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Healthy Actions: Let’s talk about joint pain and arthritis
Akron Beacon Journal - 11/15/2019
People can have aches and pains at any age -- from children and teens to senior citizens.
Is there anything you can do to prevent those aches and pains? What is considered arthritis?
My health expert for this month's Healthy Actions column, which explores a different health topic each month, is Dr. Bill Scully, an orthopedic doctor with the Crystal Clinic.
Scully's specialties include hips and knees and sports medicine, but we also discussed a wide range of topics related to joint pain.
Q: What is arthritis and is it just an issue for older adults?
A: Osteoarthritis is the natural wearing down of the joints and what's commonly known as arthritis. There's a variety of other arthritis conditions that can lead to needing treatment and those are auto-immune arthritis, such as lupus, rheumatoid arthritis and psoriasis.
There is also post-traumatic arthritis, or for instance, someone who has had a bad fracture in the past. Those types of arthritis conditions can present at a much earlier age than the standard wearing-down arthritis.
We see patients with different types of arthritis at different ages.
Q: So can kids who get injured when they're young develop arthritis from that injury?
A: It's certainly a concern and something we continue to learn a lot about.
We've learned, for example, that for athletes who have ACL tears, that addressing that tear and stabilizing their knee as opposed to ignoring it can help prevent further damage to their joint.
Obviously, sprain and such will still happen and those will heal. When you have a major injury to a shoulder or knee or hip, you have to have the underlying injury addressed or it will accumulate.
Q: What about just overuse?
A: That's a more debatable topic. Kids are much more active and playing on multiple different teams. We've learned a lot from Little League baseball. There's something called Little Leaguer elbow or shoulder from overuse, which can cause potentially long-lasting problems.
There probably is some line that we need to be a little bit careful of crossing, particularly as they're still growing. But in a general sense, fitness and being involved in sports and keeping your muscles strong and weighed down are far more beneficial than harmful.
Q: What's the difference between joint pain and arthritis?
A: Ultimately, we diagnose arthritis after an exam and X-rays. You can't see cartilage, which is the cushioning in joints that when it goes away can generate pain, on an X-ray. But we get a lot of clues based on an X-ray about the presence of cartilage.
Q: What causes arthritis?
A: We think there's multiple reasons for developing arthritis, which goes back to those different types of arthritis.
Q: Does family history have anything to do with the development of arthritis?
A: It does have a genetic component to it and the way the joints are aligned and how you develop and everyone is different. But it's not like breast cancer, where there's a specific gene that increases your risk significantly.
I wouldn't say that necessarily because you have a parent or sibling who has arthritis, that you're destined to have it. But it's probably a higher likelihood.
Q: What about age range?
A: It varies widely. For the osteoarthritis, it is more common in patients in their 50s, 60s and 70s. Once in awhile, I'll see somebody who unfortunately got dealt a bad hand of cards with arthritis in their 30s or 40s.
Q: Can arthritis be prevented?
A: For hip and knee arthritis, the No. 1 prevention is weight loss. Depending on the study you're referencing, for every pound you lose, it is three to five times less force going through your affected arthritic joint. If you're able to lose 10 pounds, that's 30 to 50 pounds less force going through your knee with every step you take.
Q: You mentioned you try to go to all nonoperative measures first before surgery. Like what?
A: We go with the most conservative end of the spectrum first. Something as simple as an occasional Aleve, ibuprofen or Tylenol, as long as they don't have a medical reason not to take it, can help.
I am often asked about heat and ice and which is better. Everybody is different.
We'll often say to use heat before exercise or activities and ice to cool down afterwards
Q: What other treatments are available?
A: Cortisone injections and gel injections are often available for knee and hip pain. Gel injections are controversial these days and haven't stood up to rigorous testing to show they're any better than placebos. But a lot of patients swear by them. There are a few insurances turning it down, which requires preapproval and could still be a couple thousand out of pocket for patients.
Bracing can be helpful, as well as physical therapy. Also, a cane may be helpful for some patients. Here's a little tip about cane use. You should use the cane on the opposite hand from your pain. Intuitively people use the same hand as their pain, but they'll lean into that hip and put too much pressure on it.
Q: When should I see a doctor?
A: When your home remedies have stopped working and when you used to get pain that would linger for a day or two and now that pain is lasting for two to three weeks. That doesn't always mean start with an orthopedic surgeon. Sometimes touching base with your primary care doctor is a good recommendation.
Q: Is it a myth that I will just get arthritis with old age?
A: The risk increases as you age, but by no means is it a sure thing.
Q: What about stem-cell injections?
A: It's a very hot topic right now. There are not enough studies to prove they are worthwhile, it is almost entirely out of pocket and not FDA approved, so there is some risk.
I think the future of that lies in catching arthritis early or halting at an early stage.
Q: What about vitamins or supplements?
A: Chondroitin and Glucosamine often come in a single pill. Again, it's another that hasn't shown definitive benefits.
If I have a patient taking it and they've found it helpful, I won't talk them out of it. On the flip side, I'm not advocating to go out and get it.
Hemp and CBD oil products are also being heavily advertised for arthritis. Again, there's not a lot of research, but I've had people say they've found it somewhat helpful.
I tell people to proceed with caution and make sure you're getting products from reputable vendors.
Betty Lin-Fisher can be reached at 330-996-3724 or email@example.com. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ and see all her stories at www.beaconjournal.com/topics/linfisher
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