1. HealthPartners Medical Group
Arthritis 101
Kenneth D. Kleist, M.D.
HealthPartners Medical Group
Regions Hospital
St. Paul, MN
Introduce yourself and the plan or plans available to the members. Let members know that you are happy to answer their questions.

2. The 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

3. Arthritis—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

4. Synovial Joints Fibrous capsule Bone Synovial membrane
Joint space filled with synovial fluid
Articular cartilage
To 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.

5. There are two general types of arthritis
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

6. Osteoarthritis (Inflammation of Joints)
Pain
Loss of
Motion
Avoidance of
Motion
Arthritis 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.
Increased
Muscle
Tightness

7. What does arthritis look like
Arthritic Knee X-Ray
Normal Knee X-Ray

8. Diagnosis: History Symptoms Pain in affected joints
Pain worse with prolonged overuse
Pain better with rest and exercise
Stiffness relieved by flexing
Unlike 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.

9. Diagnosis 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.

10. Treatment: Non-operative
Activity modification
Avoid painful activities
Low impact exercise
Decreases pain
Improves flexibility
Improves joint nutrition
Physical Therapy
Cane or other assistive device

11. Treatment: 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

12. Treatment: 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

13. Treatment: 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

14. Treatment: 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

15. Treatment: Alternative Approaches
No Scientific Evidence to Recommend
Glucosamine/Chondroitin Sulfate
Acupuncture
Green tea
Grape seed extract
Tart cherry concentrate

16. Treatment Summary Activity Modification Weight Management Medications
Injections
Alternative Treatments

17. Questions??