July 31 Kiwanis Program: Brian George from St. Barnabas Medical Center, co-leader of Chatham Mayor's Wellness program, spoke on Arthritis
His talk primarily covered more conservative treatment of Arthritis. Most of the time was spent on Osteoarthritis, which is more prevalent than Rheumatoid Arthritis. Joint anatomy and treatment options were covered.
Many people have Arthritis and don’t seek treatment. They should seek professional diagnosis and treatment.
Arthritis usually affects the hips, knees, hands or back. Pain and reduced mobility can result. Ligaments are involved. Tendons connect muscle to bone. Cartilage, which serves to lubricate and pad the interface between bones in joints, can wear away. This results in pain caused by bone-to-bone contact. Cartilage can also be damaged by injuries. We need to try to preserve our cartilage.
Arthritis is defined as an inflammation of the joints. One in six Americans has Arthritis. In general, Osteoarthritis attacks certain joints. Rheumatoid Arthritis attacks a large number of joints at the same time.
Brian showed X-rays of good and bad joints where the Arthritic joint has clearly lost cartilage. This causes pain, stiffness and swelling. This reduces physical activity and causes some deformity. Patients should seek a qualified orthopedic physician, who will diagnose their condition using X-rays. They also do range of motion tests and press on the affected joint. Bone to bone rubbing and friction can be very painful.
Weight control and management is the number one treatment because it reduces the load on the joints. Exercise is good because it reduces weight and gives patients more energy. They also sleep better. Exercise won’t make the pain worse. Walking is the best choice but aquatic exercise also works well. Alternative forms like Yoga and Tai Chi work well. Recently, the Mayor’s Wellness program sponsored training by the Chatham Club at the Farmer’s Market.
High impact exercises are not a good idea.
Heating the joint with a heat pad before exercise helps. Start slowly. Ice after exercise helps recovery.
Be sure to lift heavy objects with your leg muscles, not your back muscles which are the smallest in the body. Improve your posture. Don’t spend too much time in one position, like sitting during a lecture. Use a cart to carry heavy objects. Don’t start an activity which cannot be stopped safely. Get help if necessary.
Orthotics is helpful. Properly fitting footwear is important. Inserts that fit in your shoes can be helpful. Long “reacher” tools to reach and grab objects are useful. Larger pencils and pens can be helpful.
Supplements Glucosamine and Chondroitin (not FDA regulated) were discussed. Glucosamine is a building block of cartilage. It may be effective as a pain reliever but it is not a cure. It is extracted from shellfish. Chondroitin helps make cartilage spongier and can help preserve cartilage. It is taken from sharks. Doctors advise trying these but recommend stopping if they don’t work. Multivitamins are recommended. Too much calcium is not a problem for Arthritis. Check with your doctor before taking medications.
Topical creams can be pretty effective. Capsaicin cream contains a substance found in red peppers. It provides heat, like what you get when you bite into a red pepper. We have a fast neural path reaction to heat. The reaction to pain is much slower. The heat tends to block the pain signals and the patient feels better.
Patients close to end stage Arthritis sometimes turn to injections. Hyaluronan is an injection which can be given in an orthopedic office. Not available for the hip, it is injected into the knee. It relieves pain, restores function and lubrication for 6-12 months. It helps some patients but not others.
Cortisone is frequently used for athletes for pain relief. Relief is variable and it is not recommended for long term use. Repeated injections into the same joint can further damage the cartilage.
Orthoscopic surgery is sometime done to fix injuries to the knee.
Surgical joint replacement is used in cases where patients have bone-to-bone rubbing in their knee or hip. Brian showed and explained X-ray images of hip and knee replacement joints.
In summary, getting a correct diagnosis is key to receiving treatment. For more information, go to The National Arthritis Foundation, The New Jersey Chapter of the Arthritis Foundation, The American Association of Orthopaedic Surgeons, or The Joint Institute at Saint. Barnabas websites. The Kiwanis audience enthusiastically applauded this informative presentation.