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??
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