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. There is no known cause of RA but we do know that an overactive immune system may contribute to the disease. The symptoms of RA vary with the number of joints affected and the severity of disease.
Cleveland Clinic Department of Rheumatic and Immunologic Diseases, is ranked second in the nation by U.S.News & World Report. The Arthritis and Musculoskeletal Treatment Center at Cleveland Clinic is committed to providing state-of-the-art diagnosis, treatment and rehabilitation for adults and children with rheumatic and immunologic diseases. These diseases vary from the simple to complex and mild to life-threatening. They include bursitis/tendonitis, osteoporosis, osteoarthritis, rheumatoid arthritis, gout, pseudogout and multiple other forms of arthritis, systemic lupus, vasculitis, fibromyalgia and others.
Join us today as M. Elaine Husni, MD, MPH, Vice Chair Department of Rheumatic and Immunologic Diseases, and Director for the Arthritis and Musculoskeletal Treatment Center in the Orthopaedic & Rheumatologic Institute, discusses the two most common types of arthritis, Osteoarthritis (OA) and rheumatoid arthritis (RA) and their diagnosis, treatment and related problems.
Dr. Husni is also an Assistant Professor at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. She trained in Rheumatology at the Brigham and Women's Hospital/Harvard Medical School and completed her internship and residency at the Beth Israel Deaconess Hospital/Harvard Medical School. She received both her MD and MPH degrees at Boston University School of Medicine.
Dr. Husni is the recipient of the Clinical Investigator Award from the American College of Rheumatology for her research on health outcomes among patients with rheumatoid arthritis and psoriatic arthritis, specifically related to cardiovascular disease. She is also involved in many other clinical trials at Cleveland Clinic and serves on the Executive Committee of the PRECISION trial.
Dr. Husni is also on the Medical and Scientific Committee of the Arthritis Foundation, Northeastern Ohio Chapter. She finds mentoring rheumatology and orthopedic research trainees to be one of her most rewarding experiences.
To make an appointment with Dr. M. Elaine Husni, or any of the other specialists in our Arthritis and Musculoskeletal Center in the Orthopaedic & Rheumatologic Institute at Cleveland Clinic, 216.444.8601 or please call toll-free 866.275.7496; visit us online at www.clevelandclinic.org/arthritis
Cleveland_Clinic_Host: Welcome to our Online Health Chat with M. Elaine Husni, MD, MPH. We are thrilled to have Dr. Husni here today for this chat. She is considered an expert in the field of rheumatology and specializes in the care of patients with arthritis. Let’s begin with some general questions about arthritis.
Arthritis Overview: Rheumatoid Arthritis (RA) and Osteoarthritis (OA)
kellieetter: Hello, I have been having horrible leg pain only in my left upper leg between my hip and knee. Along with that comes lower back pain and stomach pain. I have been to 4 Drs. including an arthritis Dr. who took X-rays and could not tell me anything. Does this sound something that could have to do with arthritis?
Speaker_-_Dr__M__Elaine_Husni: Arthritis affects the joints such as your knee or hip. If there is pain in between these joints we might also think about muscle or ligament/tendon pain i.e. soft tissue related problems. This is best way to know for sure is to get an evaluation with your physician to determine the source of the pain.
squaw75: I am a secretary and I do have arthritis in knees, etc. However, last week my left hand (right-handed) developed a bump & pain on my index finger - it has sharp pains at times - also is a little dark in color on the very top of the finger. Wonder if this is arthritis or if it is a bone issue? It is lumped up and now my finger appears crooked. I don't want to go to Dr. if it is just arthritis, but if something may be broke I will go.
Speaker_-_Dr__M__Elaine_Husni: Getting proper diagnosis is the key for proper treatment. It is often difficult to know your exact diagnosis yourself and would be helpful to get an exam and sometimes will need XRs to determine the problem. This would best be evaluated by an X-Ray to determine the extent of arthritis or if there is an abnormality in the bone.
KarenP: I was diagnosed with osteoarthritis of the hip. I have many days where I am in extreme pain. I get a severe pain whenever I carry anything.
Speaker_-_Dr__M__Elaine_Husni: It is best to determine the severity of your OA. We can usually do this with an X-ray of your hip and a consultation with a rheumatologist. We can then discuss medical or surgical management of your symptoms.
nystrom: What is the distinction between joint pain of Rheumatoid Arthritis and Osteoarthritis? My hands are killing me after a lot of gardening, knuckles are stiff and swollen.
Speaker_-_Dr__M__Elaine_Husni: This is a great question. There are very important distinctions between the two. RA is known as a systemic, inflammatory disease - meaning it not only affects the joint. OA is a non-inflammatory arthritis and is generally confined to the joint.
Therefore if your hands are hurting a lot, it would be best to get an evaluation by a rheumatologist who can perform a detailed exam and to determine which type of arthritis is affecting your hands.
nystrom: I had bilateral hand x-rays and small nodules were noted, but my RA Factor was negative. What does that mean? Does it mean that I do not have RA now, but I will down the road?
Speaker_-_Dr__M__Elaine_Husni: Nodules are not usually seen on X-ray. Nodules are usually described by ultrasound or MRI. Swelling of joints, presence of nodules and arthritis can all be different. In order to answer this question, I would need the official X-ray report to determine the presence of arthritis if any. A thorough medical exam would also be helpful
Blood tests are only part of the question for diagnosing arthritis. Patients with RA have a RF (Rheumatoid factor) positive about 80-85% of the time. Up to 15% can have blood test negative but still have RA.
RA is a clinical diagnosis, not simply a blood test. We now have a new test called anti-CCP antibodies which can be more specific to arthritis and a rheumatologist can best determine if you will need this blood test.
Unfortunately, none of these blood tests can predict the future course. You may need tests to be repeated periodically if symptoms persist.
Arthritis and Bone Loss
Jackson: Is bone loss a serious issue in RA? If so, how can we slow this loss?
Speaker_-_Dr__M__Elaine_Husni: Yes, bone loss is an issue in RA. Also known as Osteoporosis, a decrease in bone mass is seen in a higher frequency of patients with RA. We recommend screening for Osteoporosis with a bone density test. The frequency of this should be discussed with your rheumatologist.
If you are diagnosed with osteopenia or osteoporosis, there are medicines available to slow down the bone loss. There are also medications that will increase bone loss such as steroids.
Arthritis Medications and Supplements
elw1706: How effective is Glucosamine and Chondroitin?
Speaker_-_Dr__M__Elaine_Husni: This is a very important question. This is one of the dietary supplements used for osteoarthritis (not other types of arthritis) and most well studied. The NIH just finished a 3 yr study on this topic for knee OA. The study was designed to test the short-term (6 months) effectiveness of Glucosamine and Chondroitin sulfate in reducing pain in a large number of participants with knee osteoarthritis.
Unfortunately there were no significant differences between the treatments tested (Glucosamine and Chondroitin) and placebo.
For a smaller group of participants with moderate-to-severe pain, Glucosamine combined with Chondroitin sulfate provided some pain relief compared with placebo—about 79 percent had a 20 percent or greater reduction in pain versus about 54 percent for placebo. According to the researchers, because of the small size of this subgroup these findings should be considered preliminary and need to be confirmed in further studies.
For participants in the mild pain group, Glucosamine and Chondroitin sulfate together or alone did not provide statistically significant pain relief.
whisperims: Is there a maximum length of time one should use a biologic DMARD?
Speaker_-_Dr__M__Elaine_Husni: Biologic DMARD's (disease-modifying anti-rheumatic drugs to minimize swelling and pain.)can be used for a very long period of time to treat inflammatory arthritis as long as there are no contraindications that develop.
Arthritis and Diet
elw1706: What food groups might make arthritis worse?
Speaker_-_Dr__M__Elaine_Husni: There are no specific food groups that affect arthritis definitively. Although diet can affect the way you feel overall, it is difficult to tailor your diet to alter arthritis. I recommend a high fiber, low fat diet and limited concentrated sweets. Eating foods high in sugar will cause a burst in energy followed by a crash. Therefore, we don't recommend eating foods high in sugar all the time.
Arthritis and Exercise
FredSpeaks: What kind of exercise could help the thumb area to relieve pain?
Speaker_-_Dr__M__Elaine_Husni: It is best to determine why you have pain in the thumb area. We usually work with the Occupational Therapist for exercises of the hand. Some times you may be required to wear a splint temporarily to rest the affected area before beginning OT. Your rheumatologist can best determine what your needs are.
Polymyalgia Rheumatica (PMR)
MSAL: I have numbness in my right jaw, teeth and tongue. I have been to doctors and dentists. I have had numerous tests and cat scans. No one seems to know the answer--I have had it about a year now. It is uncomfortable after eating until it calms down a bit. I had been treated for Polymyalgia Rheumatica with Prednisone about a year ago and noticed this happened after I had been weaned off. Is there any treatment? Any information will be greatly appreciated.
Speaker_-_Dr__M__Elaine_Husni: The muscles of the jaw can get involved with PMR and cause pain with chewing and eating. Numbness would be more atypical for PMR and would like be evaluated by a neurologist and if there is no nerve problem this could be related to PMR. Certainly being weaned off prednisone would seem it is related to PMR. If it were TMJ pain, this would be pain only and not numbness.
Since I have not had the opportunity to examine you, it is best to let your primary care physician or rheumatologist what your next step is.
MSAL: If my numbness is related to PMR, is there any treatment? Do I need to go on Prednisone again?
Speaker_-_Dr__M__Elaine_Husni: It is best to see a rheumatologist to manage your PMR to help guide the initiation and duration of prednisone used as a treatment.
MSAL: Thank you for your answers Dr. Husni, this is a fine venue.
Speaker_-_Dr__M__Elaine_Husni: Thank you so much. We appreciate all the great questions.
aprild: What is the best medicine you would use to treat an attack and then prevent a gouty arthritis attack when the individual is 74 years old, it has attacked every joint in his body at the same time, he can not move ,has had bypass surgery, not great kidneys and diabetics?
Speaker_-_Dr__M__Elaine_Husni: There are many different medicines used to treat gout. NSAID's, colchicine and steroids are examples of medications that can be used in the acute setting depending on your health status. Allopurinol, colchicine and a new drug called Urolic® (febuxostat) can be used in the chronic management of gout.
aprild: Is colchicine used during a gouty arthritis attack or to prevent an attack?
Speaker_-_Dr__M__Elaine_Husni: Both. You can work with your health care provider to determine the best dosage.
aprild: Which is harder on the kidneys the Allopurinol or Uloric®?
Speaker_-_Dr__M__Elaine_Husni: In general both can be used with mild kidney problems. For patients that have more serious kidney problems, the new medication Uloric® may also be used.
Arthritis and Prevention
rogue43: How can arthritis be prevented?
Speaker_-_Dr__M__Elaine_Husni: Arthritis is a very general term. One of the best ways we know that will slow down the progression of OA is weight loss (if you are overweight), decrease repetitive motions if you are in a field that requires repetitive motions. You should also maintain your function by doing regular exercises for flexibility and endurance.
whisperims: I have RA and I am on Orencia®. Should I take any extra precaution against H1N1?
Speaker_-_Dr__M__Elaine_Husni: I think this is an important concern and we are learning more about the H1N1 everyday. The American College of Rheumatology does not provide a statement regarding specific precaution for those on Orencia however, following the general precautions that the CDC recommends for the H1N1 virus would be important to review. Please refer to the CDC web site at the end of this transcript.
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Husni is now over. Thank you again Dr. Husni for taking the time to answer our questions about arthritis today.
Speaker_-_Dr__M__Elaine_Husni: We really appreciate the opportunity to talk about arthritis today. Hopefully the answers provided some insight into your symptoms. We encourage you to make an appointment.
We have recently opened the doors to the Cleveland Clinic Arthritis and Musculoskeletal Treatment Center on the Main Campus. The center has a multi-disciplinary approach with Orthopaedists and Rheumatologists to efficiently diagnose and treat arthritis and related musculoskeletal symptoms.
For more information about Cleveland Clinic Orthopaedic and Rheumatologic Institute, you may visit clevelandclinic.org/ortho
To make an appointment with Dr. Husni, or any of the other specialists in our Arthritis and Musculoskeletal Treatment Center, please call 866.275.7496 or visit clevelandclinic.org/ortho
Some interesting articles about this topic from Cleveland Clinic may be found at the following links:
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This chat occurred on May 19, 2009.
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