Kenneth D. Kleist, M.D.HealthPartners Medical Group

Regions HospitalSt. Paul, MN

Arthritis 101Arthritis 101

The Key PlayersThe 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—BackgroundArthritis—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

BoneFibrous capsule

Joint space filled with synovial fluid Articular

cartilage

Synovial membrane

Synovial JointsSynovial Joints

There are two general types of There are two general types of arthritisarthritis

• 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

Pain

Avoidance of

MotionIncreased

MuscleTightness

Loss of Motion

OsteoarthritisOsteoarthritis(Inflammation of Joints)(Inflammation of Joints)

What does arthritis look likeWhat does arthritis look like

Normal Knee X-RayNormal Knee X-Ray Arthritic Knee X-RayArthritic Knee X-Ray

Diagnosis: History Diagnosis: History

• Symptoms– Pain in affected joints– Pain worse with prolonged

overuse– Pain better with rest and

exercise– Stiffness relieved by flexing

DiagnosisDiagnosis

• Physical exam• X-rays• Blood test to rule out other

diseases

Treatment: Non-operativeTreatment: 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-operativeTreatment: 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: MedicationTreatment: 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: InjectionTreatment: 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: InjectionTreatment: 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 Treatment: Alternative ApproachesApproaches

• No Scientific Evidence to Recommend

– Glucosamine/Chondroitin Sulfate

– Acupuncture

– Green tea

– Grape seed extract

– Tart cherry concentrate

Treatment SummaryTreatment Summary

• Activity Modification

• Weight Management

• Medications

• Injections

• Alternative Treatments

Questions??Questions??