Dr. Sonja Mathes, orthopedic surgeon, joins us to speak about
this very common condition.
Alicia Power: Welcome to Growing Healthy Podcast! Today
we are a lucky to have Dr. Sonja Mathes with us to talk about a
very common problem….Osteoarthritis. Sonja is an
orthopaedic surgeon here in Victoria and we will get to this
discussion right after this little reminder!
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Alicia Power: Sonja, Thanks for coming to talk to us
SM: No problem Alicia, Thanks for having me!! This is a very
common problem which I see every day…and I think it is important to
get more info out there about it!
Alicia Power: well lets get started!! Tell us a little bit
SM: Well, Osteoarthritis, or OA is the most common type of
arthritis, and it affects millions of people world wide. It
occurs when cartilgae, the protective coverings of ends of bones in
joints, , breaks down. This starts with roughening of the
cartilage, and it can go on to thin and get so thin that eventually
the bone is exposed, causing bones to rub on bones.. This can
cause pain, stiffness and swelling in joints. Some of the
most common joints that are affected are the hands, hips, knees and
Alicia Power: Do we know why it happens?
SM: Not entirely. We think that in part, it is worsened by
asking the joint to do more - things like repetitive stress or use
of a joint - some professions could increase this risk. But there
are also some genetic factors that seem to play a role.
Lifestyle factors can definitely increase the risk of OA.……
Alicia Power: What do you mean by lifestyle factors?
SM: well weight certainly increases the risk of arthritis.The
more we weigh the more force is put onto our joints with even
simple activities such as walking. People who are significantly
overweight have a 40 times higher risk of developing arthritis of
their knees. Also the longer we have been using our joints,
the higher the risk of OA is, so the older we are, the more risk we
have of getting OA.
Alicia Power: what about injuries?
SM: yup certain injuries also can increase the risk of the
cartilage breakdown leading to OA, this is often an issue in the
knee and ankle where jumping and twisting injuries can cause damage
that protective layer quite easily. Also certain
abnormalities in the alignment of joints can increase the
Alicia Power: okay so age, repetitive use, obesity, previous
injury or alignment issues in certain joints can all contribute to
osteoarthritis….Is it more common in men or women?
SM: it seems to be more common in women, but we aren’t certain
why that is.
Alicia Power: all right so we have an idea what can cause it,
and the symtpoms we get from it - joint pain, swelling and
stiffness. But how do we know it is Osteoarthritis as opposed
to another form of arthritis.
SM: There is a pretty typical pattern for osteoarthritis, at
the beginning a sharp stabbing pain associated with certain
activities. Usually, the pain comes and goes when the
arthritis is milder. This can progress to a more constant
dull aching pain with periods of swelling and sharper pain which
starts to affect daily function which can then progress to
significant debilitating pain. Usually affecting one to two
joints, as opposed to many as we can see with other types of
inflammatory or autoimmune arthritis like rheumatoid
arthritis. We can confirm our diagnosis with conventional
xrays, and rarely we need other types of imaging if the symptoms
are a bit different than we might expect.
Alicia Power: its quite interesting, i’ve had some patients
with minimal pain and severe OA on their X-rays and others with
sever pain with what appear to be very minor changes. Would
you say it is important in OA to manage the symptoms as opposed to
SM: yes, very much so. I always tell patients that we treat
patients, not xrays. osteoarthritis can look and feel
differently in everyone. So our goal is managing your pain
and stiffness, to allow you to do the things you like to do!
Alicia Power: Is there anything we can do to prevent it from
happening, or from worsening if we do have it?
SM: Almost all of us will develop arthritis in some joint as
we age, but not all of us will have pain or symptoms from the
osteoarthritis. Many people think that they should be less
active to try to prevent worsening wear and tear on their joints,
however, moderate activity is actually really helpful for managing
symptoms. By keeping the muscles around a painful joint
strong, you can take the pressure off the joint. Especially
for osteoarthritis in the legs, using non or low impact activities
like walking, cycling or pool based exercise can dramatically
improve pain and stiffness.
Alicia Power: If you do have it, and it is causing pain, how
can we manage it?
SM: Our goals with managing OA are to improve the pain,
improve the patients function - i.e. what they can do day to day
and to help slow down the progression of arthritis
i have already talked about the benefits of staying active
It is important to lose weight if you are overweight or obese,
as this decreases the stress on your joints. In fact by losing 10%
of your body weight you can decrease your pain by up to 1/2! Pretty
amazing! and great for so many aspects of your health as
well. Using aids for walking - such as walking poles
can help with hip or knee arthritis. Also sometimes braces
can help to improve the way that the joint moves taking pressure
off of the more damaged parts of the joints. Exercise and
strengthening are very important - and the knowledge of a good
physiotherapist or exercise prescription expert can be very
Alicia Power: okay so those are things that you can get
started on even before seeing the doctor! Great…what about other
ways of helping such as medication or surgery?
SM: So generally if you have done the lifestyle changes and
you are still experiencing pain we usually start with topical anti
inflammatories or tylenol. If these are not effective then we
move onto oral anti inflammatories as needed. these are used
to treat the pain, they do not change the progression of the
disease. Please make sure to stay well hydrated, and if you
are using them more than occasionally see your family doctor to
make sure your blood pressure is normal, and there are no reasons
in your medical history why you should not be taking
Occasionally we can use an antidepressant which is shown to
help with some pain conditions, if you have mood concerns as
Alicia Power: now what about injections into joints, such as
steroids or hyaluronic acid - what I like to call a Lube job for
SM: Well we can use steroid injections for an arthritic
joint. This can work well if there has been a sudden
worsening or flare of the arthritis. This isn't a permanent
solution, but for many patients who are trying to delay or avoid
surgery it can be an option. But it often wears off fairly
quickly within two to six months. The lube job or
Hyaluronic acid injections can help many patients with mild to
moderate arthritis and can give longer benefit,maybe up to 10
months. They are expensive at up to 450 per injection but the
studies show that not all patients benefit from them, but certainly
I have had patients that have had good effect from this and it is
relatively safe, so may be worth a try.
Alicia Power: What about more natural substances people might
be looking into.
SM: well if you are going to try something, topical capscasin
has some evidence to it, but can be irritating to the skin.
And in some studies, oral fish oil and chondroitin have shown some
Alicia Power: there is all kinds of talk about the anti -
inflammatory nature of turmeric….do you know anything about
SM: Well the active ingredient known as Curcumin has again
some evidence for it, but it is poorly absorbed in our bowels, so
you need to take a supplement that has been formulated to improve
its absorption in our GI tract.
Alicia Power: Great…so we spoken about lifestyle changes,
medications and injections. What if none of these help and
you are suffering daily and unable to do what you enjoy doing in
life…what is the next step?
SM: Surgery is an option for most kinds of osteoarthritis when
patients have disabling symptoms. For most large joints - the
shoulder, knee and hip - surgery to replace the joint, a joint
replacement is the most effective option. Arthroscopic
surgery through where a as small camera goes into the joint -
usually ankle or knee - can used to "clean up" a joint if
there is locking or cathcing in select patients. But most patients
don't get any benefit from arthroscopic clean up and it is usually
not recommended for arthritis.
Total joint replacement surgery can have dramatic improvements
in quality of life for patients who have advanced arthritis and are
disabled. Joint replacement surgeries are big operations and
although the majority of patients are satisfied, there are risks to
the operations and not all patients are happy after having their
joint replaced. About 20% of knee replacements and 9% of hip
replacements report ongoing pain after surgery - so its important
to have realistic expectations and know that you may not be
entirely pain free after your surgery. If you have multiple
painful joint, depression or other health issues, its more likely
that you may have pain after a joint replacement. Alicia Power: OK
so I think we have done a pretty good review of OA, are there any
other pearls or tidbits that we haven’t mentioned that you think
are important for people to know about? Or any new treatments
SLots of patient ask me about two newer types of treatments
for arthritis - stem cell injections and platelet rich plasma
injections. What we are all hoping for is a treatment that
can grow new cartilage. However, this doesn't exist
yet. Once the cartilage has thinned in arthritis, there is no
way to bring it back.
Stem cell therapy is still an experimental treatment that does
not have any strong studies to support it yet. Platelet rich plasma
injections has some studies that show benefit for patients with
mild to moderate arthritis in the knee, it is still fairly
I have seen many patients who have chosen to have these
treatments and often spent a lot of money on them and not had any
benefit, so i really encourage patients to talk to their physicians
or an orthopaedic surgeon before they consider these
Alicia Power: Well That is some great information! Thanks
Sonja for coming on the Growing Healthy Podcast….it’s a beautiful
day out so i’m going to go do some moderate joint strengthening
activity….So keep on Growing Healthy!