Osteoarthritis: An Overview

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Osteoarthritis: An Overview




Guest:  Dr. Gary Gilkeson – Rheumatology & Immunology

Host:  Dr. Linda Austin – Psychiatry


Dr. 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?


Dr. 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.


Dr. Linda Austin:  It seems as if that’s an awfully common problem.  Does anybody not get osteoarthritis, if they live long enough?


Dr. 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. 


Certainly, 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.


Dr. Linda Austin:  How about repetitive sports, like long distance running, is that a risk?   


Dr. 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.


Dr. 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.


Dr. 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.


Dr. Linda Austin:  So, would you, personally, take any of these supplements if you had significant osteoarthritis?


Dr. 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.


Dr. Linda Austin:  What are some of the ways that you help your patients who have osteoarthritis?


Dr. 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.


Dr. Linda Austin:  Can this become a crippling problem?


Dr. 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 replacement.


Dr. Linda Austin:  Are there any specific treatments for subtypes of osteoarthritis?


Dr. 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. 


There 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 patients. 


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 or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.

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