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Dr. Robert Durbin addresses arthritis basics in Columbus CEO Magazine
Arthritis: Though diagnoses are on the rise, more advanced treatments are helping patients battle the pain.
By: Tami Kamin-Meyer
It can be mild enough to cause only an annoying stiffness in joints, or severe enough to gnarl a person's fingers and leave her disabled. According to the Centers for Disease Control and Prevention, one in five American adults suffers from some form of arthritis. Right now, that's about 50 million people. But as the nation's population ages, an estimated 67 million adults could suffer from the painful disease by 2030--assuming risk factors, such as obesity and heredity, remain at current levels.
Arthritis is the umbrella under which more than 100 different rheumatic diseases, including fibromyalgia, gout and lupus, are grouped. These conditions mainly affect joints, but lupus is an autoimmune disease that also affects organs; unchecked, it can even lead to death.
Osteoarthritis and rheumatoid arthritis are the two most common--and familiar--types, though the former is the most prevalent. "Nearly 21 million Americans in the United States have osteoarthritis," says Dr. Joseph Ruane, medical director of the Spine, Sport & Joint Center at the McConnell Heart Health Center.
Osteoarthritis is a degenerative disease, while rheumatoid arthritis is a systemic inflammatory disease that can damage cartilage and bones. "That could lead to [the need for] for joint replacement," says Dr. Seth Kantor, a rheumatologist with the Grant Arthritis & Osteoporosis Center.
While the number of Americans diagnosed with some form of arthritis is on the rise, the good news is that treatments for the disease are improving, says Dr. Tom Ellis, vice chair of the Department of Orthopaedics at the Ohio State University Medical Center and an associate professor in the College of Medicine. Treatments for osteoarthritis, in particular, can be "ridiculously successful," says Ellis, an orthopedic surgeon who specializes in treating patients under age 50.
The ABCs of Arthritis
The main symptoms of arthritis are joint pain and stiffness. Osteoarthritis sufferers experience a wearing away of the cartilage that caps joint bones. Rheumatoid arthritis, on the other hand, results from a person's immune system attacking joints and causing inflammation in the joint lining.
Physicians say people experiencing symptoms of arthritis should see their doctor as early as possible. In addition to evaluating a patient's symptoms and medical history, doctors commonly order an x-ray to confirm a diagnosis. Blood tests also may be used for patients suspected to have rheumatoid arthritis.
Thanks to medical advances, an arthritis diagnosis doesn't relegate sufferers to a painful, sedentary lifestyle. With proper diagnosis and care, Ellis says, "It's possible for people to regain quality of life and function in the body part affected."
Ruane says an early and accurate diagnosis is key to counteracting the effects of arthritis. "It's better to treat arthritis early because there is a lot that can be done, short of surgery, if a diagnosis is done early," he says. Like many doctors, Ruane favors treatments such as physical therapy, warm-water exercise, medications and joint injections as alternatives to surgery.
Early diagnosis also is key to effectively managing rheumatoid arthritis, says Kantor. The sooner it is discovered and treated, the less likely it is that a patient will suffer the disease's more debilitating effects, including chronic pain and joint deformities, which-in the most severe cases-can leave a patient disabled.
Still, those diagnosed shouldn't despair. Kantor says rheumatoid arthritis is a "totally different disease than it used to be." Medications, both over-the-counter and prescribed, have advanced markedly. Kantor says symptoms often can be managed with one of several categories of medicine, from nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen to so-called biologics (genetically modified drugs that suppress the immune system, sold under brand names such as Enbrel and Humira).
While arthritis "never goes away," its effects can be minimized, says Dr. Robert Durbin, an orthopedic surgeon and partner with The Cardinal Orthopaedic Institute.
There are a variety of risk factors for osteoarthritis, including family history, age, injuring a joint, repetitive motion and--especially--obesity.
"It is unbelievable how extra weight contributes to arthritis. I see patients every day who are 100 to 150 pounds overweight. That puts so much stress and weight on the joints," says Durbin. An ever-increasing number of younger people are developing arthritis because they are "grossly overweight," he says.
In 2010, Durbin says he performed about 250 knee, hip and shoulder replacement surgeries, with knees leading the pack. He says the numbers are increasing, partly due to people being overweight.
Ellis, who limits his practice to treating arthritis of the hip, says additional weight can be particularly troublesome on those joints. "The country's obesity is leading to more and more arthritis," he says.
The good news is that losing weight can have a positive impact. "Because of the mechanics of the hip, for every pound you lose, it takes three pounds of force off the hip," says Durbin.
Predicting rheumatoid arthritis, however, isn't so clear-cut. While there is no known cause, a family history of the disease increases a person's risk. Rheumatoid arthritis occurs far more commonly in women than men, and is most often diagnosed in middle age, though there is a juvenile form of the disease. "There's not really anything known to prevent [rheumatoid arthritis]," says Kantor.
People with rheumatoid arthritis often have osteoporosis, and run a greater risk of developing heart disease, Kantor says. The chronic inflammation characterizing rheumatoid arthritis is believed to be systemic, meaning coronary arteries also can become inflamed, he explains. However, with proper care, rheumatoid arthritis can be put into remission. "It's not cured, but in remission," says Kantor.
A variety of treatments may bring arthritis sufferers relief beyond that afforded by medication. Their success in diminishing the pain and discomfort associated with the disease depends on several factors, including:
•A patient's age •The type, severity and joints affected by arthritis •Level of mobility and activity prior to the disease's onset •The climate where the patient lives •The patient's physical condition Treatments may include exercise, physical and occupational therapy, applying heat or ice, acupuncture, use of assistive devices (such as shoe inserts, canes and walkers) or joint injections.
Injected steroids, such as cortisone, or so-called lubrication shots can combat the discomfort brought on by the disease. Ruane says localized cortisone shots can provide relief, but generally only in the disease's early stages. "As the arthritis advances, cortisone becomes less effective," he says. Because each patient responds differently, it's impossible to predict how long cortisone treatments will last.
Viscosupplementation, another type of injection, was introduced to the United States in 1998. Sometimes called lubrication shots, the treatments consist of a substance that's similar to joint fluid. Ruane describes it as a "thick gel injected into the knee to lubricate it and offer pain relief. It can last six months or more, but is currently approved for arthritis of the knee only," he says.
The best candidates for either cortisone or lubrication shots are those who either can't or don't want to take pills to combat their discomfort, or people with heart conditions, high blood pressure and certain kidney problems. "They can't take arthritis medications," Ruane says.
Surgery, generally to repair, fuse or replace joints, is another treatment option. While the term "minimally invasive" has come into vogue, Ellis says it's "almost a misnomer. Most surgeons make smaller incisions than they used to [in conventional surgeries], but ‘minimally invasive' sounds more palatable," he says.
Incision size actually doesn't vary much between a conventional and a minimally invasive operation, Ellis says. Instead, accompanying factors play a substantial role in reducing a patient's post-surgery discomfort and recovery. For example, he says, improved pain management practices, more advanced physical therapies and more knowledgeable patients all contribute to improved outcomes.
Tremendous advancements in replacement joints also contribute to the increasing success of those surgeries, says Ellis. "They last longer," he says. Knee replacements in use today last six times longer than their predecessors, Ellis says, while shoulder replacements generally last twice as long.
Living with Arthritis
Ron and Mae Rooker of Whitehall have been married for 52 years. They've raised four children and enjoy their nine grandchildren. They also share something not nearly as satisfying: osteoarthritis.
After the kids were grown, Mae, 70, worked as a seasonal receptionist for H&R Block. But her final tax season was five years ago because the job became too difficult. "I stood a lot," she says.
Just over two years ago, Mae was diagnosed with arthritis in her knees. Her doctor ordered an x-ray after she complained about excessive discomfort. The pain is worse in her left knee, which she says is "bone on bone." About 30 years ago, Mae was diagnosed with arthritis in her neck, and she suffers from back pain, too. The pain was so intense that she went to a specialist 10 years ago to find out whether she had rheumatoid arthritis (she didn't).
Determined to stave off knee replacement surgery for as long as possible, Mae takes anti-inflammatory medicines as needed. A little more than a year ago, she got cortisone shots in each of her knees, which alleviated much of her discomfort. She's now considering undergoing another round of injections.
At the recommendation of her physician, Mae began participating in warm-water exercise classes twice a week in January 2010. "I really think it's good. I move so much better afterwards. I was struggling to walk, but then after, I can move," she says.
Arthritis runs in Mae's family. Her mother had it, and her sister suffers from rheumatoid arthritis. "Just about everyone I know has some form of arthritis," she says. She wishes she would have done more to prevent the onset of the disease by being more active when she was younger. She advises others to "take care of their body. And take vitamins."
Husband Ron, a retired air traffic controller, was diagnosed with arthritis by Durbin about a decade ago. "My knees started to hurt and my knuckles grew larger and crooked," Ron recalls.
The couple laments that arthritis has rendered them unable to square dance, an activity they enjoyed participating in together. "We used to cut the rug," says Mae.
But dancing isn't the only activity the Rookers miss. "It's affected our sex life quite a bit because it hurts my knees," says Ron.
An avid golfer, the 76-year-old is waiting for golf season to see if he needs to undergo another round of cortisone shots. He has grudgingly accepted the fact that he has to use a golf cart rather than walking the course as he used to. He also participates in the warm-water exercise classes with his wife, but with a caveat: "I don't do it if it interferes with golf," he says.
Tami Kamin-Meyer is a freelance writer.
Reprinted from the March 2011 issue of Columbus C.E.O. Copyright © Columbus C.E.O.