Online Health Chat with Dr. Ajay Buddaraju

May 17, 2010

Introduction

Cleveland_Clinic_Host: Osteoarthritis (OA) and rheumatoid arthritis (RA) both cause joint pain and limit movement. OA results from wear-and-tear of the cartilage cushioning the joints, typically after injury or with advancing age. RA is a less common form of arthritis, known as an autoimmune disease.

The exact cause of RA is not known at this time, but we do know that disturbance in the immune system contributes to the disease. The symptoms of RA vary with the number of joints affected and the severity of disease. Gout is an increasingly common form of arthritis in people, with earlier onset in males and usually after menopause in females. It involves sudden, severe inflammation of a joint in which uric acid crystals have collected

Ajay Buddaraju, MD is a staff physician in the Department of Rheumatic and Immunologic Diseases. He is also a part of the Orthopaedic and Rheumatologic Institute’s Arthritis and Musculoskeletal Center. He completed his fellowship in rheumatology at Wayne State University, Detroit Medical Center in Detroit, MI. Dr. Buddaraju’s specialty interests include general rheumatology, crystal-induced arthropathy (gout, pseudogout), rheumatoid arthritis, and systemic lupus erythematosus.

To make an appointment with Dr. Buddaraju or any of the other specialists in our Arthritis and Musculoskeletal Center at Cleveland Clinic, please call 216.445.3330 or call toll-free at 800.223.2273, ext. 53330. You can also visit us online at clevelandclinic.org/arthritis

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Ajay Buddaraju. We are thrilled to have him here today for this chat. Let’s begin with the questions.

Types of Arthritis

dliving41: How is gout diagnosed? I have the classic symptoms.

Speaker_-__Dr__Ajay_Buddaraju: The definitive diagnosis of gout can be made by taking out fluid from the involved joint and looking at the fluid under a special microscope to look for uric acid crystals. However, in some instances, depending on the patient's history, symptoms and the joint involved, you can diagnose gout without taking fluid from the joint.

mylee: What is Lyme arthritis?

Speaker_-__Dr__Ajay_Buddaraju: Lyme arthritis is an infectious arthritis caused by Borrelia bacteria. It is a late manifestation of Lyme's Disease that follows the initial skin rash by a few months to a year or more. It usually affects one or more joints, mostly in the lower extremities.

plato: Is carpal tunnel pain in the wrist a form of arthritis development?

Speaker_-__Dr__Ajay_Buddaraju: Carpal tunnel syndrome is not a form of arthritis but it can result from an underlying arthritis, such as rheumatoid arthritis. Carpal tunnel syndrome is basically a pinching of the nerve in the wrist and can be caused by a number of reasons, including an underlying arthritis.

Rheumatoid Arthritis & Genetics

jenlynch75: My mother was diagnosed and received treatment for rheumatoid arthritis. No other women in our family ever had this diagnosis that we know of. Is this hereditary? If yes, what are the early warning signs and symptoms?

Speaker_-__Dr__Ajay_Buddaraju: There is an increased risk of rheumatoid arthritis (RA) in family members of patients with RA, compared to the general population. Usually RA starts out in the small joints of the hands and feet. Patients usually have pain, stiffness and swelling in these joints.

Preventing Osteoarthritis & Rheumatoid Arthritis

companyb: What is the best way to prevent OA and RA?

Speaker_-__Dr__Ajay_Buddaraju: The cause and type of arthritis varies with each individual. Some kinds of arthritis have a strong genetic influence and there is nothing that can be done to prevent it. But, in general, healthy lifestyle, good diet and regular exercise can prevent and perhaps slow down the progression of arthritis.

Osteoarthritis Treatment Options

jumpingbeans: My thumb keeps jumping out of joint and popping back. What should I do?

Speaker_-__Dr__Ajay_Buddaraju: It sounds like you have a form of dislocation in the thumb. I would recommend consulting an orthopaedic surgeon or hand specialist.

proud2b: Either hip replacement or drug therapy – how do you decide?

Speaker_-__Dr__Ajay_Buddaraju: It depends on your overall health and functional status, as well as your expectations. If the pain symptoms are not severe and it is not functionally limiting, I would suggest holding off on surgery until the point where quality of life is affected. There are also more innovative procedures today that are less invasive than a total joint replacement. You can discuss these options with an orthopedic surgeon.

dropout: How effective is SYNVISC® in treating OA (osteoarthritis) of the hip? How about the knee?

Speaker_-__Dr__Ajay_Buddaraju: Currently, SYNVISC® is not approved for the treatment of osteoarthritis of the hip. Having said that, I think there are studies underway using SYNVISC® in the treatment of osteoarthritis in the hip.

SYNVISC® is however, approved for treatment for osteoarthritis of the knee, for those who don't have an adequate response to conservative measures like exercise, weight control and medications. Response to SYNVISC® can vary between individuals.

stfjonz: Other than medications, do you know of any salves that help arthritis?

Speaker_-__Dr__Ajay_Buddaraju: Currently there are many topical treatments available for the treatment of arthritis. They are helpful in some forms of arthritis, depending on the joint involved. For example, they are not as helpful when a deep joint, like shoulder or hip, are involved. There are various over the counter and prescription creams available. Discuss with your physician what would be right for you.

nystrom: What is a treatment for a very arthritic thumb needed for writing?

Speaker_-__Dr__Ajay_Buddaraju: It needs to be determined what type of arthritis you have in your thumb. The treatment depends on the kind of arthritis. The treatment can vary from taking something to help with the pain, to stronger medications used to control the arthritis, to a local steroid injection in the thumb. Depending on the type of arthritis, thumb splints can also help. You should see an arthritis specialist for evaluation and treatment.

hundredeyes: How can a person get rid of pain from a shoulder with bad arthritis when pills and a cortisone shot did not help? Hopefully non-surgical?

Speaker_-__Dr__Ajay_Buddaraju: As I mentioned earlier, the treatment depends on the kind of arthritis you have. Depending on your age and your overall health status, surgery might be an option if your arthritis is severe. To help with the pain itself, there are a lot of medications that can be given. Talk to your arthritis doctor to discuss these options.

Osteoarthritis & Joint Replacement

flowers: Do you know how successful elbow replacements are?

Speaker_-__Dr__Ajay_Buddaraju: I would recommend considering an appointment with an orthopaedic surgeon, who is better equipped to answer this question.

howdiedo: If a person has severe osteoarthritis of hips and knees and joint replacement is indicated, how does the person decide where to begin? Is there any Dr. that does an overall joint evaluation?

Speaker_-__Dr__Ajay_Buddaraju: Yes, the doctors at the Cleveland Clinic Arthritis and Musculoskeletal Center do overall joint evaluations. Even though you have arthritis in both hips and knees, the option of surgery is determined by where you have the most symptoms and which joint causes the most limitation to mobility.

batterup: Can you still have osteoarthritis after total knee replacements?

Speaker_-__Dr__Ajay_Buddaraju: Once you have a total knee replacement, there is no 'joint' left where arthritis can develop. If you have pain following the joint replacement, a problem with the artificial joint, like loosening, infection, etc., needs to be ruled out.

lion: Is there an age limit on a total knee replacement?

Speaker_-__Dr__Ajay_Buddaraju: More than the age of the individual, it depends on the overall health and functional status of the patient.

Psoriatic Arthritis

susanbw: Anything new on the horizon for severe psoriatic arthritis? I have gone through most of the NSAIDS, Methotrexate, Enbrel® (discontinued because of numerous skin cancers) and have for the time being settled on daily prednisone and meloxicam.

Speaker_-__Dr__Ajay_Buddaraju: There are some drugs that are currently being tested, but have not yet been approved. You might want to talk to your doctor to see if he/she knows of any studies being done in your area that you might qualify for.

hobo2: I am a 68-year old female with severe Psoriatic Arthritis and a nine-month old new aortic valve (from Cleveland Clinic). What are the long-term effects of my daily anti-arthritis regimen of 5 mg prednisone and 7.5 mg Meloxicam -- in addition to Metoprolol, Lovastatin, and baby aspirin?

Speaker_-__Dr__Ajay_Buddaraju: From the heart standpoint, I don't think the
prednisone alone will affect the heart valve. As with any medication that can decrease immunity, you have to watch for infection in the heart valve. I would be more concerned with the long term affects on your bones. I would recommend doing a bone density test and taking calcium with vitamin D, along with weight bearing exercises as tolerated.

susanbw: Follow up query from hobo 2: does the daily prednisone (5 mg) account for the extreme ease of bruising, especially on the tops of my hands? The SLIGHTEST "knock" to my hands or shins produces ugly, long-lasting bruises.

Speaker_-__Dr__Ajay_Buddaraju: I believe this is from a combination of taking the Prednisone and aspirin, and also if you might be taking any blood thinners for your valve replacement.

Alternative Treatments

pressureson: I take 2,000mg flaxseed oil each day on advice from my eye Dr. Can I also take fish oil? How much? Is flaxseed oil as effective as fish oil?

Speaker_-__Dr__Ajay_Buddaraju: The benefits of fish oil supplements for patients with arthritis has been shown in small studies. There have been no large randomized controlled studies of the efficacy of fish oil in the treatment of osteoarthritis. The recommended dose is 1000-3000mg daily, in divided doses.

There are no current studies that compare the flaxseed oil to the fish oil in the treatment of arthritis.

peanuts: Can you recommend a good acupuncture person?

Speaker_-__Dr__Ajay_Buddaraju: We have a certified acupuncturist at Cleveland Clinic, as part of the Wellness Institute.

couchpotato: Do insurance companies generally pay for alternative therapies?

Speaker_-__Dr__Ajay_Buddaraju: In general, most insurance companies do not. However, you will have to check with your insurance company.

yellow: How much glucosamine chondroitin should be taken?

Speaker_-__Dr__Ajay_Buddaraju: Based on current evidence, the recommended dose for glucosamine is 1500 mg per day, and for chondroitin sulfate, 800-1200 mg per day. This should be in divided doses for each.

Arthritis & Exercise

corley: Any advice on running. I have some discomfort in lower back right side, some discomfort in right hip and leg down to the knee. I love to run.

Speaker_-__Dr__Ajay_Buddaraju: There is no contraindication for exercise in patients with arthritis, but you may have to allow for some limitations. You may consider seeing an arthritis specialist for evaluation before continuing with running to determine the exact cause of your pain.

JohnD: Is it true that you should keep moving your hands and knees if you have arthritis or it will get worse and stiffer- is it better to keep moving?

Speaker_-__Dr__Ajay_Buddaraju: Exercise in general helps with improving muscle strength, flexibility and maintaining an optimum weight, which helps in slowing down the progression of arthritis as well as the symptoms of arthritis. This helps in improving mobility/functional status.

Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Dr, Ajay Buddaraju is now over. Thank you again Dr. Buddaraju for taking the time to answer our questions about arthritis.

Speaker_-__Dr__Ajay_Buddaraju: Thank you for taking the time to chat with me today.

More Information

• Cleveland_Clinic_Host: To make an appointment with Dr. Buddaraju or any of the other specialists in our Arthritis and Musculoskeletal Center at Cleveland Clinic, please call 216.445.3330 or call toll-free at 800.223.2273, ext. 53330. You can also visit us online at clevelandclinic.org/arthritis.
• A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult website. To request a remote second opinion, visit eclevelandclinic.org/myConsult.
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