):
The first line choice? Absolutely. We do also
cortisone shots, you know,steroid injections in the
joints. They're not, and I tellpatients it's not the cure.
This is a symptomatic therapy.
We , we helps you with thepain. Uh , so steroid
injections is an option. So
Speaker 3 (17:39):
Steroids are, you know, when we say steroids,
again for the, for peoplelistening, we're not talking
bodybuilding steroids, we'retalking anti-inflammatory
steroids. How does that work inosteoarthritis, which is got a
little bit of inflammation,but's primarily wear and tear.
Why would it work correct toinject steroids in there? It's
Speaker 4 (17:55):
A great question.
There's two things we inject,actually. We inject steroids
and the numbing medicine calledlidocaine. Uh , first of all,
there's evidence that lidocaineby numbing up those nerves
around the joint actually helpsand last longer than we think.
And number two, the steroid,they suppress that mild
inflammation that the newstudies are showing in o
osteoarthritis. Um, and it'slocalized in the joint so it
doesn't have as much sideeffects as cortisone or
(18:16):
steroids that we take by mouthor by um, by IV in the , in the
blood vessel. So for
Speaker 3 (18:22):
Those people who get some relief from, we use the
word cortisone injection, it'snot cortisone , um, you know,
it's a cousin of cortisone, weuse a , a corticosteroid.
Right? Um, how long can theyexpect relief? And then the
corollary to that is how oftencan you get it done?
Speaker 4 (18:38):
Yep . So corticosteroid injections in
the joints can last up to threemonths. Some patients, you
know, we inject one time andthat does the trick for a year
or two. Some patients need itevery three months. And you
know, depending on the joint,we also as physicians sometimes
are reluctant to do more thanone or two injections,
particularly the shoulder. Theshoulder is a complex area in
the body. There's two, threejoints there. There's multiple
(19:01):
tendon and um, and ligaments.
So we inject one or two timesin the shoulder. On the other
hand, the knee, again, weindividualize therapy for the
patient. Uh, you know, there'salways risk and benefit with
anything we do. But in the kneeyou can do it more frequently.
That's
Speaker 3 (19:14):
Interesting about the shoulder. I think a lot of
people don't realize there'stwo or three joints in the
shoulder. Yes . There's notjust one thing. It's so
complicated. It's why, it's why, uh, we can, a baseball
pitcher can throw a hundredmile an hour fastball as that
shoulder has got incredible ,uh, abilities. But you don't
inject it quite as often, yousaid correct. Couple times a
year or three times a
Speaker 4 (19:31):
Year? Yeah . Yeah, a couple times. You know, because
steroid injections, the jointsis has, you know, potential
side effects. They're low, butyou know, it can make the
ligaments and the tendons alittle bit weaker around the
joint. More prone to be, youknow, ruptured or, or torn. So
we, we do this judiciously anddepending, you know, on the
patient's situation, there areother injections that we do in
the joint. For example, we callit hyaluronic acid injections,
(19:54):
which are like cartilagesupplement if you want. Um,
does that work? You know, itworks in about 60% of patients
and I tell that patients beforewe inject it and if it works,
it lasts for six months.
Usually we use it bridging tosurgery. 'cause the other
intervention that might happenwhen the cartilage has
completely gone and the jointis bone and bone, then surgical
intervention or replacing thejoint would be kind of your
(20:14):
last resort for the patient.
Yeah, we
Speaker 3 (20:16):
Haven't got to that yet, but I'm glad you did
because we've talked aboutphysical therapy, we've talked
about medications. Let's talkjust a little bit more about
surgery. Who should get theirjoint replaced? When is it
time?
Speaker 4 (20:26):
There's many factors we talk about when we do , uh,
when we recommend surgery forthe joint one , uh, on the
x-rays on the imaging, youknow, the cartilage is gone,
it's bone on bone. Number two,how much is the patient's daily
function being affected by thejoint? So if they're having
pain all day, the joint islimited in range of motion,
they can't walk, walk, theycan't lift their shoulder, then
(20:48):
that's another consideration.
Number three, what is thehealth condition, the general
health condition of thepatient? Will they tolerate the
surgery? So those are the threefactors that determine when to
do surgery to a joint. And
Speaker 3 (20:59):
They're , it's pretty successful. Yeah . Yep .
Surgeries are
Speaker 4 (21:01):
Very high successful, very high
successful rate of jointreplacements, you
Speaker 3 (21:05):
Know , and I know it's a big deal, but especially
knees and hips. I, I, that's ,those are the ones at least I
know the most about. Um, aren'tthose the most common ones?
Knees and hips?
Speaker 4 (21:12):
They are correct.
Knees and hips are the mostcommon one. The most successful
ones.
Speaker 3 (21:15):
What about other non-medication, non-surgical
treatments? Do other thingswork? Um, other range of motion
things , uh, tai chi,acupuncture, any of that stuff?
What, what other things are outthere?
Speaker 4 (21:25):
Yeah, so that brings me a little bit to the topic of
trying to prevent, to develop.
Yeah, we
Speaker 3 (21:30):
Were
Speaker 4 (21:30):
Talk about prevention of arthritis.
Mm-hmm. . Um, andin general for health , um, you
know, we say eat well, exercisewell, sleep well. All of that
for general health would applyfor arthritis. I think. Um, one
of the most important parts isstaying active and moving the
joints and doing exercisesaround strengthening muscles,
around joints. Uh, number two,eating healthy and trying to ,
(21:53):
uh, not to be obese. And I ,and I know that's, that's hard.
It's not, it's , it's easy forme to sit here, you know,
trying not to gain weight.
It's, it's a hard , uh, thingto achieve. But one of the
preventative features, if, ifwe can , um, help us lose
weight, you know, there'sstudies that showed if you lose
10% of your weight, painimproves in the joints, whether
it's in the hands or in thefeet or the knees. Also,
(22:14):
interestingly , uh, forexample, smoking , uh, not to
smoke, smoking has beenassociated, for example, with
rheumatoid arthritis. One ofthe biggest risk factors for
rheumatoid arthritis. So, soavoiding some uh, environmental
exposures or not smoking alsohelps
Speaker 3 (22:29):
All the time. I keep hearing another thing that
smoking does. Yes .
Speaker 4 (22:32):
Yes, absolutely.
What
Speaker 3 (22:34):
About acupuncture?
Yeah,
Speaker 4 (22:36):
So for acupuncture it can certainly have a role in
helping with pain. It's notpreventative. But yes,
acupuncture might have a rolein pain. Also chiropractor
maneuvering in some joints orthe spine can be helpful for
pain. Um, you know,acupuncture, what I tell
patients to try it. 'cause insome patients it has success
and some patients it doesn't.
But certainly it has a role.
You mentioned tai chi. Yoga canhelp Tai chi. It's a Chinese
(22:57):
martial arts that help relaxthe body and relax the muscles
and nerves around the jointsthat can help. Uh, yoga can
help. Now yoga always cautionif somebody has hypermobility,
their joints are very mobile.
You wanna be cautious aboutyoga or overdoing it on the
joint. 'cause that can actuallytrigger pain or accelerate wear
and tear arthritis in thejoint. I never
Speaker 3 (23:16):
Even thought of that.
Speaker 4 (23:17):
Yep . So hyper morbidity , joint syndrome ,
uh, it's common. It's patientswho are more flexible in their
peers or double jointed , is
Speaker 3 (23:23):
That what people say is double jointed? Yes. You
don't have two joints, no
Speaker 4 (23:26):
, but they
can do maneuvers with their
joints that others can do. Andit's about one in 10 people and
there's no like treatment forthat. But the prevention in
that case is to still do theexercises or the sports you do,
but to be aware of notoverdoing it. So a lot of
movements that they do that arenormal for them, they're
actually abnormal to theirjoints. Hmm . So it's more like
, uh, controlled physicaltherapy or controlled exercise
(23:49):
program where you're notoverdoing it on a joint. 'cause
that can predispose toosteoarthritis even at a
younger age than 50. So
Speaker 3 (23:55):
If you could leave our listeners with three tips
regarding osteoarthritis, wear, tear, arthritis, the one that
80% of older adults might endup with, what would those three
tips be?
Speaker 4 (24:05):
Exercise as much as your body lets you listen to
your body. Exercise. Try tomove as much as you're able to
eat. Well, sleep well, don'tsmoke to prevent it. I think we
come back to the basics ofpreventative medicine, which is
trying to live as much as weare able to. I mean, life has
challenges. Yeah , exactly. Butif we can try to prevent it,
honestly, that's the best way.
If we can.
Speaker 3 (24:25):
Solid tips. And I think that is a great way to
leave us. We've been talkingwith Dr. Rahad Nasser Rahad ,
thanks for being on the show.
Speaker 4 (24:32):
Absolutely. Thanks for having me, David. It's
always a pleasure.
Speaker 3 (24:34):
We've been talking with Dr. Rahad Nasser, the
director of rheumatology atHennepin Healthcare, A
brilliant doctor and a goodfriend to me. I really
appreciate him being on theshow and I hope you've enjoyed
the show today. If so, tellyour friends and leave us a
review. I hope you'll join usfor our next episode. And in
the meantime, be healthy and bewell.
Speaker 2 (24:52):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden. To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. You got a questionor a comment for the show?
Email us at Healthymatters@hcme.org or call 6 1 2
8 7 3 talk. There's also a linkin the show notes. And finally,
(25:14):
if you enjoy the show, pleaseleave us a review and share the
show with others. The HealthyMatters Podcast is made
possible by Hennepin Healthcarein Minneapolis, Minnesota, and
engineered and produced by JohnLucas At Highball Executive
producers are Jonathan, CTO andChristine Hill . Please
remember, we can only givegeneral medical advice during
this program, and every case isunique. We urge you to consult
(25:36):
with your physician if you havea more serious or pressing
health concern. Until nexttime, be healthy and be well.
Speaker 2 (00:04):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host, Dr. David
Hilden .
Speaker 3 (00:21):
Hey everybody, it's Dr. David Hilden, your host of
the Healthy Matters podcast.
And welcome to episode 17.
Today, I am going to be joinedby an old friend and colleague,
Dr. Rahad Nasser , to talkabout arthritis. We've all
heard there's lots of kinds ofarthritis, everybody's joints
hurt. We're gonna break allthat down and find out what's
(00:41):
the real scoop on your jointsand keeping them healthy. Rahad
great to have you on the show.
Great.
Speaker 4 (00:46):
Uh , to be here, David, it's always a pleasure
to join , uh, your podcast oryour radio show,
Speaker 3 (00:51):
So, so Rahad , you are the director of
rheumatology, and I'm gonnajust go right out there and say
nobody knows what that is,
doctor that deals withconnective tissues in joint
care and systemic problems thatare related to that. But today
we're gonna talk aboutarthritis. So I'm gonna ask you
just straight up what isarthritis? Uh,
Speaker 4 (01:12):
Arthritis , uh, is a term used to describe
conditions that cause jointpain , uh, swelling and
stiffness and other jointsymptoms sometimes like redness
and warmth over the joint. Soit's a broad term to describe
the conditions that cause thesesymptoms in the joints.
Speaker 3 (01:27):
And there's lots of kinds of it. Yes,
Speaker 4 (01:29):
There's many types of arthritis. The main two
types we think about in ageneral manner is whether the
arthritis is inflammatory, it'scaused by inflammation, or
whether the arthritis isnon-inflammatory caused by wear
and tear and damage to thejoints.
Speaker 3 (01:44):
Are those , uh, which is more common, I guess
is what I'm trying
Speaker 4 (01:47):
To say. The most common arthritis , uh, we see
in clinic and in the UnitedStates is o osteoarthritis. So
osteoarthritis is wear and teararthritis. It comes as we age
and use our joints. Main riskfactors for this type of
arthritis is aging genetics.
There is genetic componentdamage to the joint obesity.
Mm-hmm .
(02:09):
it? If you, if you're in a jobthat requires you to do a
repetitive motion to a certainjoint that predisposes that
joint to get osteoarthritis. Ifyou're an athlete and you get
an injury in a joint thatpredisposes it to get
osteoarthritis. We mentionedobesity, aging also, and
genetics. That's why you seearthritis has become more
common or more diagnosedbecause we've done so well in
(02:31):
healthcare over the years thatwe've prolonged people's age.
And so as they age, theydevelop osteoarthritis.
Speaker 3 (02:37):
So is it inevitable that as we get older that our
joints are gonna wear down?
Because I, I'm gonna guessthere are loads of people out
there and those listening tothis are thinking, yep , that's
me. My joints hurt.
Speaker 4 (02:48):
Absolutely. So in the United States, there are
about 33 million people whowere diagnosed with arthritis.
So about 25% of thepopulations, one out of four
people will be diagnosed witharthritis. 80% of people as
their age will getosteoarthritis. 60% of them
will have symptoms
Speaker 3 (03:05):
Okay.
Speaker 4 (03:05):
From it. That's
Speaker 3 (03:06):
Almost everybody though. That's almost
Speaker 4 (03:07):
Everybody. Almost everybody.
Speaker 3 (03:09):
And so what is going on in a person's body , um,
when they have osteoarthritis,say more about what's actually
going on in your joints.
Speaker 4 (03:17):
So the joint, you know, is usually two bones and
then there's cartilage inbetween. And the cartilage is
like the cushion between thebones and the joint when it
moves. So what happens is thatcartilage wears and tears and
becomes thinner and thinner andthe bones become closer to each
other. And so as that cartilagebecome thinner, when you move
the joint, the bone hits thebone 'cause it lacks that
cushion and that's when ithurts. So it's really wear and
(03:40):
tear of the cartilage betweenthe bones or also when that
cartilage thins, some of itcalcified and you start to have
calcifications in the joint.
And also the ligaments, whichare the tissues around the
joint, they become also moreprone to injury. 'cause they're
losing that thickness of thejoint.
Speaker 3 (03:57):
It sounds like the brake pads in your car, they're
wearing down. Exactly,
Speaker 4 (04:01):
Exactly.
Speaker 3 (04:02):
What symptoms would people first start to, to
notice that , what are theearly signs of arthritis?
Speaker 4 (04:08):
Yep . The early signs of arthritis is joint
pain, pain in the joint,sometimes stiffness in the
joint, and sometimes they willnotice swelling in the joint.
Now the , the first symptom ispain. If you look at the
arthritis foundation and theirrecommendations for people when
to watch for arthritis is ifyou develop joint pain that is
lasting more than three days.
And if you're having more thanthree episodes per month, so if
(04:29):
it's a prolonged joint pain andit's episodic and starting to
become more persistent, itmeans the patient is developing
arthritis.
Speaker 3 (04:36):
So those are the early symptoms. You get joint
pain here and there. First Iwanna ask you a two part
question. What happens as itprogresses? And then the second
question I want to ask you,which joints are affected?
Speaker 4 (04:46):
Yeah , great questions, David. So as, as
the, as the cartilage wears andtears become thinner as the
arthritis progresses, whathappens is you start to lose
range of motion of the joint.
Because when you bend the jointor extend the joint, it hurts.
We tend not to bend them andextend them as we should. And
so with time, we lose range ofmotion if we don't address
that. The other thing thatcould happen is the pain could
(05:09):
become so severe that it'spresent at rest even so it, it
wakes up the patient from sleepor it hurts even with sitting.
And that's when it becomesreally advanced when you have
persistent pain, regardless ofthe motion of the joint. And
also when you start to noticeloss of range of motion with
the joint.
Speaker 3 (05:25):
So at the beginning it's mostly the pain is when
you're trying to move thejoint. Correct. It's amazing
what the human body can do. Allof the joints of your body that
can move in all these differentdirections, from your hands to
your knees to your spine,there's joint , there's uh ,
uh, more joints than peoplerealize. Where are the common
places in your body whichjoints are most commonly
affected? You
Speaker 4 (05:44):
Know, it depends again on the type of arthritis.
You know, we discussed there'swear and tear arthritis and
there's inflammatory arthritis.
So we're kind of focusing onthe wear and tear arthritis in
the wear and tear arthritis.
The most common joints are thethumbs, the distal knuckles,
the knuckles that are close toyour nails in the hands.
Speaker 3 (06:00):
Distal, the ones closest to your fingernails.
Speaker 4 (06:02):
Exactly. Mm-hmm.
Um, and um, uh, and the hips.
Um, however, in inflammatoryarthritis, it's a different
distribution of jointinvolvement. And I wanna
mention also that ininflammatory arthritis, when it
starts, the pain could happenat rest. It doesn't have to be
(06:25):
with motion. Also, there's moreswelling, more redness, more
warmth , uh, more pain withinflammatory arthritis. And the
joints involved are different.
They're more with the knucklesthat are more closer to your
wrist. Uh, the small knucklesin the, in the hands that are
more closer to the wrists. It'susually the wrists, elbows,
shoulders, all the toes insteadof just the big toes.
Speaker 3 (06:45):
So say more about , um, so just so to be clear for
people about the otherinflammatory or threads , I've
learned that right? Uh , uh,what are the other types of
inflammatory arthritisconditions?
Speaker 4 (06:55):
So for inflammatory arthritis conditions, the
common one is rheumatoidarthritis, which is , uh,
autoimmune inflammationaffecting the joints. But it
has a lot of cousins if youwant. There's psoriatic
arthritis when patients havepsoriasis and develop
inflammation, the joints, thereis a form of arthritis called
crystal arthritis. Probablypeople have heard of gout,
which is triggered by uric acidcrystals in the joints that
(07:16):
cause inflammation. And there'sa lot of different of
inflammatory arthritis. Uh, wecan go over, for example,
there's inflammatory arthritisdue to connective tissue
disease like lupus for example.
There's inflammatory arthritisthat affect the back, the spine
and the sacro iliac joints inthe back and the hips, it's
called ankylosing spondylitis.
So with the years go by, wewere able to sub classify if
(07:40):
you want inflammation in thejoints or inflammatory
arthritis to many differentforms. In the past it was
mostly rheumatoid arthritis,but now we have rheumatoid
arthritis, psoriatic arthritis,ankylosing spondylitis, gout,
et cetera.
Speaker 3 (07:51):
Lots of 'em . And they're all treated
differently. What is on therise? Um, oh , and what is on
the decline are , are all ofthese conditions getting more
common, less common? Where,where , where does that sit?
The
Speaker 4 (08:01):
Arthritis that is on the rise is osteo arthritis
because the
Speaker 3 (08:03):
Wear and tear. Yeah.
Because
Speaker 4 (08:05):
Patients are living longer. And if you look at
arthritis in general, between1990 and now, the diagnosis has
increased by about 111%. As Isaid, most probably. 'cause
people are living longer.
They're living longer. Yeah.
And you know, the inflammatoryarthritis usually occurs in
younger age. Um ,osteoarthritis occurs usually
at a older age. And
Speaker 3 (08:23):
So what would be an average , um, time of onset
for, we're going back toosteoarthritis. The wear and
tear arthritis,
Speaker 4 (08:29):
Osteoarthritis is more common. Patients are 50
years and above. Inflammatoryarthritis is more common
between 20 and 40. Althoughsome of them, we call them
biphasic, which means can occurin two stages of life, you
know, early, which is 20 to 40in older age.
Speaker 3 (08:43):
So I'm on a certain side of age 50. Um ,
Speaker 4 (08:46):
I'm behind you. Yeah .
Speaker 3 (08:47):
because of the passing of theyears and the wear and tear and
the use of your, your body,right? Correct.
Speaker 4 (08:57):
It's , uh, wear and tear use of the body. Obesity
is a risk factor.
Speaker 3 (09:00):
Why is obesity a risk factor?
Speaker 4 (09:02):
It's a great question. So there's two things
about obesity that we know.
One, when we have more weight,the weight bearing joints have
to handle this weight. So thatput more strain on our ankles,
knees, and hips. However,interestingly, studies have
shown that obesity also isassociated with osteoarthritis
in our hands. Um, right.
Speaker 3 (09:19):
And you're not putting weight on your hands .
Speaker 4 (09:21):
Exactly. So I think there's two components. There's
the weight bearing, you know,we're putting more weight,
which causing more stress onthe weight bearing joints. But
also there is a signal thatthere is some mild inflammation
that happens in the body as wegain weight. And that can cause
wear and tear arthritis in thehands. Now you'll tell me, well
wear and tear arthritis is wearand tear. Right. Overuse.
However, you know, recentstudies have shown that even in
(09:43):
wear tear arthritis, some mildinflammation happens in the
joints. Mm-hmm . It's not theinflammation of inflammatory
arthritis like rheumatoidarthritis, but it's a mild
inflammation that's triggeredby that wear and tear. And that
is being studied moreextensively because the
challenge in wear and teararthritis, we don't have a
medicine that reverses theprocess or stops the process.
(10:03):
Our treatments or interventionsare to help with the symptoms,
the pain. However, if we can domore research on that mild
inflammation, we can probablytry more, more medications that
could help reverse the process.
Speaker 3 (10:15):
What that'd be the ultimate goal there would be
ultimate . After our break, weare gonna talk about what
treatments , um, are availablefor these various types of
arthritis on osteoarthritis. Isit more common in certain , uh,
patient populationsspecifically? Is it more common
in men or women?
Speaker 4 (10:29):
Yeah , so osteoarthritis and rheumatoid
arthritis are more common infemales , uh, than males.
Mm-hmm .
females. So there is adifference. Um, actually female
being female is a higher riskfor osteoarthritis. It's a risk
factor for osteoarthritis aswell as rheumatoid arthritis,
while male is a risk factor forgout, for example.
Speaker 3 (10:47):
Okay. So how do you diagnose it? Do you, do you
simply just listen to a patientand and say, yep , that's what
you got? Or, or what do you do?
Um, when someone comes into youwith joint pain,
Speaker 4 (10:57):
It brings the question, what do
rheumatologists do?
Speaker 3 (11:00):
Exactly. I was kidding at the beginning when I
said, nobody knows what you dofor a living. I know what you
do for a living. And, and it ,it is one of the most
fascinating areas of medicine,if I would say.
Speaker 4 (11:08):
Absolutely.
Rheumatology.
Speaker 3 (11:09):
You've got your hands in all kinds of parts of
people's lives, you know.
Speaker 4 (11:11):
Exactly. And to correctly diagnose a disease in
rheumatology, you have to dothree, four things. One, you
have to listen to the patient,you have to listen to the
patient, you have to take verygood detailed history. Then you
have to examine them,particularly the joints on
physical exam, signs ofinflammation or we talking
about signs of wear and tear.
We order labs, blood tests,sometimes a connective tissue
(11:33):
disease, urine test . Butusually for arthritis, they're
mostly blood tests and thenx-rays. Sometimes we perform
ultrasound over the joint orMRIs of the joints. And to
diagnose it, you have to havethe full picture, the history
of the patient, the examinationand the test all have to point
to where the diagnosis toconfirm a diagnosis or get a
diagnosis. When
Speaker 3 (11:53):
Should they come to see you as opposed to their,
their primary care doctor?
Speaker 4 (11:56):
You know, we mentioned when the patient
start to develop pain in thejoint that is persistent and
very frequent and episodic ,uh, they need to see us to, to
examine them because the earlywe diagnose inflammatory
arthritis, the early weintervene, the better it is
because we can calm theinflammation earlier and
prevent damage in the future.
So it's very important to seeus early in the stage to see if
(12:19):
this is where arthritis orinflammation, inflammatory
arthritis. 'cause there is abig difference in treatment and
outcome because of the earlyintervention , early treatment
we can do in inflammatoryarthritis.
Speaker 3 (12:29):
Makes sense. So we're gonna take a short break
and when we come back we'regonna discuss treatments,
available medications, and ifthere are any preventive
measures you can take toprevent the development of
arthritis. So stay with us.
We'll be right back.
Speaker 2 (12:42):
You are listening to the Healthy Matters podcast
with Dr. David Hilden. Got aquestion or comment for the
doc, email us at Healthymatters@hcme.org or give us a
call at six one two eight seventhree talk. That's 6 1 2 8 7 3
8 2 5 5 . And now let's getback to more healthy
(13:02):
conversation.
Speaker 3 (13:05):
And we're back.
We're talking to Dr. RahadNasser. He's the director of
rheumatology at HennepinHealthcare and a friend and
colleague of mine here indowntown Minneapolis. Uh, I
have heard it said just thispast week, a person said to me
in the hallway, Dr. Nasser isthe best rheumatologist in the
state of Minnesota. That was anunsolicited comment from
(13:25):
another physician colleague.
And so we are absolutelyprivileged to hear Rahad give
us his wisdom about arthritis.
We're gonna move now into whatcan be done about it. We've all
seen that commercials on the tvask your rheumatologist if X,
y, Z is right for you. Sothere's a lot of stuff out
there. So I wanna ask you thebasic question. Is arthritis
(13:48):
curable?
Speaker 4 (13:49):
So for osteoarthritis, there is no
medication right now thatreverses the process or
prevents it from happening. Uh,currently with the evide , with
the current evidence , um, wehave, for those osteoarthritis,
we have medications orinterventions that help with
the symptoms. Now forinflammatory arthritis, what I
tell patients, we don't haveactually a cure per se. What we
(14:10):
have are medications thatsuppress the immune system to
stop the inflammation, to stopthe immune system from
attacking the joints to stopthe inflammation so you don't
have damage to the joints. Sowe have medications that temper
down the immune system, temperdown the inflammation, so we
don't get symptoms and we don'tget damage to joints. So
whether you consider that acure or not, yeah , it's not
clear. You know. Um , maybe inthe future the cure would be
(14:34):
gene therapy or I don't know.
Um , but right now this is what, where we are in terms of
treatments. Yeah.
Speaker 3 (14:40):
And when doctors talk about treatments, it's
sometimes a little bitdifferent from , uh, uh, what
the public might alwaysconsider. Are there treatments?
Yes, there's treatments totreat your symptoms. We do our
best to treat your symptoms,but are there treatments to
reverse the course of thedisease? And that's a different
kind of a treatment. And that'swhat you're talking about is
that there are some for theinflammatory arthritis and then
(15:00):
people wanna know, is therejust a cure? Stop it, make it
go away forever. And , and sothere's different forms of
treatments. Let's dive intothat just a little bit. How do
we treat the symptoms, the painof osteoarthritis?
Speaker 4 (15:14):
Yeah , so for osteoarthritis , uh, what we do
, uh, first we , uh, recommend, uh, physical therapy , uh,
basically a program tostrengthen the muscles around
the joints to preserve as much,strengthen the joint. And that
decreases usually pain improvesrange of motion , uh, improves
stability of the joint. Sophysical therapy is very
important , uh, individualizedto the joint and to the
(15:36):
patient.
Speaker 3 (15:36):
But doctor, it hurts to move the joint. Yes . You're
telling me to go move it more.
Uh , can I tell you how manytimes I've heard that? I don't
even know zillions of times. Soin
Speaker 4 (15:43):
Order to help patients with the pain in
physical therapy or in general,there are many , uh,
medications we prescribe orrecommend. One, you know,
acetaminophen or Tylenol forpain, of course with a dose
that is not too much, you know,a , a controlled dose. Second
are what we call NSAIDs ,nonsteroidal anti-inflammatory
drugs. Like I ibuprofen, Aleve, um, meloxicam . There is also
(16:05):
, um, a medication that is acousin of nsaid like Celebrex
for example. Uh, there's alsogels and uh , creams. For
example, diclofenac gel, whichis volar and gel. It's like
ibuprofen and gel that you rubover the you
Speaker 3 (16:17):
Rub your
Speaker 4 (16:17):
Skin. Yeah, exactly.
Or there's new medications thatare like, for example,
duloxetine. It's anantidepressant, but it works on
pain. And there's some studiesthat showed help with pain. Uh,
for example, arthritis of theknees. Uh, so that's a new
medication we use in , in casethere is contraindication to
give somebody the othermedications. Tylenol and
non-steroidal anti-inflammatorydrugs.
Speaker 3 (16:36):
In your experience, you've just listed of half a
dozen classes of medications,you've listed physical therapy,
you have not listed controlledsubstances such as opioids and
those things that, you know,people are asking about. How
effective are these things thatyou've just mentioned? Not even
opioids, but everything. Well,and opioids, I guess we
Speaker 4 (16:56):
Usually start with, as I said, Tylenol, nonsteroid,
antiinflammatory drugs, youknow, duloxetine opioids might
have a role in treating painfrom osteoarthritis in , in
patients who cannot tolerate orhave contraindications for the
medications we mentioned. Um,obviously with opioids there
have to be a discussion withthe patient. There's risks with
opioid intake from dependence ,uh, to many things. And they
(17:16):
have to be, usually we have todo it through a pain clinic
setting where everything is ,um, monitored for the patient's
safety. Nothing
Speaker 3 (17:24):
Else . Certainly not the first line choice. Is it
not
Speaker 4 (17:26):
The first line choice? Absolutely. We do also
cortisone shots, you know,steroid injections in the
joints. They're not, and I tellpatients it's not the cure.
This is a symptomatic therapy.
We , we helps you with thepain. Uh , so steroid
injections is an option. So
Speaker 3 (17:39):
Steroids are, you know, when we say steroids,
again for the, for peoplelistening, we're not talking
bodybuilding steroids, we'retalking anti-inflammatory
steroids. How does that work inosteoarthritis, which is got a
little bit of inflammation,but's primarily wear and tear.
Why would it work correct toinject steroids in there? It's
Speaker 4 (17:55):
A great question.
There's two things we inject,actually. We inject steroids
and the numbing medicine calledlidocaine. Uh , first of all,
there's evidence that lidocaineby numbing up those nerves
around the joint actually helpsand last longer than we think.
And number two, the steroid,they suppress that mild
inflammation that the newstudies are showing in o
osteoarthritis. Um, and it'slocalized in the joint so it
doesn't have as much sideeffects as cortisone or
(18:16):
steroids that we take by mouthor by um, by IV in the , in the
blood vessel. So for
Speaker 3 (18:22):
Those people who get some relief from, we use the
word cortisone injection, it'snot cortisone , um, you know,
it's a cousin of cortisone, weuse a , a corticosteroid.
Right? Um, how long can theyexpect relief? And then the
corollary to that is how oftencan you get it done?
Speaker 4 (18:38):
Yep . So corticosteroid injections in
the joints can last up to threemonths. Some patients, you
know, we inject one time andthat does the trick for a year
or two. Some patients need itevery three months. And you
know, depending on the joint,we also as physicians sometimes
are reluctant to do more thanone or two injections,
particularly the shoulder. Theshoulder is a complex area in
the body. There's two, threejoints there. There's multiple
(19:01):
tendon and um, and ligaments.
So we inject one or two timesin the shoulder. On the other
hand, the knee, again, weindividualize therapy for the
patient. Uh, you know, there'salways risk and benefit with
anything we do. But in the kneeyou can do it more frequently.
That's
Speaker 3 (19:14):
Interesting about the shoulder. I think a lot of
people don't realize there'stwo or three joints in the
shoulder. Yes . There's notjust one thing. It's so
complicated. It's why, it's why, uh, we can, a baseball
pitcher can throw a hundredmile an hour fastball as that
shoulder has got incredible ,uh, abilities. But you don't
inject it quite as often, yousaid correct. Couple times a
year or three times a
Speaker 4 (19:31):
Year? Yeah . Yeah, a couple times. You know, because
steroid injections, the jointsis has, you know, potential
side effects. They're low, butyou know, it can make the
ligaments and the tendons alittle bit weaker around the
joint. More prone to be, youknow, ruptured or, or torn. So
we, we do this judiciously anddepending, you know, on the
patient's situation, there areother injections that we do in
the joint. For example, we callit hyaluronic acid injections,
(19:54):
which are like cartilagesupplement if you want. Um,
does that work? You know, itworks in about 60% of patients
and I tell that patients beforewe inject it and if it works,
it lasts for six months.
Usually we use it bridging tosurgery. 'cause the other
intervention that might happenwhen the cartilage has
completely gone and the jointis bone and bone, then surgical
intervention or replacing thejoint would be kind of your
(20:14):
last resort for the patient.
Yeah, we
Speaker 3 (20:16):
Haven't got to that yet, but I'm glad you did
because we've talked aboutphysical therapy, we've talked
about medications. Let's talkjust a little bit more about
surgery. Who should get theirjoint replaced? When is it
time?
Speaker 4 (20:26):
There's many factors we talk about when we do , uh,
when we recommend surgery forthe joint one , uh, on the
x-rays on the imaging, youknow, the cartilage is gone,
it's bone on bone. Number two,how much is the patient's daily
function being affected by thejoint? So if they're having
pain all day, the joint islimited in range of motion,
they can't walk, walk, theycan't lift their shoulder, then
(20:48):
that's another consideration.
Number three, what is thehealth condition, the general
health condition of thepatient? Will they tolerate the
surgery? So those are the threefactors that determine when to
do surgery to a joint. And
Speaker 3 (20:59):
They're , it's pretty successful. Yeah . Yep .
Surgeries are
Speaker 4 (21:01):
Very high successful, very high
successful rate of jointreplacements, you
Speaker 3 (21:05):
Know , and I know it's a big deal, but especially
knees and hips. I, I, that's ,those are the ones at least I
know the most about. Um, aren'tthose the most common ones?
Knees and hips?
Speaker 4 (21:12):
They are correct.
Knees and hips are the mostcommon one. The most successful
ones.
Speaker 3 (21:15):
What about other non-medication, non-surgical
treatments? Do other thingswork? Um, other range of motion
things , uh, tai chi,acupuncture, any of that stuff?
What, what other things are outthere?
Speaker 4 (21:25):
Yeah, so that brings me a little bit to the topic of
trying to prevent, to develop.
Yeah, we
Speaker 3 (21:30):
Were
Speaker 4 (21:30):
Talk about prevention of arthritis.
Mm-hmm.
know, we say eat well, exercisewell, sleep well. All of that
for general health would applyfor arthritis. I think. Um, one
of the most important parts isstaying active and moving the
joints and doing exercisesaround strengthening muscles,
around joints. Uh, number two,eating healthy and trying to ,
(21:53):
uh, not to be obese. And I ,and I know that's, that's hard.
It's not, it's , it's easy forme to sit here, you know,
trying not to gain weight.
It's, it's a hard , uh, thingto achieve. But one of the
preventative features, if, ifwe can , um, help us lose
weight, you know, there'sstudies that showed if you lose
10% of your weight, painimproves in the joints, whether
it's in the hands or in thefeet or the knees. Also,
(22:14):
interestingly , uh, forexample, smoking , uh, not to
smoke, smoking has beenassociated, for example, with
rheumatoid arthritis. One ofthe biggest risk factors for
rheumatoid arthritis. So, soavoiding some uh, environmental
exposures or not smoking alsohelps
Speaker 3 (22:29):
All the time. I keep hearing another thing that
smoking does. Yes .
Speaker 4 (22:32):
Yes, absolutely.
What
Speaker 3 (22:34):
About acupuncture?
Yeah,
Speaker 4 (22:36):
So for acupuncture it can certainly have a role in
helping with pain. It's notpreventative. But yes,
acupuncture might have a rolein pain. Also chiropractor
maneuvering in some joints orthe spine can be helpful for
pain. Um, you know,acupuncture, what I tell
patients to try it. 'cause insome patients it has success
and some patients it doesn't.
But certainly it has a role.
You mentioned tai chi. Yoga canhelp Tai chi. It's a Chinese
(22:57):
martial arts that help relaxthe body and relax the muscles
and nerves around the jointsthat can help. Uh, yoga can
help. Now yoga always cautionif somebody has hypermobility,
their joints are very mobile.
You wanna be cautious aboutyoga or overdoing it on the
joint. 'cause that can actuallytrigger pain or accelerate wear
and tear arthritis in thejoint. I never
Speaker 3 (23:16):
Even thought of that.
Speaker 4 (23:17):
Yep . So hyper morbidity , joint syndrome ,
uh, it's common. It's patientswho are more flexible in their
peers or double jointed , is
Speaker 3 (23:23):
That what people say is double jointed? Yes. You
don't have two joints, no
Speaker 4 (23:26):
joints that others can do. Andit's about one in 10 people and
there's no like treatment forthat. But the prevention in
that case is to still do theexercises or the sports you do,
but to be aware of notoverdoing it. So a lot of
movements that they do that arenormal for them, they're
actually abnormal to theirjoints. Hmm . So it's more like
, uh, controlled physicaltherapy or controlled exercise
(23:49):
program where you're notoverdoing it on a joint. 'cause
that can predispose toosteoarthritis even at a
younger age than 50. So
Speaker 3 (23:55):
If you could leave our listeners with three tips
regarding osteoarthritis, wear, tear, arthritis, the one that
80% of older adults might endup with, what would those three
tips be?
Speaker 4 (24:05):
Exercise as much as your body lets you listen to
your body. Exercise. Try tomove as much as you're able to
eat. Well, sleep well, don'tsmoke to prevent it. I think we
come back to the basics ofpreventative medicine, which is
trying to live as much as weare able to. I mean, life has
challenges. Yeah , exactly. Butif we can try to prevent it,
honestly, that's the best way.
If we can.
Speaker 3 (24:25):
Solid tips. And I think that is a great way to
leave us. We've been talkingwith Dr. Rahad Nasser Rahad ,
thanks for being on the show.
Speaker 4 (24:32):
Absolutely. Thanks for having me, David. It's
always a pleasure.
Speaker 3 (24:34):
We've been talking with Dr. Rahad Nasser, the
director of rheumatology atHennepin Healthcare, A
brilliant doctor and a goodfriend to me. I really
appreciate him being on theshow and I hope you've enjoyed
the show today. If so, tellyour friends and leave us a
review. I hope you'll join usfor our next episode. And in
the meantime, be healthy and bewell.
Speaker 2 (24:52):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden. To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. You got a questionor a comment for the show?
Email us at Healthymatters@hcme.org or call 6 1 2
8 7 3 talk. There's also a linkin the show notes. And finally,
(25:14):
if you enjoy the show, pleaseleave us a review and share the
show with others. The HealthyMatters Podcast is made
possible by Hennepin Healthcarein Minneapolis, Minnesota, and
engineered and produced by JohnLucas At Highball Executive
producers are Jonathan, CTO andChristine Hill . Please
remember, we can only givegeneral medical advice during
this program, and every case isunique. We urge you to consult
(25:36):
with your physician if you havea more serious or pressing
health concern. Until nexttime, be healthy and be well.
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