Good evening and welcome to Doctors on Call.

I'm Dr.

Chrisa Kite, a hospitalist with Aspirus St.

Luke's and faculty member in the department of family medicine and behavioral health at the University of Minnesota Medical School here in Duth.

I am your host for this episode tonight on arthritis types, tendon and muscle problems and prevention and treatments.

The success of this program is very dependent on you, the viewer.

So, please call in with your questions or send them to our email address askpbsnorth.org.

Our panelists this evening include Dr.

Umar Sadiki, an internal medicine specialist from Aspirus, and Dr.

Anna Fernandez, a rheatologist from Essentia.

Our medical students answering the phones tonight are Ellie Tine from Clara City, Minnesota, and Olivia Ha from Rushford, Minnesota, and Sydney Clawson from Steuartville, Minnesota.

And now on to tonight's program on arthritis types, tendon and muscle problems, and prevention and treatments.

Hi, welcome you guys.

So, do you want to just introduce yourself to the audience and tell them what you do and what your specialty is and how it is that you come to treat arthritis?

I'm Anna Fernandez.

I'm a rheatologist at Essentia and there are many different types of arthritis.

So, there's a lot of opportunities to um help patients and there's a lot of changes that have occurred in the last several decades.

So, it's very exciting to be able to offer different treatments to our patients.

Good.

Okay.

Dr.

C. as I'm I'm sadiki.

I'm an internist at St.

Luke's and I do primary care and out in inatient care.

So we see a lot of arthritis concerns in from all over patients of all ages and something we I deal with on a daily basis.

Yeah, it's a common problem, isn't it?

I do have some questions to start with.

We can just start right in and we can fill in the gaps as we go.

Okay, a pretty popular question.

Do you get arthritis from cracking your knuckles?

That's a wonderful question, isn't it?

Probably not.

Uh, so even probably not.

You don't get it from cracking your knuckles.

Yeah.

Even though our grandmothers would tell us not to because it's not.

Um, usually not, right?

It just releases air from the joint space and it doesn't cause inflammation.

So, you're all good if you're a knuckle cracker.

All right.

So, um, what are some So, lots of people have arthritis, right?

And lots of people throughout history have had arthritis and there's many different types.

Um do you want to lead us through like what's a common form of arthritis?

Maybe just teach us a little bit about the different arthritises people can have common.

So the the most common type of arthritis is what we call osteoarthritis or the degenerative arthritis.

Um we don't like to say it's wear and tear arthritis or arthritis that we get as we get older.

We don't want to think about that.

uh but it is a damage to the cartilage and so the cartilage thins out and people do notice the grinding and and this type of uh noise in in the joint and it tends to be very painful particularly in the weightbearing joints when they're walking.

Um but it can occur in the hands, the base of the thumb, the tip of the fingers.

You may look at your grandmother's hands and you'll see enlargement of the tip of the fingers.

And so that's the most common type of arthritis that we see.

We call it osteoarthritis.

And then we have different categories of inflammatory arthritis.

So these are the ones that we want you to be really attentive because these are the ones that can cause a lot of damage.

And now we have medications that can prevent this.

And so in this category, think of it as an umbrella of inflammatory arthritis.

We have rheumatoid arthritis.

We have arthritis associated with psoriasis.

We have gout, which is a very common inflammatory arthritis.

We have arthritis associated with inflammatory bowel disease.

So that gives you an idea of the different types of arthritis.

Uh there are very and in primary care gout is something that is very common.

Um yes gout the disease of King Henry VIII who loved to eat swan legs and drink a lot of wine.

So those would be risk factors for developing gout living large I always say.

Um Dr.

Sadiki do you want to add to any arthritis?

What do you see in your clinic?

What are common arthritis complaints?

Well Dr.

Dr.

Fernando said I do see osteoarthritis is is the primary one that I I see.

We do have patients who have family history of rheumatoid arthritis or ser psoriasis and seratic arthritis.

So we you know we'll do we'll do some testing and if we find that they have it we refer them to dermatology because we want to get them on the proper treatment sooner than later.

Yeah, we want to prevent the inflammation because it's that inflammation that can destroy the joints so so badly.

And I'm going to add on to the comment of prevention because you saw that on your title.

Yeah.

Um and so there's some really interesting things that are happening for rheumatoid arthritis.

And so in terms of prevention, if you're a smoker, quit because it's a risk factor now for rheumatoid arthritis.

And if you have poor teeth or gingivitis, that's another risk factors.

So if you have a family member who has rheumatoid arthritis, your risk is higher.

And so these are two things that you can do for yourself to prevent the disease.

So just things to be proactive.

Very good.

Rheumatoid arthritis.

Yeah, it's a pretty disabling type of arthritis.

I know when you see it, could you describe maybe what are some physical findings of what joints hurt with rheumatoid arthritis for example and like um what might be a clue or a tip off that you would have something more than osteoarthritis?

Sure.

So when we commented on the osteoarthritis, we talked about the cartilage thinning out in the rheumatoid arthritis presentation.

It's more the lining of the joint.

We call that the synovium and it gets inflamed.

So we call it synovitis.

And so there's a specific pattern that we see.

We see a lot of the small joints of the hands u that can be very inflamed.

That means warm to the touch.

They're visibly red.

They're painful to move.

So so those are the signs of inflammation that we look for when we're evaluating patients and there's a pattern of a lot of stiffness in the morning.

Um it can be very progressing.

The pain can be pretty unbearable for some of our patients.

And so we always look for inflammation in the small joints of the hands and feet.

But we have people that have it in the knees, the wrists, the the all the joints.

But it's a symmetrical type of pattern with a lot of morning stiffness and inflammation of the joints.

And we're lucky that we have a couple blood markers known as a rheumatoid factor and the CCP antibbody that can give us a hint.

Uh but not everybody that has rheumatoid arthritis has those blood markers.

That's why we rely on their physical exam.

Very good.

I just wanted to clarify symmetrical means it's happening on both sides and tends to like these metacarpal felangial joints.

So you'll see that type of um inflammation good um or not good for anyone who has it.

It's a pretty tough disease.

If I have arthritis, what are some non-farmaceutical options that I can pursue to treat instead of medications?

Well, for like osteoarthritis, you know, more, you know, exercise is is a big one to kind of help improve, you know, joints ability, help some blood flow, can reduce inflammation, improve pain because you you don't lose you don't use it, you lose it.

So, kind of you lose the muscles around on get weaker and everything kind of just progresses to a point where you may eventually need especially osteoarthritis may need surgery like a knee replacement.

Well, diet is important too.

Thank you.

Keep going.

Uh so um so exercise is important, diet and so not for everyone but for some people um uh wheat may be an issue for some people sugar is an issue, processed foods is an issue.

So kind of be attentive if you eat something and you don't feel well.

Your body may be telling you that these are some of the certain types of foods that you need to that you need to um avoid.

You know, pay attention to the role of stress because that can exacerbate thing.

You need a good sleep cycle.

You know, take care of yourself.

So, so these are some of the things that people can use are over-the-counter uh rubs that can be pretty helpful to calm down some of the inflammation.

Don't forget your heating pad or your ice pack.

No, shorter intervals can be helpful to calm down a joint that's inflamed.

Very good.

Thank you.

I have a big hello from Donna from Superior and Donna asks, "Why does arthritis seem to be worse when it is wet outside?"

Oh, isn't that wonderful?

It's such a good question.

And I was hoping someone would ask this and our patients are very good meteorologists.

Uh so um we think that it's because of the changes in the barometric pressure that people can notice that their joints do ache and sometimes it's when the change is happening not necessarily when the weather bad weather is here.

So yes, our patients can be pretty sensitive to that those changes.

Yes, I wouldn't discount that.

But I would say that's not reciprocated in studies.

No, because I swear I get worse back pain when it is the weather is changing and one day I was curious and I started looking through the medical literature and Yeah, it's very limited.

It's very limited.

It doesn't support but I believe you.

Exactly.

So, I really believe you.

Okay, we have a question from Diane.

Um, who can a patient go to to get a comprehensive arthritis evaluation other than from their PCP, their primary care provider?

So can I guess the question is asking can they go to a joint specialist right off the bat?

Do they need a referral?

So I think your primary care provider is a very important person in identifying which way to go because there are many different types of arthritis and some types of arthritis do not need the imunosuppressive therapy that maybe we'll talk later on which is where I can help the primary care doctor in provide that uh service.

So usually our primary care doctors are very important in identifying the initial blood work um because of the resources.

We have limited resources.

So we're trying to make sure that we are attending to people.

Our some of our orthopedic our medical orthopedic uh groups can help us get that initial evaluation of uh of joint pain to make sure to make the difference differentiate between sports injury versus developing an inflammatory arthritis which is where rheumatologists help our primary care team.

Sure.

And we should not forget our sports medicine doctors.

They're very helpful.

Um so certainly they they can sometimes offer that initial evaluation, that initial screening.

Yes.

sports medicine, um rheumatologist, uh um orthopedics, um but I would say intern.

Yes, definitely.

I guess we are primary care though too.

Okay, this is another question kind of about access to care which I feel like even though it's not an arthritis question is very much a legitimate question today.

I was just reading something about how we're going to be short 180,000 physicians in the US by 2020 or 2030.

So Jeff's question from DUTH is if a person doesn't have health insurance, where can they go to get help?

So where do we have that might offer care for individuals that might not have health insurance that have arthritis?

Do are we aware of any resources?

I do know some.

I can help with this if you want.

I know there's the community health center.

So that is a um a clinic that offers a sliding uh fee scale.

Um, that would be a good place to start.

You could certainly Google that, right?

Sure.

Um, and then you could also call the clinic and just ask for some resources.

Maybe you qualify for Minnesota Care or Wisconsin Care.

Um, and you can apply for those.

Yeah.

And there's some community resources, too, that could help.

So, there is help available if you need that.

That's a really good You can also ask some clinics for like self-pay rates and what that would cost, too.

I miss the days when you could write no charge.

Yeah, those are really the good old days.

Okay, I do have another arthritis related question.

You had mentioned um some of the joint noises, Dr.

Fernandez, but I will ask both of you, why do my joints make popping and cracking noises?

Well, kind of as like the the cartilage space between the joints diminishes eventually.

Sometimes you do get bone on bone that sometimes is what you're hearing.

Yeah, it's a fun word, isn't it?

We call it crerepitus.

I like saying fun medical words.

All right.

Um, okay.

Great question here.

Are there any adverse effects of using Voltaterin and um other topical therapies long term?

Can they do anything for to your skin perhaps?

So most of our patients tolerate the topicals very well.

Um, I think you skin may be sensitive.

So you have to pay attention that you don't have a a sensitive skin and so make sure that you try it in a small area first.

But most of our patients tolerate the topicals uh fairly well because the absorption is not compared to what we take them orally.

So as long as you're tolerating as long as it's giving you relief um it's worthwhile to continue.

It's less problematic than the ulcers that come with taking the what we call the NSAIDs things like ibuprofen or Alie and the kidney damage that can come with that.

Some of our patients cannot be on those medications because of the impact on the kidney, right?

And they can cause gastritis and ulcers.

They're a little harder to take.

If you can take them, take them with food, maybe.

Yep.

Talk to your doctor.

Take it as directed.

There you go.

Take as directed, Dr.

Sadiki.

All right.

This is a good question from Leslie from Duth.

How is physical therapy supposed to help with arthritis?

Does it help with um pain card um misuse cartilage bone pain etc?

All the above.

So it helps one to strengthen the muscles helps kind of gives you more depending on what your what joint hurts and kind of give you more directed treatment to that help strengthen those you know the muscles and help improve that pain and range of motion.

Physical therapists also pay attention to how you walk because sometimes you don't realize that you're walking with a in a different way because you have a muscle group that it's weaker.

So I agree the the strengthening is really important.

How do you your posture?

How do you carry yourself?

You learn a lot of things from our physical therapists and that's how they help.

They also tell you joint protection techniques.

We were talking about the hands and rheumatoid arthritis.

They give them a lot of hints to our patients in using splints and compression gloves and the paraffin wax.

the melted wax that feels good.

So, they give a lot of good hints for our patients, too.

So, physical therapists can be a do a world of good.

I love it.

I would love to plug our therapists.

I also want to note um in addition to physical therapy, we have occupational therapists and they might be helpful as well because what do they do?

Maybe that could help with a patient with arthritis.

Well, the the occupational and hand therapists too, they are they're crucial in trying to make sure that you continue to do what you want to do.

You just have to adapt and so they do a lot of adaptive equipment, splints and things for our patients.

So for our rheumatoid arthritis patients and patients with a lot of hand arthritis, they're very very helpful.

Good.

And I would have to say they can help with home modifications and all types of things like that.

Okay, here's a really wonderful question from Pat from Duth.

Oh, I guess I don't know if it's a female or male, but Pat says, "As I get older, it is more difficult to get out of chairs.

Is that related to arthritis and what can I do about it?

That's a great question.

Could be related to arthritis and could be related to some deconditioning if you're not as as mobile as you as you were because nowadays we sit a lot.

So kind of we don't we we lose a lot of that strength that we had before.

So getting out of a chair can become more difficult.

So it could be arthritis, it could be a variety of different things.

Okay.

So, it sounds like if you can't get out of a chair and you're not having joint pain, it might be a muscle issue.

Could be your back, right?

And there are some like the big muscles in your legs.

Um, certainly if you're using your arms a lot, you might have a strength issue there.

Maybe should you see your physician?

Are diseases associated with that?

And maybe you could speak to what they might be if it's a significant issue, for example.

Well, particularly if it's in the muscles and it's not due to a bad hip or a bad knee, for example.

Some people can have inflammation in the muscles.

So, what we call a myioitis or a myopathy.

And so, um that is very important to pay attention because we don't want people falling and hurting themselves.

And so, physical therapy can help with that.

But yes, if you're noticing a lot of weakness, it's important to evaluate where it's coming from.

Is it the back, the hip, the knees, the muscles?

Right.

We're caught up for a moment on questions.

So maybe we can just talk a little bit about arthritis and some of the history of it.

I mentioned that there's different types.

So we had talked about osteoarthritis.

Um and um I know that there's all I have to do is look toward the golf world and then you see arthritis, right?

There's some famous golfers that have given us a lot of publicity about arthritis.

Jack Nicholas notoriously had osteoarthritis and then Phil Mickelson is a good spokesperson for seroriatic arthritis.

Do you guys want to tell me a little bit about what that is?

What is so psoriasis is a condition on the skin which are red plaques, scaly plaques.

Typically patients see them at the elbows uh the knees but they can occur everywhere.

Not everyone who has psoriasis will develop seroriatic arthritis.

uh about 30% depending on what literature you're reading will develop the inflammatory component.

So again red hot swollen very painful joints.

Um and we treat it very similar to to rheumatoid arthritis.

There's a lot of newer medications that the goal is to shut down the inflammation so that the damage uh does not occur and it can they can be pretty effective.

Good.

So we have a lot of options for our patients now.

Great.

Here's a question maybe I'll ask Dr.

Sadiki.

Does massage therapy help with arthritis and how would that help?

Trish from Two Harbors.

I feel like it can help because when you're not using the joint, everything kind of gets stiff.

So, loosen up some of the muscles, relieve some of that inflammation and kind of help improve some blood flow to the area which may improve some pain.

And can't we all agree that a good massage feels good?

Yeah.

Yep.

So, it might help with some of chronic pain.

Um, all right.

This is one that's maybe an autoimmune question more than arthritis.

I don't know who asked, but how do rheatologists help patients with Shoggrren's disease?

So, Shogrren's disease is a condition where people have dry eyes, a dry mouth um and so um they can also have inflammation in their joints.

They can have other internal organ issues like kidneys and this type of things, skin.

Um so rheumatologists help by identifying that it's jogrints.

Uh there are some medications but a lot of it is symptomatic treatment uh um drops for the dry eyes.

There's some um things that you can use over the counter.

Biotin silts uh different things that help with a dry mouth.

important to pay attention that you're not experiencing any enlarged lymph nodes in your neck uh uh area, armpit area, because patients who have sugar disease can be at higher risk of developing lymphoma.

And so this is where we work together with the primary care team uh to make sure that we're monitoring um our patients.

That's a good public service message about shogrins.

That's great.

Thank you.

I think that um I'm going to ask you about let's pretend I am a patient and I have an osteoarthritic knee and Dr.

Dr.

Sadiki, you are my doctor and I come to you and I say, "What do I do?

I can't walk on this knee any longer.

How would you help me?

What would be the next steps?

When do you involve a specialist?

How do I know that I need a new knee?"

I mean, we kind of want to get the history.

How long have you had this knee pain for?

What have you done before to kind of help improve it?

And if after you know you've done the exercises, you've done physical therapy, you've used the brace and still aren't getting any relief and it becomes difficult to walk you then that might consider referring you to orthopedic surgeon for the knee replacement.

But if I don't want quite to have surgery yet, can you can I have injections?

And is there um is there an injection that might help me?

I see Dr.

Fernandez is grabbing the knee joint here.

So you can do so so one of the important things that uh Dr.

Sadiki is mentioning is you're having knee pain uh but there's a lot of sources of pain in your knee.

So it could be the cartilage, it could be your ligament, it could be a torn meniscus, it could be the muscles, it could be the bersas and so Dr.

Sadiki is going to be evaluating all of these different areas to find out whether you need a cortisone injection to give you some relief.

uh whether you need uh referral to physical therapy to strengthen your quad muscles, whether you are bone on bone because the cartilage is all gone and then you would need a joint replacement.

So a lot of the primary care helps us in trying to understand what is the source of your pain.

Where is it?

Sure.

So if I'm the patient and I come to my doctor and I say, "Doctor, my knee hurts.

Is it reasonable for me to have an X-ray?"

Would that be a good thing to That would be a good place to start to kind of see I want to get the see what's going on with the bone and see where if there's a fracture someone's older, you know, could be a lot of different things that like Dr.

Vern said could be causing that pain.

Good.

Okay.

So, expecting an X-ray would be something that might happen for somebody who comes with knee pain.

All right.

Very good.

and you know basic things um your level of activity uh your deconditioning or not you know we have to pay attention to our weight uh because extra weight can have a big impact on our weightbearing joints so even losing five pounds can make a huge impact on an arthritic knee so these are some things that it's a team effort everybody's trying to help you stay active because the more active you stay the better you do thank you for bringing up the weight is so important because it can hurt a joint and we used to never have much to offer for weight loss.

But now we do have some medications that might be really helpful for patients with arthritis.

Is that true?

Yeah.

So for I think for every pound you get put one four pounds of pressure on your joints when you walk.

So when you have when you lose some of that weight less pressure on all your joints and with that can that itself can improve your pain.

Good.

Okay.

Um, someone from Duth asks, "Are there any foods or over-the-counter me medications that can prevent joint inflammation?"

Prevent.

So, we have to be careful there with the terminology.

Um, I think if you have a predominantly Mediterranean diet, I think you're doing the best that you can in preventing uh inflammation.

And so I think um careful with gluten, careful with processed foods, careful with alcohol, careful with pop.

Uh those are things that all tend to be more pro-inflammation.

Um if you gain a lot of weight, that tends to be inflammatory.

So these are the things that diet uh uh can help you.

Some people try different supplements that could be of assistance, but you have to see what works for you.

That's a great answer.

Thank you.

I do think we often think about what we put in our bodies and how it affects our bodies.

So, that's a really good question.

Okay, this is a caller from Ashlin, Wisconsin.

If I have arthritis and also get Lyme disease, can my Lyme disease worsen the arthritis?

So, Lyme arthritis typically we see it's a knee.

So, it's a big swollen knee.

And thank goodness, primary care team, internal medicine, family medicine, all of our teams recognize because it we are in an endemic area.

And so I think we recognize it very early that we're not seeing some of those very dramatic cases.

Um I think any infection in the body does tend to make people flare more.

That's a term that we use to explain a sudden intensification of pain.

So I think it's possible that someone who developed a lime disease and then all of a sudden they feel that their arthritis is doing a little worse.

It's possible that it's due to that.

Just like if you have a strep infection or a pneumonia, all of a sudden it just kicks into high gear.

Yep, that sounds yep, that sounds like a terrible thing to have arthritis and then have lime on top of arthritis.

Sounds like misery.

So very good question and thankfully one is a chronic condition, one is an infection that we can usually treat and so hopefully we can just get bit get back to the the plain old arthritis instead of the lime.

We are running out of time so we have 13 seconds or 30 seconds left.

I want to thank our panelists Dr.

Anna Fernandez and Dr.

Umar Sadiki.

Please join doctors on call next week where Dr.

Mary Owens is Owen is joined by regional experts for a panel discussion about indigenous health with a panel of experts from around the region.

Thank you for watching and joining us for season 44 of Doctors on Call.

Have a good night.