So You Have Arthritis….What Now?

1. Do nothing, wait and see: 

For many, the pain and inconvenience is the result of a recent injury or just the beginning of symptoms.  Returning to your normal life with no or minimal modifications may be just fine or at least tolerable. Joint pain is sometimes episodic and may go away for months or years. Maybe you just want more time to think about what we’ve discussed or are anticipating insurance changes. My job at this time is to give advice or information about what might likely occur in the coming months and years. If I diagnose severe arthritis, we’ll discuss the cons of waiting through increasing pain and an inactive lifestyle that may occur or is already occurring.

2. Conservative care: 

Many patients’ condition is bad enough to do something, but not yet severe enough to strongly consider surgery. In this situation, I will present helpful tools that often make a difference. These recommendations can be classified into four areas:

• Exercise

Joint function is unbelievably complex and requires healthy strong muscles to be done properly. Strengthening the muscles that move a particular joint is an effective treatment that is frequently overlooked. Furthermore, smooth motion that occurs with bike riding, swimming and walking can greatly benefit a mildly, or even moderately affected joint. If you know me, you might know that I am passionate about exercise. Bicycle riding is one of my favorite activities and lucky for many, it is an amazing treatment for the ailing joint for many reasons. Chief among these are the muscles that move the hip and knee are specifically strengthened and the smooth motion is exactly what the delicate cartilage of the knee and hip need. I prefer outdoor riding to indoor riding, as the former is out in the fresh air and also helps with balance. Wherever you choose to pedal, work hard and keep moving!

• Shots

There are many types of injectable medicines available for arthritic joints. Steroids are the most commonly used and most effective. Steroids are powerful anti-inflammatory medicines which can have substantial effects when properly administered. Knee injections are done in-clinic and can be done at three month intervals. Steroid injections in the hip require imaging such as ultrasound guidance or x-ray guidance and are less commonly used.

Steroid injections can have lasting effects and can aid one in initiating an exercise program by removing the obstacle of pain. Many patients choose this treatment for varied durations. It’s important to note, not all shots are successful. This may indicate that the arthritis is too severe for the shots to help, or it may require two or three injections to see maximum effect. I’m also happy to discuss other types of injections with patients such as stem cells and other biologics.

• Nonsteroidal anti-inflammatory medication (NSAIDs)

This type of medication is a mainstay of arthritis treatment.  There are many pills in this category, the most popular OTC being ibuprofen (Advil, Motrin, etc.), naproxen sodium (Aleve, EC Naprosyn, etc.) and aspirin. There are a variety of others prescribed, such as meloxican (Mobic). These medications attempt to decrease pain by inhibiting an enzyme required by the body to cause pain. These medications have possible side effects. Patients with histories of ulcers or kidney issues should check with their doctors before initiating NSAIDs treatment. I see the benefits of this treatment most poignantly when we ask patients to stop NSAIDs just prior to surgery and they report how their arthritic pain increased– often dramatically.

• Weight Loss

As of this writing, about 74% of adults in the United States are considered overweight according to the Centers for Disease Control and Prevention (www.cdc.gov/obesity/data/adult.html). That includes nearly 43% who are considered obese, meaning they have a body mass index (BMI), a measure of body fat based on weight and height, of 30 of higher. According to the CDC, approximately 40% of overweight and 10% of obese people don’t see themselves as such and face a potential array of health issues related to their weight. Biomedical data suggests that losing just 10 lbs. will decrease joint pressure by 4X or 40 lbs. The weight loss topic is difficult to address. I was once told by a patient, “it’s like I went to the tire shop for tires and you called me fat”. I totally get it! You just want a new hip or knee and I’m talking to you about your weight.  Please understand how interconnected weight and joint issues are and how vital the conversation is to your success. From personal experience (I have knee arthritis), when I carry 40 lb. bags of cattle feed, my knee pain goes up significantly, immediately. When necessary to discuss a patient’s particular weight issue, I promise I’m doing my best to be sensitive, even if you don’t think I am. Weight loss is a powerful way to treat joint arthritis pain and will also benefit patients’ overall health.

3. Hip/Knee Replacement Surgery

This option is for severely diseased joints and has been the focus of my professional life. It is estimated that joint replacement supersedes even cancer treatment as an aid to living a healthy lifestyle. A successful joint replacement allows patients to stay active and healthy, remain at home versus a care facility, and prevents falls and subsequent fractures. Before deciding on surgery, patients should have a clear understanding of the diagnosis and nonoperative options, as well as the possible surgical complications. I’ve created videos to educate the public about procedures, share patient experiences, to supply knowledge and instill confidence in making the choice to undergo hip or knee replacement surgery. Please see my website, www.ElevateSurgicalUtah.com to access these resources.