During Saturday's Deseret Morning News/Intermountain Healthcare Hotline from 10 a.m. to noon, LDS Hospital rheumatologists Dr. Sean McMillan and Dr. Don Stromquist will take phoned-in questions about arthritis, from self-help to effective treatments and managing pain.
The most common form is osteoarthritis, which Stromquist calls a disease of "wear and tear." Cartilage breaks down, causing increased pain and difficulty with mobility of the joints.
The other major category of arthritis is inflammatory and results from your immune system attacking your body. The largest one in that group is rheumatoid arthritis. While it's less common than osteoarthritis, it's more serious, he said. It's also more treatable. Nothing stops the advance of osteoarthritis, which may eventually lead to the need to replace joints, including hips, knees, elbows and shoulders, among others.
The chance of having osteoarthritis increases with age. Unfortunately, there's no cure and there are also no medications that effectively prevent progression. Instead, McMillan said, care focuses on getting symptoms under control and maintaining joint function.
Depending on which joint is affected, changes may prevent further injury. For the knees and hips, even moderate weight loss reduces the stress on the joint. Patients with osteoarthritis are also steered away from high-impact activities, McMillan said, although exercise is important. A patient may be told to try swimming or walking, for instance.
"It's important to stay fit and toned. There's a tendency when it hurts to lay off things, but when you do, the muscles atrophy and it becomes weak around the joint," McMillan said. "That puts more load on the joint." Losing as little as 10 pounds takes a 30-pound load off the knees and 60 off the ankles. And better-toned muscles take up the strain and load.
For osteoarthritis in the hands, treatment may include physiotherapy or occupational therapy to keep hands mobile and maintain range of motion. Not losing the ability to grip and pinch is important. Some people get relief from contrast baths, alternating cold and warm water. Stretching seems to help.
In some cases, surgery may be needed. "We change the existing structure, but do as little as necessary," he said.
Osteoarthritis affects people differently and progresses at different rates.
McMillan and Stromquist are often asked about two dietary supplements, glucosamine and chondroitin. McMillan said scientific studies for the most part have not been done or, in the case of blinded studies where patients didn't know whether they got a placebo or the supplement, they have not found that taking something makes a big difference.
"That doesn't mean that, for individuals, it's unhelpful. If you stumble across something that seems to work and it doesn't cause harm, there's no reason not to try it," he said. But make sure, he added, that it doesn't interfere with medications or cause other problems.
Superficial joints like those in the hands and knees may also respond to topical treatments.
Or patients may be given injections, either of anti-inflammatories or something that mimics joint fluid. Taking something like Tylenol to control pain prophylactically helps, as well. More severe cases may require low-dose narcotics, and that can escalate to prescription anti-inflammatory drugs, clear to opioids like OxyContin.
The end stage, McMillan said, is joint replacement surgery. The good news with prosthetic joints is they're lasting longer than they used to. Still, he said he looks forward to a day when they won't be needed.
Tomorrow: Rheumatoid arthritis
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