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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??