Online Health Chat with Scott Burg, DO

May 21, 2015

Description

When a joint aches, how do you know whether it’s caused by arthritis or something else? And if you have arthritis, how do you know which of the more than 50 types of arthritis you have?
 
Treatment for joint pain differs greatly depending on the cause, so getting the right diagnosis is critical. With the right di¬≠agnosis and early treatment, joint damage can be prevented, and you can return to your previous level of activity. The wrong treatment — or avoiding treatment — may mean joint deterioration, poor function and compromised mobility.

Arthritis literally means “joint inflammation,” and it can result in pain, stiffness and swelling around the joint. Because inflammation is painful, arthritis limits movement. The three most common types of arthritis are:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Gout

The causes, symptoms and risk factors for each of these forms of arthritis may differ. You may suffer from more than one type of arthritis — for example, gout and osteoarthritis. Our expert will discuss the symptoms and treatments and explain how to better communicate with your doctor so together you can arrive at the right diagnosis and treatment sooner.


About the Speakers

Scott Burg, DO, is a rheumatologist in the Orthopaedic & Rheumatologic Institute. He specializes in osteoarthritis, rheumatoid arthritis, gout, osteoporosis, systemic lupus and golf-related injuries. Dr. Burg graduated from Philadelphia College of Osteopathic Medicine and went on to Mount Sinai Medical Center in Cleveland for his residency in internal medicine. He completed his rheumatology fellowship at University Hospitals of Cleveland.


Let’s Chat About Arthritis

Moderator: Welcome to our chat about arthritiswith Cleveland Clinic specialist Scott Burg, MD. Thank you, Dr. Burg, for taking the time to be with us to share your expertise and answer our questions.

Let’s get started with our questions.


Pain-relieving Possibilities

garnold1: 1. Is there any peer-reviewed literature on the efficacy of Australian Dream?
What is your opinion about it? 2. I'm in stage 3 kidney disease and can't take NSAIDS. Tylenol® doesn't have much effect for pain relief for me. Do you have any suggestions? 3. I may have "gamer's thumb." Do you have any suggestions to relieve pain? Thank you.

Scott_Burg,_DO: The few people in my practice who have tried Australian Dream have not seen any remarkable results. With stage 3 renal disease, you are not a candidate for NSAIDS for pain relief. My suggestion would be to see a pain management specialist in your community. I suggest this because there are beneficial drugs for pain relief available, such as Cymbalta®, but whether or not you can take them depends on the other medicines you are taking for your other conditions, and this could be best managed with the help of a pain management specialist.

gil1FJ: My surgeon recommends against injections for treating hip arthritis pain, although I have heard other practitioners such as chiropractors recommend it. What are the risks and outcomes of hip injections?
 
Scott_Burg,_DO: That is a very good question. A cortisone injection into a severely arthritic hip joint may give someone temporary relief of the pain, but not long-lasting. Typically, given the fact that the hip is a weight-bearing joint, a single injection in a six month period of time is the most frequent interval I would give one. Typically, if there is minimal or no relief, I would rarely give another one, but not before the six month timetable has passed. There is a risk of bleeding, infection and the possibility of creating a condition called osteonecrosis from frequent corticosteroid injections into any joint. Also, frequent injections can, in some cases, accelerate the joint damage.


Considering Surgery

sinaihospital: I have had arthritis in my right knee and in both feet since 2000. I tried shots, physical therapy and medicine for my arthritis. It did not help me or it helped very little. Can surgery help me in this case, yes or no? Thank you, doctor.

Scott_Burg,_DO: Yours is a commonly asked question. If you are having pain at rest in your knee and have failed multiple conservative treatment modalities, including physical therapy, anti-inflammatory agents and injections of corticosteroids or the lubricating medications such as HYALGAN®, you may be a conservative candidate for joint replacement surgery. The risks of conservative therapy with anti-inflammatories, such as bleeding and kidney insufficiency, may outweigh their benefits.

johnk: I have arthritis in my shoulder. Any movement hurts, and I have trouble sleeping. I have heart failure from a heart attack. I am currently scheduled for an ablation for a-fib. I still run each day and try to maintain an active lifestyle. Golfing, casting a fishing lure or riding a bike is difficult. What options do I have for my shoulder? Is shoulder replacement the only treatment? Thank you and have a blessed day.

Moderator: There is a chat about joint replacement on August 19, 2015. To register, go to http://chat.clevelandclinic.org/chatpage.aspx?chatid=1718. The three physicians presenting would be the best sources to discuss options for arthritis in your shoulder.

keberly1: My left thumb base feels as if it is always "popping" out of place. I went to a hand and microsurgeon who x-rayed it and gave me a diagnosis of arthritis. He said the feeling of popping out of place is actually bone on bone. I had a cortisone shot in September 2014 and a second one in January 2015. Both injections helped for a few months, but now the pain has worsened considerably. It now sometimes brings me to my knees when I feel as if I cannot get the joint back in place. I'm in need of relief but not sure what my next options are.

Scott_Burg,_DO: I would suggest that you be evaluated by a board-certified orthopaedic surgeon with a strong association with a university. Your next option is possibly surgery.


Medication Matters

gil1FJ: Which non-prescription drugs are best for treating arthritis pain?

Scott_Burg,_DO: I tend to use Tylenol Arthritis Pain, as the risk of GI bleeding, liver toxicity and renal toxicity are definitely reduced. However, you need to discuss with your treating physician any over-the-counter medication that you use, as they can conflict with other medications you may be taking or medical conditions you have.

Tululahbelle : I have trouble with most drugs. What would you recommend for rheumatoid arthritis?

Scott_Burg,_DO: This is another good question. There are a number of options today for patients with rheumatoid arthritis. We are able to not only give people symptomatic relief, but also to modify the disease with disease-modifying agents such as methotrexate and Plaquenil® and the biologics such as Enbrel®, Humira® and Remicade®. Many of our medications can be either self-injected or given by IV, avoiding any GI side effects in certain cases.

54558pdc: Are there any better alternative for psoriatic arthritis than Enbrel? My daughter is young (28 years old) and I'm concerned about the long-term effects, not to mention the increased risk of cancers. Thanks.

Scott_Burg,_DO: There are a number of new medications for psoriatic arthritis, but they generally fall into the class of drugs called TNF inhibitors or monoclonal antibodies. Their side effects are similar, but they work exceptionally well. Unfortunately, PsA is a persistent condition and requires long-term therapy presently, as we do not have a cure yet. I think we have to balance the improvement in her quality of life versus side effects. Generally speaking, if monitored appropriately by a health professional who has strong familiarity with these medications, the risks are low.

Clara35: How effective is Euflexxa®, and when is it appropriate to use it?

Scott_Burg,_DO: Euflexxa is used for the treatment of osteoarthritis of the knee. Symptomatic relief is obtained to some degree in about 70 percent of patients for about six months. This medication can be repeated every six month indefinitely, as it is not a corticosteroid. We use it when traditional anti-inflammatories, injectable steroids and physical therapy have not been successful.


Determining Diagnosis

simtech: How is arthritis diagnosed? Are there definitive tests that can say for sure the problem is arthritis? Is there anything that can be done to slow it down?

Moderator: Please refer to this health information document regarding diagnostic tests for arthritis:
http://my.clevelandclinic.org/health/diseases_conditions/hic_arthritis/hic_arthritis_and_blood_tests

Jack_in_Florida: Doctor, I've had elbow pain for two months following the use of a hand saw on a tree. The pain prevents a normal "curl" exercise with a hand weight (palm up), but not an alternative position with my thumb up. Could this be arthritis or "tennis elbow," whatever that is?

Scott_Burg,_DO: If that pain is on the outside aspect of your elbow, it could very well be tennis elbow or what we call lateral epicondylitis. If the pain is on the inside of the elbow, this could be medial epicondylitis or golfer's elbow. Either way, this would require an examination by your physician. Treatment could include an injection of a cortisone preparation and physical therapy. Only rarely is surgery indicated.

Elliot: How can I know which of the more than 50 types of arthritis I have?

Moderator: A thorough evaluation with a rheumatologist would be beneficial.

Clara35: My mother is now unable to lift her leg high enough to get into the car. It doesn't cause pain, she is just no longer able to do it. Could it be a result of the arthritis in her knee?

Scott_Burg,_DO: Yes it could be arthritis, but the fact that she has no pain is of some concern. I would suggest she see her primary care physician for an appropriate evaluation and if needs be x-rays of her hip/leg.


Natural Notions

gil1FJ: Which of the alternative "natural" treatments, if any , have the best potential for treating osteoarthritis, e.g., supplements, laser, etc?

Scott_Burg,_DO: There are no bonafide natural treatments that have been demonstrated to clearly impact the course of osteoarthritis. Glucosamine is the most widely used supplement for symptomatic relief, but studies done in the last 10 years have not been encouraging. However, given the relatively low risk of side effects, I try it for six to eight weeks in my patients. If it gives them relief, I will continue it; but if not, we will try more traditional medications.

PatY: Hello. My question concerns foods. I have osteoarthritis, I believe, and I am studying the effects of different foods on joint pain. Can you give me some insight as to whether certain foods cause inflammation and, therefore, heighten the arthritic condition? What about weather? My son-in-law says that "high-pressure fronts" puts pressure on our joints and causes pain.
 
Moderator: Regarding questions about diet and arthritis, there will be a chat on July 13, 2015, discussing the benefits of the Anti-inflammatory Diet. Details will be posted in the next few days at chat.clevelandclinic.org. This is a very popular topic.

Coldgm67: Can bursitis in the shoulder go away on its own?

Scott_Burg,_DO: Yes it can. Our body's potential for healing is truly amazing, but oftentimes, the use of physical therapy or an injection of cortisone can help the bursitis resolve sooner.


Disturbing Disorders

miamickey: Is there more than "association" with psoriatic arthritis and pulmonary embolus? I am wondering if I need anticoagulants for life? I did have emboli about months after PsA. Thanks.

Scott_Burg,_DO: There is a small number of case reports regarding the association, but no prospective or large retrospective studies that I am aware of. I will research this question further as well. With respect to the length of time you require anticoagulation, much depends on your other medical conditions, previous history of blood clots and present medical issues apart from the PsA.

turt21: Greetings. I am a pulmonary sarcoid patient who has also been dealing with arthritis pain for years. Throughout the years, I have been told I have many forms of arthritis including psoriatic, osteoarthritis, rheumatoid arthritis and sarcoid arthritis. Could you please touch on the different forms, and of great interest to me is the sarcoid arthritis. I have been on prednisone for 23 years, which of course has wreaked havoc on my bones. I've had injections and use opiates including Vicodin® and Opana®. Any other suggestions are appreciated.

Moderator: We have a sarcoidosis chat scheduled in October, and I am waiting for further information and the promo. Because of the interest in sarcoid arthritis, I will try to find a specialist to speak to that during the chat in October.

WaveWolf: I have rheumatoid arthritis and sarcoidosis and am 63 years old. Medications for both include prednisone (<15mg now), methotrexate (25mg/week) and Remicade (every six weeks). Twice daily I take non-prescription anti-inflammation supplements: glucosamine sulfate (1000mg), MSM (1000mg) and tart cherry extract (465mg). I am paralyzed at T9 from sarcoidosis and living independently using a wheelchair, which puts tremendous strain on my upper joints. For neuropathic pain, I take R-alpha lipoic acid (300mg twice daily). I also take baclofen (20mg twice daily) for spasms, not more, so I can use spasticity for standing transfers. But I take nothing specifically for joint pain, which is becoming life-limiting. My knees were very deteriorated before paralysis in 2009, and sarcoidosis caused a particular type of arthritis in my knees and ankles.

  1. Please address sarcoid arthritis.
  2. Do you have an ideas for joint pain relief?
  3. What are your thoughts on palmitoylethanolamide?

Moderator: On October 21, 2015, we will be doing a sarcoidosis chat. We do not have the date or promo yet posted, but it will be posted at chat.clevelandclinic.org.

Gail Ann: After the age of 65, how often should a woman have a bone density scan? My mother had severe osteoporosis and I'm concerned that I too will eventually suffer from this condition. Are there any other tests or things I should do that would be beneficial in this regard? Thank you for your time answering my questions.

Moderator: We just had a wonderful chat with two physicians last month about osteoporosis. Here is a link to the transcript, which has answers to your questions:
http://my.clevelandclinic.org/health/transcripts/2749_osteoporosis-answers

Closing

Moderator: That is all the time we have for questions today. Thank you, Scott Burg, DO, for taking time to discuss the different types of arthritis and treatment options.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at http://my.clevelandclinic.org.

Scott_Burg,_DO: Thank you for your wonderful questions. I wish I could have answered more of your questions.

For Appointments
To make an appointment with Scott Burg, DO, or any of the other specialists in our Department of Rheumatic and Immunologic Diseases at Cleveland Clinic, please call toll-free at 866.275.7496. You can also visit us online at clevelandclinic.org/rheum.


For More Information

Cleveland Clinic
The Orthopaedic & Rheumatologic Institute at Cleveland Clinic offers expert diagnosis, treatment and rehabilitation for adults and children for bone, joint or connective tissue disorders. The Institute blends the strengths of Cleveland Clinic’s Orthopaedic and Rheumatologic Programs, both ranked first in Ohio and among the top three nationally by U.S. News & World Report.

Cleveland Clinic’s Arthritis & Musculoskeletal Center within the Institute is a multidisciplinary clinic combining the expertise of nonoperative orthopaedists and rheumatologists in one location. Our evaluation and treatment center brings together experts so the cause of your joint pain can be quickly and appropriately diagnosed. Our team includes rheumatologists, nonoperative orthopaedic physicians, musculoskeletal radiologists, physical and occupational therapists, brace technicians and musculoskeletal patient educators.

Cleveland Clinic’s Department of Rheumatic & Immunological Diseases provides state-of-the-art diagnosis, treatment and rehabilitation for adults and children for diseases ran including rheumatoid arthritis, osteoarthritis, bursitis/tendonitis, osteoporosis, gout, pseudogout and multiple other forms of arthritis, systemic lupus, vasculitis, fibromyalgia and other diseases.

Cleveland Clinic Health Information
Learn more about symptoms, causes, diagnostic tests and treatments for arthritis:

Arthritis Documents
http://my.clevelandclinic.org/disorders/Arthritis/hic_Arthritis.aspx

Rheumatoid Arthritis
http://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/hic-rheumatoid-arthritis

Gout
http://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/hic-gout

For additional health information, visit clevelandclinic.org/health.

Arthritis Treatment Guide
Please use this guide as a resource to learn about the causes of arthritis and your treatment options. As a patient, you have the right to ask questions and seek a second opinion.

Arthritis Treatment Guide

Clinical Trials
For additional information about clinical trials: clinicaltrials.gov (must use Chrome or Firefox as browser to link)

Managing Your Health
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An online second opinion from a Cleveland Clinic specialist is available as a service  for patients who have received a diagnosis and are unable to travel to Cleveland, OH. For more information please visit http://my.clevelandclinic.org/online-services/myconsult.aspx.


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