Arthritis: Everything You Always Wanted to Know and Were Afraid to Ask

Joanne Halbrecht, MD

Grandma had it, so did Uncle Bill, now you do. What is arthritis anyhow? In my 25 years as an orthopedic surgeon, I have found that most patients are not quite sure what it is. Understandable– you didn’t go to medical school, but when the diagnosis is made, you want to know more…

The term “arthritis” has roots in latin. “Arth” means “joint” and “itis” is inflammation. Mystery solved: joint inflammation. The most common form of arthritis is osteoarthritis. The joint becomes inflamed because the cartilage, the white stuff at the end of a chicken bone, wears out. In the beginning, the cartilage becomes soft, then it frays and fissures develop. Now it looks like crabmeat (hold the butter). The surface of the bone is no longer smooth. Rough surfaces are irritating and result in an inflamed joint that may be painful, swollen and noisy. At the final stage, the cartilage is completely worn off and the joint is bone-on-bone. Ouch!

What’s the cause? Genetics, age, obesity, high impact activities and trauma are all potential causes. More often, its’ a combination of factors such as bad genes and obesity. How can you avoid the same fate as grandma’s arthritic knee? Maintain a normal weight and eat well. Avoid white flour, sugar, white rice and potatoes. These are all high glycemic foods meaning that they are readily converted to sugar. Sugar is inflammatory… and makes you gain weight. When my patients ask how they can lose weight, I recommend either the South Beach or Mediterranean Diet. It’s about changing your eating habits, not starving yourself. I also advise activity modification:  anything on wheels or in water. Low impact activities are easier on your joints.

How do you know you have arthritis? Symptoms typically include joint stiffness in the morning, joint pain going up and down stairs, increased pain with increased activity. When the arthritis is more severe, the joint swells and can catch or make a grinding noise.

So, your doctor gives you the bad news about that aching knee: arthritis. What do you do? If you are overweight, try the South Beach or Mediterranean Diet and increase your metabolism with low impact exercise. NSAIDs work better than Acetaminophen (Tylenol) as the cause of pain is inflammation and Tylenol ® is not an anti-inflammatory medication. I prefer Naproxen sodium (Aleve®) to ibuprofen (Advil®) because it lasts for 12-18 hours where as Advil® only lasts for 3-4 hours. If you take medication for other reasons or get stomach irritation with NSAIDs, check with your doctor before taking NSAIDs.

What about joint injections?  A simple solution to buy you more time may be a steroid injection. Steroids decrease inflammation and can last for weeks to months. Don’t have a steroid injection within 3 months of a joint replacement as it increases the risk of joint infection You may have heard of hyaluronic acid (HA) or a “lube job”. There are many brand names for this: Supartz, Hyalgan, Synvisc, Orthovisc. These have had good success in many patients, but recently insurance companies have stopped covering this medication due to studies showing limited benefit. The new trend in arthritis is the use of orthobiologics. This involves using a biologic substances such as blood products, fat or bone marrow to treat orthopedic pathology. These substances contain growth factors and in some products, stem cells that have the potential to decrease inflammation and stimulate healing of damaged tissue. Current studies show that platelet rich plasm (PRP) obtained from the patient’s blood can be more effective than HA for pain associated with arthritis.  There are also many clinical studies published which use the patient’s own fat or bone marrow to treat arthritis pain. Other orthobiologics available on the market include umbilical cord or amniotic products, but clinical studies are lacking and some products have been taken off of the market due to safety concerns and lack of compliance with FDA regulations. When choosing an orthobiologic, do your research on the product and make sure the doctor has extensive experience in reparative medicine. The catch: orthobiologics are not covered by insurance.

When the degree of pain and level of function is no longer acceptable, joint replacement surgery needs to be strongly considered. Studies show 80-90% success for total hip, knee and shoulder replacement. Certainly, the benefits of surgery must outweigh the risks. Not everyone is a surgical candidate.

More treatment options are available when early diagnosis is made. If you have joint pain, don’t wait. Seek a medical evaluation.