Presentation on theme: "HealthPartners Medical Group"— Presentation transcript:
1HealthPartners Medical Group Arthritis 101Kenneth D. Kleist, M.D.HealthPartners Medical GroupRegions HospitalSt. Paul, MNIntroduce yourself and the plan or plans available to the members. Let members know that you are happy to answer their questions.
2The Key Players Orthopaedic Surgeon The expert in the musculoskeletal systemDiagnoseTreatMedicationPhysical TherapyExerciseBraceSurgeryPreventPhysician AssistantPrimary Care Sports Medicine PhysicianPhysical Therapist
3Arthritis—Background Arthritis is the second most common chronic condition in the US (sinusitis is first)Most common among elderlyArthritis affects over 20 million people in the US76 million by 2030Leading cause of disability in people > 65 yoTotal costs associated with arthritis are over $82B/year, including hospital and drug costs, nursing home costs, and lost productivity and work
4Synovial Joints Fibrous capsule Bone Synovial membrane Joint space filled with synovial fluidArticular cartilageTo understand osteoarthritis, it is helpful to first look at a joint and understand how it works. A joint is the place where the ends of two or more bones meet. These bone ends of the joint are covered with a smooth material called cartilage. Cartilage cushions bone and allows your joints to move smoothly and without pain. The synovium is a fibrous envelope that encloses the joint and produces fluid that helps reduce the friction and wear on that joint. Ligaments connect bones and keep your joints stable. Finally, muscles and tendons power your joints and allow them to move.
5There are two general types of arthritis Osteoarthritis: By far the most common“Garden Variety” or “wear and tear”Caused by the breakdown of cartilageRemainder of the talk will focus hereRheumatoid Arthritis and related diseases:These involve not only the joints but other organs like skin, tissues, eyes, and blood vesselsImmune system attacks the tissues of the joint
6Osteoarthritis (Inflammation of Joints) PainLoss ofMotionAvoidanceofMotionArthritis is, simply put, inflammation of the joints. Inflammation is one of our bodies’ normal reactions to injury or disease. Inflammation in turn results in visible swelling, pain, and stiffness, because as the joint becomes painful, the individual avoids moving it, which causes the muscles to tighten, making it harder to use that joint. This results in more pain.Usually this inflammation is temporary. But in an arthritic joint it may cause long-lasting and sometimes permanent disability. Osteoarthritis is a particular type of arthritis which affects the cartilage in the joints, causing it to break down and eventually be lost altogether.IncreasedMuscleTightness
7What does arthritis look like Arthritic Knee X-RayNormal Knee X-Ray
8Diagnosis: History Symptoms Pain in affected joints Pain worse with prolonged overusePain better with rest and exerciseStiffness relieved by flexingUnlike other systemic forms of arthritis, osteoarthritis does not affect the other organs of the body. Symptoms vary greatly from patient to patient, but the most common early symptom is pain in the affected joint or joints. This pain gets worse with prolonged overuse and is relieved by rest and moderate exercise. In addition to pain, many osteoarthritis sufferers experience a stiffness that is relieved by flexing the joint a few times. This stiffness, called gelling, is generally most pronounced first thing in the morning.
9Diagnosis Physical exam X-rays Blood test to rule out other diseases The effects of osteoarthritis can be fairly significant, but with proper treatment, we can get you back into the game, living your life to the fullest. Your orthopaedic surgeon will use a combination of an evaluation of your symptoms, a physical examination, and x-rays to make an arthritis diagnosis. Your physician will likely also order a blood test, to rule out other forms of arthritis as well as other ailments that could be causing your symptoms.
10Treatment: Non-operative Activity modificationAvoid painful activitiesLow impact exerciseDecreases painImproves flexibilityImproves joint nutritionPhysical TherapyCane or other assistive device
11Treatment: Non-operative Weight ControlMaintain current weight or lose weight10 lbs of weight loss30-50 lbs less weight on your hips and kneesHeat/Cold – Both Can be effective
12Treatment: Medication Acetaminophen – Pain control (Tylenol)NSAIDs – Pain and inflammationStandardIbuprofen, naproxen, piroxicamCox-2CelecoxibUltram – Non-narcotic, addiction potentialMild NarcoticsNot recommended except short term
13Treatment: Injection Corticosteroids (Cortisone) Injection Anti-inflammatory placed into the jointTemporary pain reliefTemporary swelling improvementDoes not change the arthritisLimited number per yearBlood sugar elevation in diabetes
14Treatment: Injection Hyaluronic Acid Injections (knee only) A series of 3 – 5 injectionsMuch more costly than steroidsMay last longer than steroidsNo one knows exactly how they workMay increase lubricationMay soothe the nerve endingsMay have anti-inflammatory effect
15Treatment: Alternative Approaches No Scientific Evidence to RecommendGlucosamine/Chondroitin SulfateAcupunctureGreen teaGrape seed extractTart cherry concentrate