Hosted by Dr. Mary Owen, University of Minnesota Medical School, Duluth and guests Ana Fernandez, MD, Essentia Health Rheumatology, Addie Vittorio, MD, …

DR. OWEN: GOOD EVENING, AND
WELCOME TO "DOCTORS ON CALL."
I'M DR. MARY OWEN, FACULTY
MEMBER AT THE UNIVERSITY OF
MINNESOTA MEDICAL SCHOOL, DULUTH
CAMPUS, AND FAMILY MEDICINE
PHYSICIAN FOR THE CENTER FOR
AMERICAN INDIAN RESOURCES, FOND
DU LAC BAND OF LAKE SUPERIOR
CHIPPEWA.
I AM YOUR HOST FOR OUR PROGRAM
TONIGHT ON RHEUMATOLOGICAL
DISEASES.
WE WOULD BE HAPPY TO TAKE YOUR
QUESTIONS ON RHEUMATOID
ARTHRITIS, TENDONITIS, GOUT,
OSTEOARTHRITIS, OR ANY OTHER
RHEUMATOLOGICAL QUESTIONS YOU
MIGHT HAVE.
THE SUCCESS OF THIS PROGRAM IS
VERY DEPENDENT ON YOU, THE
VIEWER, SO PLEASE CALL IN OR
EMAIL YOUR QUESTIONS FOR OUR
PANEL OF DOCTORS.
THE TELEPHONE NUMBERS AND EMAIL
ADDRESS CAN BE FOUND AT THE
BOTTOM OF YOUR SCREEN.
OUR PANELISTS THIS EVENING
INCLUDE DR. ANA FERNANDEZ, A
RHEUMATOLOGIST WITH ESSENTIA
HEALTH.
AND DR. ADDIE VITTORIO, A FAMILY
MEDICINE PHYSICIAN WITH ST.
LUKE'S MT ROYAL MEDICAL CLINIC.
OUR MEDICAL STUDENTS ANSWERING
THE PHONES TONIGHT ARE JENNY
FOURNIER OF HERMANTOWN, NEA
MOYER OF RED WING, MINNESOTA,
AND EMILY RIEMER FROM TWO
HARBORS.
AND NOW, ON TO TONIGHT'S PROGRAM
ON RHEUMATOLOGICAL DISEASES.
THANK YOU FOR JOINING US, BOTH
OF YOU.
WE WILL TRY SOMETHING A LITTLE
BIT DIFFERENT, JUST ORIENTED
PEOPLE WHILE WE ARE WAITING FOR
QUESTIONS, WE HAVE A COUPLE OF
SLIDES WE ARE GOING TO SHOW
VIEWERS TO GIVE THEM A BETTER
IDEA OF SOME BACKGROUND OF
ARTHRITIS.
CAN YOU TELL A BUS THIS LED WE
ARE SEEING HERE, — ABOUT THIS
SLIDE WE ARE SEEING HERE, DR.
VITTORIO?
DR. VITTORIO: WE ARE SEEING
BONES WITH CARTILAGE AND A
SYNOVIAL MEMBRANE.
WHAT WE ALSO SEE HIS
OSTEOARTHRITIS.
WE SEE THE BONY ENDS AND
DESTRUCTION OF THIN CARTILAGE IN
THE MIDDLE.
ON THE RIGHT IS RHEUMATOID
ARTHRITIS.
THAT IS A DIFFERENT CONDITION
WHERE THE JOINT'S OVERALL
SWOLLEN AND INFLAMED.
AND WHAT IS IN FLINT IS THE
SYNOVIAL MEMBRANE, WHICH MAKES
SOME OF THE JOINT FLUID.
AND THEN WE SEE THE BOMBS
ACTUALLY BECOME ERODED BECAUSE
OF THIS PROCESS.
DR. OWEN: ANYTHING YOU WANT TO
ADD TO THAT, DR. FERNANDEZ?
DR. FERNANDEZ: WE THINK OF A
STILL ARTHRITIS AS A
DEGENERATIVE TYPE OF ARTHRITIS,
THERE MAY BE RISK FACTORS AS WE
GET OLDER, INJURIES OR TRAUMA
THROUGH THE JOINT.
RHEUMATOID ARTHRITIS IS THE
INFLAMMATION OF THE LINING OF
THE JOINT.
IT CAN BE VERY DESTRUCTIVE.
THERE'S A LOT OF INTEREST IN
ATTACKING THAT VERY EARLY AND
RECOGNIZING IT EARLY TO PREVENT
THAT DAMAGE INSTRUCTION THAT
OCCURS WITH THAT JOINT.
THE RISK FACTORS ARE IMPORTANT,
BECAUSE THEY INCLUDE BEING A
SMOKER OR HAVING FOR DENTAL
CARE.
THOSE ARE TWO THINGS THAT COULD
LOWER INCIDENCE OF
RHEUMATOID ARTHRITIS.
DR. OWEN: CAN YOU TELL US THE
IMPORTANCE OF THIS SLIDE?
DR. FERNANDEZ: THIS IS SHOWING
DIFFERENT AREAS OF JOINTS.
PEOPLE WONDER IF THEY HAVE
ARTHRITIS OR NOT.
IT IS HIGHLIGHTING THE
SHOULDERS, ELBOWS, WRISTS.
IF YOU SEE THE HAND BEING SHOWN
IN THE PICTURE, A LOT OF
RHEUMATOID ARTHRITIS INVOLVED
THE SMALL JOINTS OF THE HAND.
YOU TEND TO SEE A LOT OF
INFLAMMATION OF THE FINGERS AND
THE TIP OF THE FINGERS.
THIS CAN ALSO HIGHLIGHT THE
GENERATIVE — THE DEGENERATIVE
ARTHRITIS WHEN YOU HAVE
DEFORMITY AT THE TIP OF THE
FINGERS.
IT'S IMPORTANT TO SORT OUT WHICH
ARTHRITIS A PERSON HAS.
DR. OWEN: WHY IS IT IMPORTANT?
DR. FERNANDEZ: IF IT IS
RHEUMATOID ARTHRITIS, WE CAN
MAKE A DIFFERENCE IN TERMS OF
MEDICATIONS THAT ARE AVAILABLE
TO DELAY THE DESTRUCTION OF
THOSE JOINTS.
ONCE THE DAMAGE IS DONE, WE
CANNOT REVERSE THAT.
THERE'S A LOT OF MEDICATIONS
AVAILABLE RIGHT NOW THAT WE DID
NOT HAVE EVEN A DECADE OR TWO
AGO THAT REALLY ARE MAKING A BIG
IMPACT ON THE LIVES OF OUR
PATIENTS.
DR. OWEN: DR. VITTORIO,
WELL PATIENTS GET RHEUMATOID
ARTHRITIS?
OR OSTEOARTHRITIS?
IS ONE MORE COMMON IN THE OTHER?
DR. VITTORIO: RHEUMATOID
ARTHRITIS IS THE MOST COMMON
ARTHRITIS.
MANY HAVE AN ENLARGED JOINT OR
NEED A HIP REPLACEMENT BECAUSE
OF THAT DEGENERATION.
THERE ARE CERTAIN FAMILIAL
TRAITS.
YOU MAY END UP WITH BAD
OSTEOARTHRITIS.
BY AND FAR, THAT IS THE MAJORITY
OF THE ARTHRITIS WE SEE IN THE
GENERAL POPULATION.
WE DO STILL SEE PEOPLE DIAGNOSED
WITH RHEUMATOID ARTHRITIS.
BUT THOSE ARE MUCH LESS THAN
10%.
I DON'T KNOW THE EXACT
STATISTIC.
DR. OWEN: ATHLETES OFTEN TIMES
WILL GET SOME FORM OF
OSTEOARTHRITIS, BUT YET, WE KNOW
EXERCISE IS SO GOOD FOR PEOPLE.
SO HOW DO YOU ADVISE YOUR
PATIENTS?
DR. VITTORIO: I THINK THAT
ATHLETES COME AT US WITH A
DIFFICULT TASK.
A LOT OF ATHLETICS, EVEN
MARATHON RUNNING OR OTHER SPORTS
WHERE THEIR RESTROOM ON, LIKE
FOOTBALL, TRAUMA CAN ACTUALLY
DAMAGE FOR THIN THE CARTILAGE
AND PREDISPOSE YOU TO GETTING
OSTEOARTHRITIS SOONER.
THE NATURE OF THE SPORT MAY
CONTRIBUTE, HOWEVER MOST
ATHLETES ARE ACTUALLY FAIRLY
WELL CONDITIONED AND HAVE STRONG
MUSCLES, LIGAMENTS, AND TENDONS.
THEY ACTUALLY, BY THE NATURE OF
WHAT THEY DO, ARE HELPING
PREVENT FURTHER ARTHRITIS.
THERE ARE TWO SIDES OF BEING AN
ATHLETE.
DR. FERNANDEZ: WHAT SHE IS
SAYING IS IMPORTANT.
PATIENTS WITH ARTHRITIS NEED TO
STAY ACTIVE.
WE CANNOT USE IT AS AN EXCUSE
THAT IF WE EXERCISE AND INJURE
OURSELVES, THEN WE ARE NOT GOING
TO STAY ACTIVE.
PEOPLE WITH ARTHRITIS NEED TO
MAINTAIN A RANGE OF MOTION, THEY
DO MUCH BETTER MAINTAINING A
PHYSICAL ACTIVITY OR EXERCISE
ROUTINE.
DR. VITTORIO: OUR PATIENTS WILL
TELL US THAT.
IF I TAKE A LONG CAR RIDE OR SIT
DURING LONG PERIODS OF TIME, MY
JOINTS HURT.
BUT THEN THEY SAY, WHEN I GET UP
AND MOVE AND I AM MORE
PHYSICALLY ACTIVE, I FEEL
BETTER.
DR. OWEN: IT IS HARD TO CONVINCE
PATIENTS, BECAUSE THEY ATTRIBUTE
THEIR PAIN TO MORE ACTIVITIES.
DR. FRIEND, YOU MENTIONED
EARLIER
— DR. FERNANDEZ, YOU MENTIONED
EARLIER THAT SMOKING AND
GINGIVITIS, DENTAL DECAY CAN
MAKE YOU HAVE A HIGHER RISK.
WHAT IS THE BASELINE RISK THAT
IS HIGHER THAN OTHERS FOR
RHEUMATOID ARTHRITIS, RHEUMATOID
DISEASES?
DR. FERNANDEZ: ABOUT 1% OF THE
POPULATION WILL HAVE RHEUMATOID
ARTHRITIS.
SOME OF OUR NATIVE AMERICAN
PEOPLE WILL HAVE A 5% INCIDENCE.
IF YOU HAVE FAMILY MEMBER WHO
HAS RHEUMATOID ARTHRITIS, YOU
MAY HAVE A HIGHER INCIDENCE OF
DEVELOPING IT.
THAT IS WHERE THE RISK OF
SMOKING OR GINGIVITIS COMES IN.
BUT IT IS NOT PERFECT.
BECAUSE YOU CAN HAVE IDENTICAL
TWINS, AND ONE MAY HAVE
RHEUMATOID ARTHRITIS AND THE
OTHER ONE MAY NOT.
THERE APPEAR'S TO BE A GENETIC
AND ENVIRONMENTAL COMPONENT THAT
CAN BE DISPOSED — CAN
PREDISPOSE PEOPLE TO RHEUMATOID
ARTHRITIS.
THERE'S A LOT OF RESEARCH GOING
ON TO IDENTIFY THOSE AT RISK AND
MAYBE TREAT THEM BEFORE IT EVEN
SETS IN.
DR. OWEN: ARE THERE FACTORS
OUTSIDE OF PEOPLE'S CONTROL THAT
CAN MAKE THE DISEASE WORSE?
DR. FERNANDEZ: SOME PEOPLE
COMPLAIN ABOUT CHANGES IN THE
WEATHER MAKING IT HURT, STRESS
TENDS TO AGGRAVATE THINGS, DIET
MAY PLAY A ROLE IN NEVER
— IN AGGRAVATING SOME DISEASES,
LACK OF PHYSICAL ACTIVITY CAN
MAKE THINGS WORSE.
THERE ARE SOME THINGS WE CAN DO
TO HELP OURSELVES, THE GENETICS,
WE CANNOT CONTROL, THAT COMES
FROM OUR FAMILY, SO WE ARE STUCK
WITH THAT ONE.
DR. OWEN: GAYLE OF DULUTH ASKS,
DOES WEARING A KNEE BRACE
HELPS THE WITH STABILITY
AND MANY?
DR. VITTORIO: THAT DESTRUCTION
INHIBITS YOUR ABILITY TO FEEL
WHERE YOU ARE IN SPACE WITH THE
JOINTS.
THERE'S NO RESEARCH OR EVIDENCE
THAT WEARING A KNEE BRACE WILL
HELP YOUR KNEE GET BETTER OR
IMPROVE.
IT MAY HELP YOUR PAIN, BECAUSE
YOU'RE LESS LIKELY TO DO THINGS
THAT WILL HARM YOUR JOINT.
BUT THE OTHER DOWNSIDE OF
WEARING A KNEE BRACE, YOU ARE
NOT EXERCISING THE STABILIZING
FACTORS OF THE KNEE, MUSCLES,
THAT ARE NEEDED FOR EVERYDAY
MOVEMENT, AND IT CAN WEAKEN THE
ACTUAL MOVEMENTS OF YOUR KNEE.
DR. OWEN: VERY IMPORTANT.
DR. FERNANDEZ, CAN YOU TALK
ABOUT WHEN RHEUMATOID ARTHRITIS
AFFECTS OTHER PARTS OF THE BODY,
LIKE THE HEART OR LUNGS?
DR. FERNANDEZ: RHEUMATOID
ARTHRITIS IS CONSIDERED A
SYSTEMIC ILLNESS.
WE RECOGNIZE THAT IN THE JOINTS
FIRST.
IT BRINGS IT TO OUR ATTENTION.
PEOPLE WHO DO NOT TREAT THEIR
RHEUMATOID ARTHRITIS, OR THERE'S
A LOT OF INFORMATION ON GOING,
THEY CAN HAVE INFLAMMATION AND
THEIR EYES, THEY HAVE
INFLAMMATORY DISEASE, THEY CAN
HAVE INFLAMMATION IN THE LINING
OF THEIR LUNGS, THEY CAN HAVE
INFLAMMATION OF THE HEART, THEY
CAN HAVE INFLAMMATION OF THE
SKIN, VASCULITIS.
THIS IS SOMETHING THAT WE USED
TO SEE A LOT WHEN WE DID NOT
HAVE MEDICATIONS THAT WERE
CONTROLLING THE RHEUMATOID
ARTHRITIS.
OUR PATIENTS WERE FAIRLY
WELL-CONTROLLED, THE INCIDENCE
OF THESE FEATURES HAS GONE DOWN
SIGNIFICANTLY.
DR. OWEN: WHEN YOU SAY PEARSON
HAS — A PERSON HAS INFLAMMATION
OF THE HEART, DO YOU MEAN THEY
HAVE A HIGHER CHANCE OF HAVING A
HEART ATTACK?
DR. FERNANDEZ: YES.
PATIENTS WITH AUTOIMMUNE
DISEASES MAY HAVE PREMATURE
HEART DISEASE.
THEY MAYBE YOUNG, THEY MAY HAVE
HAD RHEUMATOID ARTHRITIS IN
THEIR 20'S AND 30'S, AND THEY
HAVE NO RISK FACTORS.
IN THEIR 40'S AND 50'S, THEY MAY
BE HAVING HEART ATTACKS AT A
MUCH EARLIER AGE.
DR. VITTORIO: I THINK THAT IS
ALSO WHY WE LOOK AT RHEUMATOID
ARTHRITIS AS ONE OF THOSE RISK
FACTORS AS PRIMARY CARE DOCTORS
AS WE DO DIABETES AND STRONG
FAMILY HISTORY.
WE TREAT THOSE PATIENTS WITH
ASPIRIN EARLIER ON TO HELP
PREVENT SOME OF THAT.
DR. OWEN: YOU'RE SAYING IN
ADDITION TO THE MEDICINES FOR
RHEUMATOID ARTHRITIS TO REDUCE
THE OVERALL INFLAMMATION NOT
JUST IN THE JOINTS, BUT ALL OVER
THE BODY, AND IF — AND THE
OTHER MEDICATIONS WE USED TO
REDUCE THE CHANCE OF HEART
ATTACKS OR OTHER CHRONIC
DISEASES, HEART PROBLEMS.
THANK YOU.
MORE SPECIFICALLY, DR. VITTORIO,
WHAT CAN BE DONE FOR ARTHRITIS
IN THE FOOT?
DR. VITTORIO: IT IS MORE
DIFFICULT TO TREAT, BECAUSE WE
DON'T REALLY REALIZE HOW MUCH
WEIGHT AND SUPPORT OUR FEET OF
US UNTIL IT STARTS HURTING, THEN
WE FULLY REALIZE THAT.
SOMETIMES, WHEN WE START TO GET
ARTHRITIS IN THE FOOT, IT IS IN
THE BIG JOINT UNDERNEATH THE BIG
TOE.
THAT IS THE MOST COMMON SPOT FOR
ARTHRITIS.
SOMETIMES, PARTICULAR SHOES,
ELEVATING, TREATING WITH TOPICAL
THINGS, ICE CAN HELP, BUT IT'S
REALLY HARD.
OUR FEET IS WHAT WE USED TO MOVE
AT ALL TIMES.
ANOTHER THING IS SEEING A
SURGEON OR PODIATRY TO LOOK AT
THE FUSION OF THOSE JOINTS,
SELENA LONGER MOVE
— SO THEY NO LONGER MOVE.
OR OTHER SURGICAL INTERVENTION.
WE TRY NOT TO DO THOSE THINGS.
DR. OWEN: DID YOU WANT TO ADD
SOMETHING, DR. FERNANDEZ?
DR. FERNANDEZ: THAT IS
EXCELLENT.
SOMETIMES, A CUSHION AND THE
SHOE CAN GIVE SOME BENEFIT,
SHOES THAT ARE WIDER MAY BE MORE
COMFORTABLE.
BE ATTENTIVE TO YOUR WEIGHT, IF
YOU ARE GAINING A LOT OF
WEIGHT,.
— IF YOU ARE GAINING A LOT OF
WEIGHT.
DR. OWEN: WE WANT PEOPLE TO
EXERCISE.
DR. VITTORIO: YOU MAY HAVE TO
THINK ABOUT OTHER TYPES OF
EXERCISE, RUNNING, SWIMMING,
BIKING, THINGS THAT ALLOW YOU TO
MOVE FREELY.
DR. OWEN: DR. FERNANDEZ, PLEASE
TALK ABOUT PSORIASIS, PSORIATIC
ARTHRITIS.
IS IT PERMANENT, OR CAN I MAKE
IT BETTER?
DR. FERNANDEZ: PSORIASIS IS AN
INFLAMMATION OF THE SKIN.
ABOUT 30% OF PATIENTS WHO HAVE
PSORIASIS MAY DEVELOP AN
ARTHRITIS, WHICH IS INFLAMMATORY
ARTHRITIS, NOT LIKE DEGENERATIVE
ARTHRITIS.
IT CAN PRESENT SIMILAR TO
RHEUMATOID ARTHRITIS.
IT CAN PRESENT ONLY IN THE BACK.
IT HAS DIFFERENT WAYS OF
PRESENTING.
THE MEDICATIONS AVAILABLE FOR
PSORIATIC ARTHRITIS CAN BE VERY
EFFECTIVE, JUST LIKE THEY ARE
FOR RHEUMATOID ARTHRITIS.
PEOPLE CAN KEEP BOTH THEIR SKIN
AND JOINTS UNDER CONTROL WITH
THE MEDICATIONS AVAILABLE.
THERE'S HOPE TO KEEP PSORIATIC
ARTHRITIS ALSO UNDER CONTROL.
DR. OWEN: IS IT AS IMPORTANT TO
TREAT VERY EARLY, AS IT IS WITH
RHEUMATOID ARTHRITIS?
DR. FERNANDEZ: ALL INFLAMMATORY
ARTHRITIS, THE ANSWER IS YES.
IF WE ARE ABLE TO CONTROL THEM,
THAN THE DAMAGES PREVENTED OR
DELAYED.
THEY ARE NOT CURES, THESE
MEDICATIONS, BUT THEY SLOW IT
DOWN.
DR. OWEN: WE HAVE TWO QUESTIONS,
HOW CAN YOU TELL IF A FLAREUP IS
AUSTERE ARTHRITIS OR
INFLAMMATORY ARTHRITIS?
DR. VITTORIO: THERE ARE CERTAIN
FEATURES.
AS WE SIGNED THE PICTURES OF
LARGE AND SMALL JOINTS, THERE
ARE DIFFERENT PATTERNS OF
ARTHRITIS THAT FIT WITH
RHEUMATOID ARTHRITIS VERSUS
OSTEOARTHRITIS.
THERE ARE CERTAIN PATTERNS ON
THE HANDS, THE MOST DISTAL ARE
COMMON WITH OSTEOARTHRITIS, BUT
THE CLOSER JOINTS CAN BE COMMON
WITH RHEUMATOID.
WE ALSO LOOK AT THE JOINTS.
IF THEY ARE HOT FEELING OR — OR
RED, WITH SWELLING, WE THINK
THIS COULD BE INFLAMMATORY
ARTHRITIS.
THERE ARE TESTS WE CAN DO IN THE
OFFICE IF WE HAVE A SUSPICION
THIS MAY BE INFLAMMATORY
ARTHRITIS.
WHILE THEY DON'T SORT OF
FORMALLY DIAGNOSE THE DISEASE,
THEY CAN BE USED IN THE
DIAGNOSIS OF THE DISEASE, ONCE
THEY ARE FOUND.
THERE ARE CERTAIN MARKERS IN THE
BLOOD WE CAN FIND.
DR. OWEN: WHAT I HEARD YOU SAY
FOR PATIENTS, IF THEY ARE
WONDERING, IF IT IS ENLARGED, IT
IS RED, OR WARM, IT IS
INFLAMMATORY.
DR. VITTORIO: ANOTHER THING
UNTIL MY PATIENCE IS IF YOUR
ELBOW START SWELLING, OR IF YOU
ONE OF YOUR JOINTS THAT YOU
RARELY USE, THE KNEES TAKE THE
BRUNT OF THE TRAUMA, HIPS,
HAMSTER, BUT THOSE ARE COMMON
JOINTS TO HAVE SWELLING IN.
UNCOMMON JOINTS MAY POINT YOU
TOWARDS AN INFLAMMATORY
ARTHRITIS.
DR. OWEN: DO YOU HAVE ANYTHING
TO ADD TO THAT, DR. FERNANDEZ?
DR. FERNANDEZ: ANOTHER
INTERESTING THING WITH
DEGENERATIVE ARTHRITIS THAT
PEOPLE FIND THAT IF THE REST,
THEY FEEL BETTER.
IF YOU ARE OVERDOING IT, IF YOU
ARE DOING OVERACTIVITY AND YOU
ELEVATE OR ICE OR PUT TOPICAL
RUBS FROM OVER THE COUNTRY, AS
URETHRITIS GETS —
OSTEOARTHRITIS GETS BETTER A LOT
QUICKER.
WITH RHEUMATOID ARTHRITIS, IT IS
VERY PAINFUL AND IT IS HARD FOR
US TO UNDERSTAND WHY IT IS SO
PAINFUL WHEN I
JUST GOT OUT OF BED.
DR. OWEN: MY PATIENCE WILL TELL
ME THAT THEY HAVE COMFORT FROM
STICKING THEIR HANDS IN THE WARM
WATER FIRST THING.
DR. FERNANDEZ, WE HAVE A
QUESTION HERE.
CAN YOU TALK ABOUT RHEUMATICA
AND THE TEST TO DIAGNOSE IT?
DR. FERNANDEZ: PEOPLE COMPLAIN A
LOT ABOUT MUSCLE PAIN IN THE
SHOULDER AREA AND HIP AREA.
IT IS IN PEOPLE THAT ARE
ELDERLY, SO USUALLY WE SEE IT IN
OUR 60-70-YEAR-OLDS.
WE SEE A LOT OF PEOPLE FROM
EASTERN EUROPEAN DESCENT WHO
DEVELOPED IT.
THERE IS NO SPECIFIC TEST, BUT
WE CHECK A SEDIMENTATION RATE,
THE BLOOD TEST THAT MEASURES
INFLAMMATION IN OUR SYSTEM.
WITH THE RIGHT QUESTIONS AND THE
RIGHT ANSWERS, PATIENTS
RESPOND REALLY WELL TO LOW DOSES
OF PREDNISONE.
IT IS KIND OF LIKE A MIRACLE.
THE NEXT THEY FEEL THEY ARE BACK
TO NORMAL.
THERE IS A PATTERN OF
PRESENTATION.
THE SEDIMENTATION RATE IS A
BLOOD TEST THAT IS DONE IN ALL
OF OUR LABS.
IT MEASURES INFLAMMATION IN OUR
SYSTEM.
THE CATCH IS THAT IT DOES NOT
TELL YOU WHERE THE INFLAMMATION
IS COMING FROM OR WHAT IS
CAUSING THE INFLAMMATION.
IT IS JUST — IT JUST ALLOWS US
AS PHYSICIANS TO SAY, WE NEED TO
LOOK INTO SOMETHING, OR FURTHER
INVESTIGATE.
DR. OWEN: YOU CAN HAVE A HIGH
SED RATE ON THE PATIENT, BUT IT
DOES NOT NECESSARILY MEAN IT IS
EDUCATED TO THAT.
DR. FERNANDEZ: BECAUSE IT CAN BE
SEEN AN INFECTION, A HIGH SED
RATE CAN BE SEEN AS WE GET
OLDER, HEAVIER, IF WE HAVE
ANEMIA — THERE'S A LOT OF
DIFFERENT THINGS THAT CAN CAUSE
A HIGH SEDIMENTATION RATE, BUT
IN THE RIGHT CLINICAL SETTING,
IT MAY POINT US TOWARD
RHEUMATICA.
DR. OWEN: BESIDES SEDIMENTATION
RATE, THEY TALK ABOUT ANOTHER
TEST.
DR. FERNANDEZ: IT MAY HAVE LESS
VARIABILITY THAN THE SED RATE,
BECAUSE IT IS NOT AFFECTED BY
HEMOGLOBIN.
WE SOMETIMES USE BOTH OF THE
TESTS TO SEE OF THE PERSON HAS
INFLAMMATION IN THEIR SYSTEM.
DR. VITTORIO: THAT TEST CAN ALSO
BE CONNECTED TO INFECTION.
DR. OWEN: SO THERE'S MORE THAN
ONE EXPLANATION TO ONE A TEST IS
HIGH.
THANK YOU.
DR. VITTORIO,
WILL YOUR FINGERS TWIST AND
DEFORM WITH OSTEOARTHRITIS?
DR. VITTORIO: THE INTERESTING
THING IS, YES, IF YOU GET AN OUT
— IF YOU GET ENOUGH
OSTEOARTHRITIS AND THE TENDONS
START SLIPPING OVER THE ENLARGED
JOINTS, YOU CAN GET SOME
DEFORMITIES OF YOUR HANDS AND
FINGERS WITH OSTEOARTHRITIS.
WHEN WE DO SEE THEM WITH
RHEUMATOID ARTHRITIS, ONE IS A
SWAN NECK DEFORMITY.
OR DIGITS WILL GO ALL OUT TOWARD
THE SIDE OF THE PINKIES IN A
PARTICULAR PATTERN.
YOU CAN GET SOME DEFORMITIES
WITH OSTEOARTHRITIS.
THERE ARE MORE DEFORMITIES IN
ADVANCED RHEUMATOID ARTHRITIS.
DR. OWEN: THANK YOU.
DR. FERNANDEZ, DO YOU HAVE ANY
OPINIONS ON TREATMENT FOR
SPONDYLITIS — ANKYLOSING
SPONDYLITIS?
DR. FERNANDEZ: IT IS AN
ARTHRITIS THAT CAUSES FUSION OF
THE JOINTS AND THE SPINE.
PATIENTS TEND TO BE REALLY
RIGID.
IT STARTS WITH MEN USUALLY, IN
THEIR 20'S AND 30'S.
IT IS AN ARTHRITIS THAT THEY GET
UP IN THE MORNING AND THEY
CANNOT MOVE AND ARE BETTER OFF
EXERCISING.
THEY CAN HAVE INFLAMMATION IN
THE EYE, ASSOCIATION WITH
PSORIASIS, INFLAMMATION IN THE
BOWEL.
THE TREATMENT FOR ANKYLOSING
SPONDYLITIS DEPENDS ON WHAT IS
BEING AFFECTED.
WE USE ANTI-INFLAMMATORY
MEDICATIONS, LIKE IBUPROFEN,
NAPROXEN, ANTI-INFLAMMATORY
MEDS.
IF YOU ARE HAVING INFLAMMATION
OF THE PERIPHERAL JOINTS, THOSE
IMAGES WE SAW AT THE VERY
BEGINNING, THE REST, THE KNEE,
THE HIP, — THE WRIST, THE KNEE,
HIP, THERE ARE MEDICATIONS WE
CAN USE.
BUT WITH INFLAMMATION
OF THE SPINE OR SACROILIAC
JOINTS, WITH SACROILIAC IS, THEY
NEED MEDICATIONS KNOWN AS
BIOLOGIC THERAPY.
THERE IS A WHOLE VARIETY OF
MEDICATIONS THAT CAN BE USED
DEPENDING ON WHAT IS BEING
AFFECTED WITH AN QS LOSING
SPONDYLITIS.
— AND YOU LOSING SPONDYLITIS.
— AND TO LOSING SPONDYLITIS
— ANKYLOSING SPONDYLITIS.
DR. OWEN: HIS TRIGGER FINGER
RELATED TO AUSTIN ARTHRITIS —
OSTEOARTHRITIS?
DR. VITTORIO: YES, BUT IT IS
ATTRIBUTED TO THE SHEATH OF THE
TENDONS UNDER THE HANDS.
THE FINGER GETS STUCK IN CERTAIN
POSITIONS, AND IT IS NOT
NECESSARILY A JOINT ISSUE, BUT
MORE OF A TENDON ISSUE
THAT CAN CAUSE THAT TO OCCUR.
DR. OWEN: OKAY.
WE HAVE A SIMILAR QUESTION.
DR. FERNANDEZ, I WAS DIAGNOSED
WITH ERODING ARTHRITIS.
HOW IS THIS DIFFERENT THAN
ARTHRITIS?
THEY ARE LOOKING AT THE TERM "ER
ODING."
DR. FERNANDEZ: IT DEPENDS.
OSTEOARTHRITIS IS THE
GENERATIVE, BUT THERE IS A SMALL
SUBSET OF PEOPLE WHO DEVELOP
OSTEOARTHRITIS THAT CAN BE
INFLAMMATORY OSTEOARTHRITIS AND
THEY CAN HAVE TYPICAL FINDINGS
WE SEE ON IT TO RAISE.
— ON X-RAYS.
WITH EROSION, WE ARE THINKING OF
MORE OF AN AGGRESSIVE
INFLAMMATORY ARTHRITIS, LIKE
PSORIATIC OR RHEUMATOID
ARTHRITIS.
IT DEPENDS ON WHAT THE FINDINGS
ARE ON PHYSICAL EXAMS.
DR. OWEN: OKAY.
IF YOU HAVE HAD A DOUBLE KNEE
REPLACEMENT AND ARE STILL IN
PAIN 20 47, — 24/7, SHOULD YOU
SEE A DOCTOR OR GET IT REDONE?
DR. VITTORIO: YOU SHOULD GET
THINGS TO THAT WITH A DOCTOR,
BECAUSE IT MAY OR MAY NOT BE
RELATED TO YOUR ANY.
WE FIX THE JOINT AND CONTINUE TO
HAVE PAIN, YOU MIGHT HAVE TO
LOOK BELOW FOR PROBLEMS, BUT
YOUR PHYSICIAN MIGHT HAVE TO DO
AN EVALUATION AND SAY SOMETHING
IS GOING ON, YOU SHOULD FOLLOW
UP WITH YOUR SURGEON TO SEE WHAT
ELSE MAY BE GOING ON.
WHEN WE DO A NIECE REPLACEMENT
AND WE DO SEE WE HAVE TO GO BACK
— SOMETIMES WE DO A KNEE
REPLACEMENT AND WE DO SEE WE
HAVE TO GO BACK AND DO ANOTHER
KNEE REPLACEMENT LATER RUN.
DR. FERNANDEZ: THERE'S
LIGAMENTS, TENDONS THAT CAN BE
IRRITATED THAT CAN ALSO
CONTRIBUTE TO THE PAIN.
DR. OWEN: YOU DON'T ALWAYS NEED
A JOINT REPLACEMENT.
ANOTHER REASON TO SEE HER
DOCTOR.
DR. VITTORIO: A LOT OF TIMES, WE
RECOMMEND P.T. AND PEOPLE GET
BETTER WITH PHYSICAL THERAPY TO
STIMULATE THE MUSCLES AROUND THE
AREA.
DR. OWEN: DR. FERNANDEZ, WE HAVE
TALKED A LOT ABOUT OSTEOPATH
RHEUMATOID ARTHRITIS, BUT WHAT
IS BURSITIS AND TENDINITIS?
DR. FERNANDEZ: BURSITIS IS A
SMALL SACK THAT WE HAVE IN A LOT
OF AREAS OF OUR BODIES, THESE
JOINTS THAT ALLOW THINGS TO MOVE
OVER EACH OTHER WITH EASE.
SO THE TENDONS AND JOINTS ALLOW
THINGS TO MOVE SMOOTHLY.
BUT THEY CAN GET IRRITATED IF
YOU HAVE ARTHRITIS OR IF YOU
OVER DID IT.
THEY CAN SWELL UP.
THE COMMON ONES WE TEND TO SEE
OCCUR AT THE ELBOW.
THEY HAVE THESE GOLF BALL
SIZES OF ELBOWS.
BURSAS ARE VERY COMMON, WHEN
THEY GET INFLAMED, WE CALL IT
BURSITIS.
DR. OWEN: EXCELLENCE.
HOW DO YOU TREAT THAT?
DR. FERNANDEZ: DIFFERENT THINGS.
ICE TENDS TO WORK, HEAT,
LIDOCAINE.
GENTLE STRETCHES, SOMETIMES WHEN
IT IS UNCOMFORTABLE, PEOPLE
RESPOND TO CORTISONE INJECTIONS
AND PHYSICAL THERAPY.
DR. OWEN: DO YOU HAVE TO GO TO A
RHEUMATOLOGIST TO GET THOSE
STEROID INJECTIONS?
DR. VITTORIO: YOU DO NOT.
THERE ARE VARIOUS STEPS OF
DOCTORS THAT WILL DO A
CORTICOSTEROID INJECTION.
MOST PRIMARY CARE DOCTORS ARE
TRAINED TO DO THAT.
YOU'LL HAVE TO ASK YOUR
PROTECTION ARE.
THERE HAS TO BE REASON.
WE WANT PEOPLE ACTIVELY
WORKING WITH THERAPY AND WORKING
ON IMPROVING THEIR STRENGTHS AND
MOBILITY AT THE SAME TIME.
JOINT INJECTIONS DO NOT
NECESSARILY SOLVE THE ISSUE.
THERE HAS BEEN MORE RECENT ISSUE
REGARDING THE RISK OF REPEATED
STEROID INJECTIONS.
JOINT INJECTIONS REALLY TREAT
THE ACUTE PAIN AND SWELLING
ASSOCIATED WITH AN INFLAMED
JOINT.
THAT MAY ALLOW YOU TO BE MORE
ACTIVE AND STRENGTHEN YOUR
MUSCLES AND LIGAMENTS SO YOU
FEEL BETTER, BUT IT DOES NOT
CURE OR TREAT THE ACTUAL
ARTHRITIS.
DR. OWEN: SOMETIMES AS WE ARE
GETTING READY OR STARTED ON SOME
OF THE ANTI-INFLAMMATORY DRUGS
FOR THE LONGER RHEUMATOID
ARTHRITIS, WE MAY GET STARTED ON
STEROIDS OR IBUPROFEN.
CAN WE SPEAK TO THAT
— CAN YOU SPEAK TO THAT?
SHOULD PEOPLE BE ON STEROIDS
FOREVER?
DR. FERNANDEZ: THE GOAL IS THAT
WE DO NOT KEEP PEOPLE ON
PREDNISONE FOREVER.
WITH PSORIATIC AND RHEUMATOID
ARTHRITIS, WE USE PREDNISONE AS
A BRIDGE, TO WAIT UNTIL
MEDICATIONS KICK IN, BECAUSE IT
MAKE TAKE — MAY TAKE FOUR-SIX
WEEKS TO TAKE IN — TO KICK
IN.
WE SEE THAT OVERTIME.
DR. VITTORIO: —
DR. VITTORIO: WE SEE THAT
OVERTIME, IT IS NOT A GOOD THING
REGARDING TO SOME SIDE EFFECTS,
THE LINING OF THE STOMACH, THERE
ARE SOME PSYCHIATRIC SIDE
EFFECTS, SOME INSOMNIA.
DR. OWEN: SHORT-TERM YES,
LONG-TERM, NO.
THANK YOU BOTH.
WE HAVE SOME HELPFUL WEBSITES TO
SHARE, IF YOU WANT TO LEARN MORE
ABOUT ARTHRITIS, VISIT
ARTHRITIS.ORG AND
RHEUMATOLOGY.ORG FOR MORE
INFORMATION.
I WANT TO THANK OUR PANELISTS,
DR. ANA FERNANDEZ AND DR. ADDIE
VITTORIO, AND OUR MEDICAL
STUDENT PHONE VOLUNTEERS, JENNY
FOURNIER, NEA MOYER, AND EMILY
RIEMER.
PLEASE JOIN DR. SANDY STOVER
NEXT WEEK FOR A PROGRAM ON LOWER
GI PROBLEMS, WHEN HER PANELISTS
WILL BE DR. JON REICH AND DR.
KEN RIPP.
THANK YOU FOR WATCHING.

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