• Mark N. Perlmutter, MS, MD

What should you know about Arthritis?

Updated: 2 days ago

Arthritis is the most common disease in the United States which causes pain, disability, and discomfort. About 50 million adults and 300,000 children are suffering from some form of arthritis. Arthritis is indeed a horribly painful disease and it is essential to know what are the things that you can do for arthritis.

What should you know about arthritis? Carolina Regional Orthopaedics

There are several classes of arthritis, but there are two general classes to be specific:

1. Wear & tear arthritis

2. Inflammatory arthritis


Wear & Tear Arthritis:

This is where the bones just grind into each other and it is typically from a ligament that may have torn.


For example: from the picture below, the knee is not seated properly and the leg tilts out a little bit more than it should and it wears out one side more than the other and that often just starts off with effusions (fluid collections) that we can treat with pills or injections, which often wonderfully resolves, but sometimes leads to cartilage tears that we have to arthroscopically fix.

Normal Knee | Varus Knee | Valgus Knee

If someone with arthritis does need surgery and if they get it early enough, an arthroscopic surgery with two little tiny incisions works wonderfully. There is another surgical option available and that is the joint replacement (in this case, knee replacement) and they are really advanced and the modern knee replacement is just amazing.


For example: At Nash, you go home literally the next day of surgery and I have had patients that want to go home that same day, but it was not the same when I was trained where the patients come to the hospital 2 days before the surgery and stay for 2 weeks afterward.

Arthroscopic vs Joint replacement Surgeries | Carolina Regional Orthopaedics

In 2021, knee replacement surgery is very advanced and it is obviously largely, much less painful than it used to be and people do well with it.


Treatment Spectrum

So, the spectrum of treatment is pills, injections, therapy, limited surgery (arthroscopic surgery), and advanced surgery (joint replacements). In my practice and most of the other orthopedic practices in Rocky Mount, I have to say conservative management really prevails.


We all treat people like it is our family and we are not at all interested in rushing you to the operating room, because that is always a treatment of last resort. And, this is the case for wear and tear type arthritis. Let’s now take a look at the other type of arthritis which is inflammatory arthritis.


Inflammatory arthritis

Inflammatory arthritis is basically two different kinds. There is a kind where inflammatory arthritis just evolves into rheumatoid arthritis and that is the classic and most common inflammatory arthritis.


There are other types of arthritis in that class, that are caused by psoriasis, passive propensity for the distal joints of your fingers and base of your thumb, and in some people, it can give little pits in the fingernails and lupus is another one, but rheumatoid arthritis is really the mainstay.


Rheumatoid Arthritis | Carolina Regional Orthopaedics
Rheumatoid Arthritic Hands

Rheumatoid Arthritis Treatments

When you go to a rheumatologist for rheumatoid arthritis, often the rheumatologist will help you keep the swelling and pain out of your body, but if you have a dysfunctional joint, you are really looking at a mechanical problem and mechanical problems have to be fixed mechanically


Mechanical fixes such as functional splinting, which often includes, if not always it includes a smart therapist to partner with, and Rocky Mount is loaded with smart therapists. Chiropractic care also has a strong role in that as well as surgery.


If someone has a torn ligament, reconstructing a ligament is not a hard thing to do with modern technology these days. This is the same for joint replacements as well. The biggest joint in our body is the knee and even that is an easy joint replacement to do these days and hip replacements are even less painful.


So, arthritis runs the gamut and severity whether it is inflammatory arthritis or wear and tear arthritis. I would encourage you to seek attention first with your family doctor. They are impressively “well-armed" intellectually and with their technical skills to manage early arthritis. They might refer to orthopedics if that is not working, but don’t ignore arthritis and don’t live with it.


Should you live with it?

I wouldn’t recommend living with joint pain as there are plenty of things that you can do on your own to help yourself.


For example: Weight loss does have a role in improving, smoking is horrible for your joints so quitting tobacco use is the best for your joints as the nicotine is very harmful to any part of your body, especially the ones with a limited blood flow.


Smoking versus Arthritis

So, if somebody says “I will stop smoking with nicotine patches right after the surgery,” I would say “DON’T!” Because that would not help them at all. It is nicotine - the biggest enemy than tar in terms of arthritis. I recommend them to go for smoking cessation medications such as Wellbutrin, or Chantix, or any other medicine or cold-turkey, but I beg them not to do nicotine patches or nicotine gums.


Surgery is always the last resort

At any rate, non-surgical treatment options should be really exploited first, and there is a new understanding of herbal medicines, which are healthy such as turmeric, omega-3s, ginger, cinnamon, garlic, etc., they all have components in it that to some degree or another help with inflammation. Turmeric has a compound in it that you can even buy from some companies as an isolated compound, but it does help with inflammation and I have patients, who swear by them. Also, I have patients, who say I have just wasted their money recommending that they get it, so it is just an individual thing that varies from person to person.


Role of injections in Arthritis

That just brings us to the last point that there is high variability in how things work and injection may work wonders in somebody and somebody may have actually less disease and it may not work at all. Even though it is also a very individual thing, injections in general, nothing works as good as the 1st one. If your 1st injection works and you hit a home run with it, you could reasonably expect a home run if you had to do the 2nd injection or maybe a triple. But if a triple lasts for 6 months it is great and if it lasts for 6 years and longer, it is much better which is true for some patients.


Takeaway

Finally, what I want to say is, if you have arthritic pain, check with your primary care physician first. There is no need for you to live with pain. I hope this is useful to you to avoid and/or manage arthritis. Now you know what to do when you get to deal with these kinds of problems. Will see you in my next article.


Carolina Regional Orthopaedics

Carolina Regional Orthopaedics provides the most effective, modern, and innovative techniques in both Orthopedic Surgery and Pain Management using proven methodologies in both the surgical and non-surgical treatment of all conditions affecting the spine, upper extremities, and lower extremities. We specialize in hand and wrist surgery, joint replacements, sports medicine, trauma care, pediatric orthopedics, pain management, wound care, regenerative medicine, physical therapy, imaging services, and EMG testing.




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