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Growing Healthy Podcast

Jul 31, 2018

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 today!
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 about osteoarthritis. 
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 spine. 
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 risk. 
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 the xrays? 
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 symptoms. 
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 useful. 
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 them. 
Occasionally we can use an antidepressant which is shown to help with some pain conditions, if you have mood concerns as well. 
Alicia Power: now what about injections into joints, such as steroids or hyaluronic acid - what I like to call a Lube job for the knee?
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 positive benefits. 
Alicia Power: there is all kinds of talk about the anti - inflammatory nature of turmeric….do you know anything about this?
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 coming out?
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 experimental.  
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 treatments.
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!