Guest: Dr. Gary Gilkeson – Rheumatology &
Host: Dr. Linda Austin – Psychiatry
Linda Austin: I’m Dr. Linda Austin. I’m talking with Dr. Gary Gilkeson, who is
Professor of medicine in Rheumatology here at the Medical University of South
Carolina. Dr. Gilkeson, in another
podcast we talked about rheumatoid arthritis, but an even more common form of
arthritis is osteoarthritis. What,
exactly, is osteoarthritis?
Gary Gilkeson: Osteoarthritis is a
disease of the joint, where the simplest way to think about it is, on the ends
of each of our bones is a protective cap, called cartilage, and in
osteoarthritis, that cartilage wears out over time, such that you end up with
bone rubbing on bone in your joints where the bones come together. And, that, basically, is osteoarthritis. It’s not quite that simple. We used to think that there was no
inflammation or no kind of immune reactivity going on in the joint in
osteoarthritis, but we know that’s not true at this point in time. There is quite a bit of inflammation. But, still, the primary defect is that the
cartilage that protects the bones has been deteriorated and is gone.
Linda Austin: It seems as if that’s an
awfully common problem. Does anybody not
get osteoarthritis, if they live long enough?
Gary Gilkeson: We always say, if you
live long enough, probably, eventually, you will get it, but it’s highly
variable. There are individuals that get
osteoarthritis in their 30s, whereas there are other individuals that are in
their 90s that do not have osteoarthritis.
And we believe that’s based on genetics.
Some people’s cartilage is just stronger than other people’s, so it
doesn’t wear out as fast.
trauma, we all hear about the football players that have had their knees ripped
up and then develop early osteoarthritis.
And that’s because any kind of trauma, any kind of repetitive trauma,
like pile driving, or whatever, will lead to early deterioration of the
cartilage and lead to early osteoarthritis that way.
Linda Austin: How about repetitive
sports, like long distance running, is that a risk?
Gary Gilkeson: Long distance running,
there hasn’t been an association of things like marathoners with
osteoarthritis, probably because they are almost all thin and they don’t have
the weight. Probably, the primary
problem that leads to osteoarthritis is obesity and the added weight that you
have. Once you have osteoarthritis,
then, if you run with repetitive trauma, it’s going to make it worse. But, if you don’t have it, then running does
not appear to make it come more quickly.
Linda Austin: So, it sounds like keeping
your body as light as possible, not gaining weight, is an important thing you
can do to prevent it. Any dietary
recommendations that will prevent osteoarthritis? There are so many supplements that make a lot
of big claims in this area.
Gary Gilkeson: We’re not aware of
any. There are no studies that show that
you can prevent osteoarthritis by taking these supplements, the glucosamine or
the chondroitin, which are the primary ones that you see out there. However, once you have osteoarthritis, it’s
controversial, some studies suggest that they are beneficial. Some studies
suggest they aren’t beneficial. So, the
jury is kind of out in that area. But
there’s not any supplement that you can take ahead of time, that we know of,
that, other than just maintaining a normal diet, maintaining good calcium and
vitamin D intake, that would prevent it.
Linda Austin: So, would you, personally,
take any of these supplements if you had significant osteoarthritis?
Gary Gilkeson: At this point in time, I
probably would not. However, I don’t
discourage my patients from taking them if that’s something that they want to
do. We don’t have any evidence that
there is harm in doing it. However,
because there is controversy as to whether they actually help or not, it’s hard
to fully recommend them until we know for sure.
Linda Austin: What are some of the ways
that you help your patients who have osteoarthritis?
Gary Gilkeson: One of the key points to
get across is that there is a lot you can do for osteoarthritis. There’s kind of a common misconception that,
you know, osteoarthritis is inevitable, there’s nothing I can do about it,
there’s no reason to seek medical care for it, and that is not the case. Common sense things are that you should lose
weight, as much as you can. The more
weight you have, the worse the arthritis is going to get. You also want to maintain good muscle tone
around the joints. If your knees are
bothering you, then you want to strengthen the big muscles of your legs in
order to protect the joint. So, those
are the kind of common sense things. And
you can do that without impact exercise, doing things like bicycling or
straight leg raise exercises or water aerobics are some of the things that you
can do. And then, you know, different
heats, heat applications, physical therapy techniques are useful as well.
Linda Austin: Can this become a
Gary Gilkeson: It can become a crippling
problem. There haven’t been any advances
that have been made in joint replacement.
Eventually, people may have to progress to the point that they have to
have joint replacements. And, for the
two primary joints that that happens are in the knee and in the hip. Those operations are highly successful. We, obviously, try to put them off as long as
we can, but they are very beneficial when they are done. So, it would be rare that somebody would be
crippled with OA (osteoarthritis) because of the ability to use joint
Linda Austin: Are there any specific treatments
for subtypes of osteoarthritis?
Gary Gilkeson: There are a couple of
different types of osteoarthritis to be aware of. There is a type where you’ve seen people that
have these big nodules on their fingers or a kind of deviation of their fingers,
and that is what we call nodal osteoarthritis or inflammatory
osteoarthritis. And that particular type
of osteoarthritis can be treated with medical therapy fairly successfully to
prevent it from progressing.
are also, if you have knee osteoarthritis, two different types of injections
that can be given into the joint. One is
a corticosteroid type injection, and another one is using a medication, hyaluronic acid, basically, injecting joint fluid
into the joint. And both of those
therapies have been shown to be effective in pain relief. They don’t stop the arthritis from getting
worse over time, but they do provide good pain relief for the majority of
Dr. Linda Austin:
Dr. Gilkeson, thank you so much for talking with us today.
Dr. Gary Gilkeson:
You’re welcome. Thank you.
If you have any questions about the services
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