kenneth d. kleist, m.d. healthpartners medical group regions hospital st. paul, mn arthritis 101
TRANSCRIPT
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Kenneth D. Kleist, M.D.HealthPartners Medical Group
Regions HospitalSt. Paul, MN
Arthritis 101Arthritis 101
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The Key PlayersThe Key Players• Orthopaedic Surgeon
– The expert in the musculoskeletal system– Diagnose– Treat
• Medication• Physical Therapy• Exercise• Brace• Surgery
– Prevent• Physician Assistant• Primary Care Sports Medicine Physician• Physical Therapist
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Arthritis—BackgroundArthritis—Background
• Arthritis is the second most common chronic condition in the US (sinusitis is first)– Most common among elderly
• Arthritis affects over 20 million people in the US– 76 million by 2030
• Leading cause of disability in people > 65 yo
• Total costs associated with arthritis are over $82B/year, including hospital and drug costs, nursing home costs, and lost productivity and work
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BoneFibrous capsule
Joint space filled with synovial fluid Articular
cartilage
Synovial membrane
Synovial JointsSynovial Joints
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There are two general types of There are two general types of arthritisarthritis
• Osteoarthritis: By far the most common– “Garden Variety” or “wear and tear”– Caused by the breakdown of cartilage– Remainder of the talk will focus here
• Rheumatoid Arthritis and related diseases:– These involve not only the joints but other
organs like skin, tissues, eyes, and blood vessels
– Immune system attacks the tissues of the joint
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Pain
Avoidance of
MotionIncreased
MuscleTightness
Loss of Motion
OsteoarthritisOsteoarthritis(Inflammation of Joints)(Inflammation of Joints)
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What does arthritis look likeWhat does arthritis look like
Normal Knee X-RayNormal Knee X-Ray Arthritic Knee X-RayArthritic Knee X-Ray
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Diagnosis: History Diagnosis: History
• Symptoms– Pain in affected joints– Pain worse with prolonged
overuse– Pain better with rest and
exercise– Stiffness relieved by flexing
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DiagnosisDiagnosis
• Physical exam• X-rays• Blood test to rule out other
diseases
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Treatment: Non-operativeTreatment: Non-operative
• Activity modification– Avoid painful activities– Low impact exercise
• Decreases pain• Improves flexibility• Improves joint nutrition
– Physical Therapy– Cane or other assistive device
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Treatment: Non-operativeTreatment: Non-operative
• Weight Control
– Maintain current weight or lose weight
– 10 lbs of weight loss
• 30-50 lbs less weight on your hips and knees
• Heat/Cold – Both Can be effective
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Treatment: MedicationTreatment: Medication• Acetaminophen – Pain control
(Tylenol)• NSAIDs – Pain and inflammation
– Standard• Ibuprofen, naproxen, piroxicam
– Cox-2• Celecoxib
• Ultram – Non-narcotic, addiction potential
• Mild Narcotics– Not recommended except short
term
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Treatment: InjectionTreatment: Injection
• Corticosteroids (Cortisone) Injection
– Anti-inflammatory placed into the joint
– Temporary pain relief
– Temporary swelling improvement
– Does not change the arthritis
– Limited number per year
– Blood sugar elevation in diabetes
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Treatment: InjectionTreatment: Injection
• Hyaluronic Acid Injections (knee only)– A series of 3 – 5 injections– Much more costly than steroids– May last longer than steroids– No one knows exactly how they work
• May increase lubrication• May soothe the nerve endings• May have anti-inflammatory effect
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Treatment: Alternative Treatment: Alternative ApproachesApproaches
• No Scientific Evidence to Recommend
– Glucosamine/Chondroitin Sulfate
– Acupuncture
– Green tea
– Grape seed extract
– Tart cherry concentrate
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Treatment SummaryTreatment Summary
• Activity Modification
• Weight Management
• Medications
• Injections
• Alternative Treatments
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Questions??Questions??