Slide 1

Report
Arthritis 101
Kenneth D. Kleist, M.D.
HealthPartners Medical Group
Regions Hospital
St. Paul, MN
The Key Players
• Orthopaedic Surgeon
– The expert in the musculoskeletal system
– Diagnose
– Treat
• Medication
• Physical Therapy
• Exercise
• Brace
• Surgery
– Prevent
• Physician Assistant
• Primary Care Sports Medicine Physician
• Physical Therapist
Arthritis—Background
• Arthritis is the second most common chronic condition in
the US (sinusitis is first)
– Most common among elderly
• Arthritis affects over 20 million people in the US
– 76 million by 2030
• Leading cause of disability in people > 65 yo
• Total costs associated with arthritis are over $82B/year,
including hospital and drug costs, nursing home costs,
and lost productivity and work
Synovial Joints
Fibrous capsule
Bone
Joint space
filled with
synovial fluid
Synovial
membrane
Articular
cartilage
There are two general types of
arthritis
• Osteoarthritis: By far the most common
– “Garden Variety” or “wear and tear”
– Caused by the breakdown of cartilage
– Remainder of the talk will focus here
• Rheumatoid Arthritis and related diseases:
– These involve not only the joints but other
organs like skin, tissues, eyes, and blood
vessels
– Immune system attacks the tissues of the joint
Osteoarthritis
(Inflammation of Joints)
Pain
Loss of
Motion
Avoidance
of
Motion
Increased
Muscle
Tightness
What does arthritis look like
Normal Knee X-Ray
Arthritic Knee X-Ray
Diagnosis: History
• Symptoms
– Pain in affected joints
– Pain worse with prolonged
overuse
– Pain better with rest and
exercise
– Stiffness relieved by flexing
Diagnosis
• Physical exam
• X-rays
• Blood test to rule out other
diseases
Treatment: Non-operative
• Activity modification
– Avoid painful activities
– Low impact exercise
• Decreases pain
• Improves flexibility
• Improves joint nutrition
– Physical Therapy
– Cane or other assistive device
Treatment: Non-operative
• Weight Control
– Maintain current weight or lose weight
– 10 lbs of weight loss
• 30-50 lbs less weight on your hips and
knees
• Heat/Cold – Both Can be effective
Treatment: Medication
• Acetaminophen – Pain control
(Tylenol)
• NSAIDs – Pain and inflammation
– Standard
• Ibuprofen, naproxen, piroxicam
– Cox-2
• Celecoxib
• Ultram – Non-narcotic, addiction
potential
• Mild Narcotics
– Not recommended except short
term
Treatment: Injection
• Corticosteroids (Cortisone) Injection
– Anti-inflammatory placed into the joint
– Temporary pain relief
– Temporary swelling improvement
– Does not change the arthritis
– Limited number per year
– Blood sugar elevation in diabetes
Treatment: Injection
• Hyaluronic Acid Injections (knee only)
– A series of 3 – 5 injections
– Much more costly than steroids
– May last longer than steroids
– No one knows exactly how they work
• May increase lubrication
• May soothe the nerve endings
• May have anti-inflammatory effect
Treatment: Alternative
Approaches
• No Scientific Evidence to Recommend
– Glucosamine/Chondroitin Sulfate
– Acupuncture
– Green tea
– Grape seed extract
– Tart cherry concentrate
Treatment Summary
•
•
•
•
•
Activity Modification
Weight Management
Medications
Injections
Alternative Treatments
Questions??

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