The Many Forms of Arthritis With Dr Adam Brown

Podcast Transcript

Nada Youssef:   Hi, thank you for joining us. I'm your host, Nada Youssef, and you're listening to Health Essentials Podcast by Cleveland Clinic. Today, we're broadcasting from Cleveland Clinic Main Campus here in Cleveland, Ohio. We're here with Dr. Adam Brown. Dr. Brown is an associate professor of rheumatology; he is specialized in vasculitis, Susac syndrome, and autoimmune inner ear disease; host of the podcast, Rheuminations; and the author of the book, Rheumatology Made Ridiculously Simple. Thank you so much for being here today.

Dr. Adam Brown:  Absolutely. I'm happy to be here.

Nada Youssef:   Did I say all those right? Rheuminations, is that the podcast?

Dr. Adam Brown:  Rheuminations. Yeah, that's my podcast, yeah.

Nada Youssef:   Tell me a little bit about that.

Dr. Adam Brown:  It's a podcast for people in the healthcare field who are interested in just kind of learning more about rheumatology. It goes through interesting cases. It goes through the history of parts of rheumatology that people really don't know much about. I designed it so, I mean, I wanted people to be able to go running or listen to it in their car and learn about interesting facts about rheumatology.

Nada Youssef:   Amazing. You just started that this year?

Dr. Adam Brown:  Yeah, no. It's been going on for one year now.

Nada Youssef:   Oh, good.

Dr. Adam Brown:  Just finished the first year.

Nada Youssef:   Oh, congrats.

Dr. Adam Brown:  I'm very excited about it. Thank you.

Nada Youssef:   That's very good to hear.

Dr. Adam Brown:  The book came out two weeks ago, though, so that's newer.

Nada Youssef:   The book just came out?

Dr. Adam Brown:  Yes.

Nada Youssef:   That's Rheumatology Made Ridiculously Simple.

Dr. Adam Brown:  Yes.

Nada Youssef:   I like that. We should read that.

Dr. Adam Brown:  I even drew cartoons, so it's pretty-

Nada Youssef:   Really?

Dr. Adam Brown:  Yes.

Nada Youssef:   I can read it and understand what's happening? Good. Thank you so much for being here again. Please remember this is for informational purposes only, and it's not intended to replace your own physician's advice. Before we jump into topic, I have some questions just to get to know you on a personal level.

Dr. Adam Brown:  Got it.

Nada Youssef:   First one I have for you is if you could live any age forever, what age would that be?

Dr. Adam Brown:  Live the same age forever?

Nada Youssef:   Forever.

Dr. Adam Brown:  I imagine most people say like early 20s, right?

Nada Youssef:   Probably.

Dr. Adam Brown:  I was going to school in Sweden in my early 20s, and that was probably one of the best times in my life, so I'll probably go with that. I know it's a generic answer and everyone says that.

Nada Youssef:   What age? Like 24, 23?

Dr. Adam Brown:  Yeah, something like that would be good, yeah.

Nada Youssef:   All right, cool. What is the scariest thing you've ever done for fun?

Dr. Adam Brown:  For fun, probably, two things. I jumped out of a plane twice.

Nada Youssef:   Wow.

Dr. Adam Brown:  But, I was attached to somebody who knew what they were doing, so it wasn't as scary. If I did it by myself, I probably-

Nada Youssef:   Terrifying.

Dr. Adam Brown:  ... never would have done it. It would've been horrible. The scarier to me, was actually doing bungee jumping. I did that in New Zealand. That's the thing to do in New Zealand, is the bungee jump.

Nada Youssef:   That's so interesting.

Dr. Adam Brown:  That's one you do yourself, you have to jump by yourself. No one's jumping-

Nada Youssef:   That's the hardest part.

Dr. Adam Brown:  ... out for you, and just the seeing your potential death right below you is much scary. To me, where skydiving, it looks kind of like a map underneath you, it looks almost fake because it's so high up. But, bungee jumping, to me, was more terrifying.

Nada Youssef:   It's closer to the Earth.

Dr. Adam Brown:  It's close to there. You're seconds away from death. But, anyway, that was scarier to me. That was also my 20th.

Nada Youssef:   Oh, you're very spontaneous.

Dr. Adam Brown:  I wouldn't do that now.

Nada Youssef:   You wouldn't do that now. What is the first thing you do when you wake up in the morning?

Dr. Adam Brown:  Now, I grab my crying child. That's what usually wakes me up.

Nada Youssef:   How old is your child?

Dr. Adam Brown:  15 months.

Nada Youssef:   Of course, he will.

Dr. Adam Brown:  He wakes me up, then my dog usually wakes up from the crying child, and I take the dog out.

Nada Youssef:   It's like butterfly effect.

Dr. Adam Brown:  Very exciting. It's the butterfly effect.

Nada Youssef:   Well, thank you so much for that. All right, so back to arthritis.

Dr. Adam Brown:  Arthritis, got it.

Nada Youssef:   I Googled it. Arthritis literally means joint inflammation. Arth refers to the joints, and itis refers to inflammation.

Dr. Adam Brown:  That's it.

Nada Youssef:   Guessing that's exactly what it is. I want to start talking about how it's not a single disease. There are more than 100 different types of arthritis affecting people of all ages, including about 300-thousand children. Let's first say, let's first ask what are the main types of arthritis.

Dr. Adam Brown:  That's a good question, Nada. People say, "I have a family history of arthritis", people throw the word arthritis around pretty often. One thing, as you mentioned, there's multiple types. By far, the most common is what we call non-inflammatory or wear and tear arthritis. That's like people get it just from living, I always say. The longer you live, the higher the chance that you have you have some wear and tear on your joints. That's called osteoarthritis, is the medical term for that. Again, that's what your grandparents, your parents, if you're old enough, you probably have some osteoarthritis somewhere in your body. The base of your thumbs, the tips of your fingers, your hips, your knees, the creaking you feel sometimes when you're getting up; that's often osteoarthritis. That's wear and tear arthritis.

Dr. Adam Brown:  Then, we have a much rarer category, which is autoimmune disease. It's called inflammatory arthritis, where the immune system is actually attacking your joints, which sounds very scary. The immune system is normally built to fight off bacteria, fight off viruses, fight off things trying to cause infections. For reasons that aren't very clear, sometimes it gets confused and actually starts attacking your joints. That's when you get big, red, swollen, painful joints. That's like what you see in rheumatoid arthritis or psoriatic arthritis, are kind of two of the more common types of autoimmune arthritis.

Dr. Adam Brown:  Then, we have another category, which is probably in between because it's a little bit more common and that's called crystalline arthritis. The most common version of that is what people hear about is gout. Gout is the disease that's been around for a long, long, long time, and most commonly affects the like big toe. People wake up and have had severe, swollen, painful toe. They can't move, they can't walk, they can't even have a sheet touch their toe it's so painful.

Nada Youssef:   Wow.

Dr. Adam Brown:  Then, it just spontaneous goes away in the most, majority of the cases, so that's crystalline that's gout.

Nada Youssef:   Crystalline.

Dr. Adam Brown:  What we're talking abouts osteoarthritis, there's wear and tear arthritis; then we have autoimmune cause of arthritis, most commonly rheumatoid arthritis and psoriatic arthritis; and then we have crystalline arthritis, which is like gout, most commonly.

Nada Youssef:   With wear and tear, OA is wear and tear, more for older people. Then, you have the rheumatoid arthritis, that's your immune system attacking your joints. What is-

Dr. Adam Brown:  That can be kind of any age.

Nada Youssef:   Could be any age. Then what is crystalline about then?

Dr. Adam Brown:  Crystalline, it's also probably mostly the time above the age of 50, when you get close-

Nada Youssef:   About 50s.

Dr. Adam Brown:  ... to 60s, but rarely you can get in your 30s and 50s, but vast majority of people above the age of 50.

Nada Youssef:   All right, that makes sense. Thank you. It's like three bigger umbrellas for arthritis?

Dr. Adam Brown:  Exactly. That's kind of how I think of when I tell patients about arthritis is that's kind of the ... those are the big umbrella things. Rheumatoid arthritis and psoriatic, again, are much more rare.

Nada Youssef:   How do I know which type of arthritis I have if I do have arthritis?

Dr. Adam Brown:  It's a good question. Usually, you have to kind of sorted out with a rheumatologist, primary care doctor, or OS or orthopedic surgeon, kind of help you out. One big differentiating factor is what makes the pain better, what makes it worse. Okay? In osteoarthritis or the wear and tear arthritis, often, the more you use the joint, the more it hurts. For example, if you have it in your knees and you're going up and down the stairs, you, "Uh, it hurts," you get kind of this ache. You sit and rest, and the pain goes away. That's what we see in wear and tear arthritis. Another common area for wear and tear arthritis is the base of your thumb. What happens is you get a little bit of a bulging at the base of the thumb, but also like opening jars hurts and just doing certain activities. Hurts writing, typing, those kind of hurt. It kind of prevents you from doing that as much as you would like.

Dr. Adam Brown:  In contrast, we have the autoimmune types of arthritis, like rheumatoid arthritis and psoriatic arthritis. They're pretty strange in the fact that the pain often gets better the more you move the joint.

Nada Youssef:   Wow.

Dr. Adam Brown:  For example, in rheumatoid arthritis, rheumatoid likes to affect a certain joint in the hand, the knuckles that people wake up in the morning, they feel really stiff, they can't move their hands much, and it aches when they move their hands, they open and close their hands. But, the more they move it, the better they feel, so by the afternoon, they're feeling a little bit better. That's a pretty major contrast. That's what I often look for when I'm talking to patients, what makes the pain better, what makes it worse.

Dr. Adam Brown:  Back to crystalline disease like gout, that will have, patients can't even really move the pain is so bad or it's so severe. It kind of helps differentiate like someone with gout in their ankle, for example, isn't going to be walking the ankle-

Nada Youssef:   I see.

Dr. Adam Brown:  ... it's so bad. Whereas osteoarthritis and the autoimmune types of arthritis, they're usually able to move-

Nada Youssef:   Little movement.

Dr. Adam Brown:  ... but it hurts.

Nada Youssef:   What are the first warning signs that you have arthritis? I guess since we do have three different umbrellas, are the warning signs very different for each one?

Dr. Adam Brown:  Yes, a little bit. Let's talk about osteoarthritis, the wear and tear one, again. Usually, it's fairly subtle, like they say, "Hmm", they see a little bit of stiffness when they first get up, or there's a little bit of something kind of deep down there, "I feel like somethings there in my hand." But, it doesn't bother them too much. It's usually pretty subtle. "The knee is starting to ache a little bit more like when I first go up and down the stairs." It's usually just kind of an acre or a little bit of the stiffness.

Dr. Adam Brown:  Where in rheumatoid and psoriatic are similar, they also have, it's usually, probably, more sudden. For example, they'll say, "Oh, one morning I woke up my hands are kind of swollen-

Nada Youssef:   Everything changed.

Dr. Adam Brown:  ... and is painful. Then, it kind of gets worse as time goes.

Dr. Adam Brown:  Gout classically doesn't really have much warning. It just-

Nada Youssef:   Happens.

Dr. Adam Brown:  ... "I was fine, then I woke up and there's this boom, my toe is huge or my ankle was huge and I couldn't move it." Gout, out of all the ones, warning-sign-wise, gout probably is the one that does not have much warning sign. It just comes very-

Nada Youssef:   It just happens.

Dr. Adam Brown:  ... suddenly. Exactly.

Nada Youssef:   You do see swelling in the part where it's heavy?

Dr. Adam Brown:  Absolutely, yeah. Rarely a patient will say, "It feels swollen," but usually it's very, obviously, visibly swollen.

Nada Youssef:   People with autoimmune disease, are they more likely to develop arthritic bones-

Dr. Adam Brown:  Yeah.

Nada Youssef:   ... or RA?

Dr. Adam Brown:  That's a good question, Nada. The answer is yes because if you don't treat the autoimmune disease like rheumatoid arthritis, all that swelling and inflammation from the immune system is attacking the joints and it wears down the joints. We talked about osteoarthritis being wear and tear arthritis. When you have rheumatoid arthritis, usually from months to years and years, it's just causing chronic inflammation, chronic damage to the joint, and then you get the wear and tear where the rheumatoid was.

Nada Youssef:   Wow.

Dr. Adam Brown:  The answer is yes if it's untreated. But, the good news is now we have very, very good treatments for the majority of these diseases and we're able to prevent that from happening.

Nada Youssef:   Excellent. Now, I read somewhere that women are more susceptible to getting arthritis. I don't know which one, which arthritis it is, but it's true.

Dr. Adam Brown:  The short answer to that is the autoimmune arthritis.

Nada Youssef:   The autoimmune?

Dr. Adam Brown:  Yes. For reasons that aren't very clear, women have a higher tendency to develop autoimmune diseases, lupus, and then rheumatoid arthritis. Women have a higher tendency to develop these conditions and we're not really sure why.

Nada Youssef:   We don't know why.

Dr. Adam Brown:  In contrast, crystalline disease like gout seems to be a little bit more common in males.

Nada Youssef:   Oh, interesting. We don't know yet thought why.

Dr. Adam Brown:  The answer why I don't know.

Nada Youssef:   We'll find out I guess.

Dr. Adam Brown:  Time will tell.

Nada Youssef:   Exactly.

Dr. Adam Brown:  Research will hopefully tell us.

Nada Youssef:   I'm sure it will. If my mom, let's say, has, let's say, OA-

Dr. Adam Brown:  Osteoarthritis.

Nada Youssef:   ... osteoarthritis, is it hereditary? Is there a chance that I will get it?

Dr. Adam Brown:  That's a good question. It looks to be, there's a component of it. For example, I usually tell people if they have osteoarthritis of their knees and their hands, they're 45, and they didn't play any major sports growing up; there's probably a component of being it hereditary. For example, they'll say, "My mom or dad had really bad osteoarthritis. I think I got it a little bit earlier." Just because your mom and dad had osteoarthritis does not mean you're going to get it. Okay?

Nada Youssef:   Okay.

Dr. Adam Brown:  It's hard to say because most people get some of the component of it the longer you live. Okay?

Nada Youssef:   Sure.

Dr. Adam Brown:  If your mom or dad had osteoarthritis in their 40s, then I would say you probably have a little bit higher chance of getting it in your 40s. But, if you're 75 and you have osteoarthritis, the chances are it may just been-

Nada Youssef:   It's more of a normal wear-

Dr. Adam Brown:  ... normal wear and tear-

Nada Youssef:   ... and tear at this point.

Dr. Adam Brown:  ... at this point.

Nada Youssef:   With osteoarthritis, since it is most common in people older than 65, it does sound like it's age-related, progressive disease. Does this mean that those affected are either going to be going through a surgery or a disability? Is there like, is that the only choice?

Dr. Adam Brown:  That's not the only choice, luckily. You're right in one aspect of it, like in contrast to the autoimmune disease, like rheumatoid arthritis and psoriatic arthritis; we're able to treat the underlying problem much better than we can with osteoarthritis, the wear and tear arthritis. The wear and tear arthritis, we don't have a great medication to reverse it. Okay? But, we do have better treatments to help you live as normal life as possible. That's usually a combination of things. It's not just one pill. Okay? The answer is, I hope not, that you don't definitely need surgery, but the answer is I can't give you a pill to prevent it. But, I'm hopefully giving you therapy to help either delay it or maybe to the point where it never really bothers you enough that you need surgery. But, I can't give you something that makes it go away.

Nada Youssef:   Enhance the quality of life-

Dr. Adam Brown:  Exactly right.

Nada Youssef:   ... basically.

Dr. Adam Brown:  Enhances the quality of life.

Nada Youssef:   Because there is no cure for arthritis?

Dr. Adam Brown:  Correct.

Nada Youssef:   For any of the three?

Dr. Adam Brown:  There is no cure for ... Well, you can argue that with gout because, sorry, that's the crystalline disease, because if you eat, some people can eat like a perfect diet, lose weight and they won't have gout anymore. But, the other two-

Nada Youssef:   That's it's other thing.

Dr. Adam Brown:  All of these conditions have some treatment, but most of them don't have complete cure. Except for gout, you can kind of argue you can cure it. Kind of like diabetes. People can cure diabetes-

Nada Youssef:   By what they eat.

Dr. Adam Brown:  ... type 2 by just like decreasing glucose and decreasing sugars, for example. Gout has that component to it that you could cure that type of arthritis.

Nada Youssef:   I'm glad you're talking about that because then my next question is about preventative measures. What kind of foods or do any kind of food affect arthritis?

Dr. Adam Brown:  Yeah.

Nada Youssef:   I've heard about turmeric and omega 3.

Dr. Adam Brown:  Sure. I get asked this question about eight times a day and the answer is I don't know and no one really knows, but the internet will tell you very assuredly about these things. Okay? There is a lot of interest in diet and arthritis, the different types of arthritis from rheumatoid arthritis to osteoarthritis. For rheumatoid arthritis and osteoarthritis, the answer is we don't know. For gout, which we can get to in a minute, there's definite, diet can absolutely help that. Okay?

Nada Youssef:   Okay.

Dr. Adam Brown:  For osteoarthritis and rheumatoid arthritis, the answer is we don't know because it's complicated. These trials looking at whether or not diet can make a difference are really hard to do because these are ... for example, rheumatoid is a fairly rare condition, so it's hard to get people who have a rare condition, all, and say, "Okay, you all eat this diet for next two years. You will eat this diet for next two years and see who does better." It's hard to get people to take a pill for a trial, let alone change their entire diet, so these studies are hard to do. No matter how much we learn about these conditions, it doesn't seem like there's ever a clear winner in terms of which diet can make people better for osteoarthritis and rheumatoid arthritis.

Dr. Adam Brown:  What we have found is that I've had patients anecdotally tell me that avoiding certain foods have made them feel much better. I often say, "Look, I can't prescribe you a diet that's going to fix this, but I've had patients tell me they've tried going gluten-free for a few weeks and see how you do. If it doesn't help, stop doing that." If they try going dairy-free for a few weeks, "If that doesn't help, stop doing it." Then, people say that probably the really hard one's going sugar-free for a few weeks. But, again, I've had patients swear by doing this, so I never say don't try it. I'll always say, "Hey, try it. If it helps you, great. If it doesn't stop doing it."

Nada Youssef:   Somehow like an elimination diet, eliminate, see how your body's reacting to it?

Dr. Adam Brown:  Exactly. See how you do. I don't have scientific evidence telling me which one's going to work, but if you try something and it makes you feel better diet-wise, I'd say keep doing it.

Dr. Adam Brown:  Back to your ... you mentioned turmeric, and I get that question often, a lot, as well as CBD oil, people talk about that-

Nada Youssef:   CBD oil.

Dr. Adam Brown:  ... a lot as well. The data on these is pretty limited, meaning that we don't have a whole lot of scientific data showing this definitely helps, but I have a lot of internet telling me this definitely helps, right?

Nada Youssef:   Internet talks about a lot.

Dr. Adam Brown:  Internet's very sure of these things. What I often say is, "Lots of these things are unregulated, meaning the FDA isn't telling the manufacture what to put in each pill, so I don't know what's in each pill when you buy turmeric, when you buy a CBD." Okay? That's the first thing, I can't guarantee you anything that's in those pills, but if you have ibuprofen or something, we know it's in the pill. But, with that said, I've had patients, again, swear by doing CBD and swear by doing turmeric. I'd say, "Great, if it works for you, keep doing it. It probably won't have a major problem, but I don't know what's in the pill to be honest with you." The other thing about it is I said, "I wouldn't spend a lot of money on it." I've had some people say $120 for a bottle of turmeric. I'd be, "Okay-

Nada Youssef:   Wow.

Dr. Adam Brown:  ... I'd be hesitant to do that."

Nada Youssef:   But, it also comes in powder form that you can cook with and things I think.

Dr. Adam Brown:  You can try all sorts of things. You're absolutely right.

Nada Youssef:   Golden milk and all that good stuff. All right, so let's jump on to exercising because now you mentioned with rheumatoid arthritis, a little bit of movement helps; maybe with the osteoarthritis, movements can kind of hurt it. Exercise, no exercise, what to do?

Dr. Adam Brown:  That's a great question, the ying and yang of oste. Let's focus on osteoarthritis for a second. What we know is that some major like people who have big sports injuries growing up often get osteoarthritis in the joint that they injured. Okay? There's some evidence showing that it's like major stressful impacts on those joints is probably bad for it long term. With that said, we've all said that people with more sedentary lives seems to have osteoarthritis more, so there's probably a bit of a nice happy medium-

Dr. Adam Brown:  ... to be in, to being staying active, staying movement, but probably not physical activity where you're running straight into the people or running into brick walls repeatedly. That seems like a bad idea. Okay?

Nada Youssef:   Okay.

Dr. Adam Brown:  There's probably a happy medium on staying active-

Nada Youssef:   Go for a walk.

Dr. Adam Brown:  ... staying moving, go for a walk. Exactly. Get your arms moving, get your legs moving, stay "healthy living." Okay? But, again, playing rugby, playing football might be a little hard on joints.

Nada Youssef:   Understandable. Something like yoga?

Dr. Adam Brown:  Yeah.

Nada Youssef:   Would that work?

Dr. Adam Brown:  Absolutely.

Nada Youssef:   Maybe stretching, things like that?

Dr. Adam Brown:  Absolutely. Yoga, stretching, tai chi, swimming-

Nada Youssef:   Tai chi, tell me what that is.

Dr. Adam Brown:  Tai chi is this very slow kind of meditative movement that I have people do. They kind of just, it's very slow, deliberate movement, not putting a lot of stress underneath certain joints, but being outside kind of meditating while you do it seems to be good.

Nada Youssef:   That's good. We had a podcast about mindfulness and then you brought that up.

Dr. Adam Brown:  Mindfulness is excellent.

Nada Youssef:   I know. Exactly. All right. Let's talk about maybe for younger generation, what would you tell the younger generation to help them avoid or prevent arthritis from happening early on?

Dr. Adam Brown:  Again, osteoarthritis, I would say just keep moving. Lots of people have very sedentary jobs nowadays. Right? I mean, people, there's not evidence behind what I'm saying, but I can tell you that it seems like it's a good idea to just get up every so often.

Nada Youssef:   Get a standup desk.

Dr. Adam Brown:  Get a standup desk, that seems like a good idea. Again, that's not proven, but I think it's probably better than sitting all day, is to just stay moving, take the stairs every so often, you know-

Nada Youssef:   Yes.

Dr. Adam Brown:  ... things like that.

Nada Youssef:   Park a little bit farther-

Dr. Adam Brown:  Exactly.

Nada Youssef:   ... not so close too.

Dr. Adam Brown:  In terms of rheumatoid arthritis, we don't know. The autoimmune diseases, we're not really sure. Autoimmune disease, we can treat much, much, much better than we could even 30 years ago. This is a ... The advancements in treatment are much, much better, but we still don't know why they happen in people. People can be completely normal. Then, they're 65, and all of a sudden they get big swollen joints and they have rheumatoid arthritis. To answer your question about preventative, that's a tough one because we don't know why it happens.

Dr. Adam Brown:  There is some studies going on right now about people who have blood markers for rheumatoid arthritis. It turns out a lot of these conditions have markers in the blood years before the disease develops.

Nada Youssef:   Wow.

Dr. Adam Brown:  I'm not advocating running out and getting your blood tested because these are all very rare diseases. But, people who have found to have these markers, they're doing studies on trying certain interventions like medications before they have symptoms to see if we can actually prevent development of these conditions. The jury's still out that. We don't know the answer to this yet.

Nada Youssef:   All right. How about the third umbrella? I don't know if I'm saying it right. Is it-

Dr. Adam Brown:  Crystalline.

Nada Youssef:   Crystalline.

Dr. Adam Brown:  Gout.

Nada Youssef:   Gout. It sounds like that.

Dr. Adam Brown:  You can just call it gout.

Nada Youssef:   Anti-inflammatory disease, right?

Dr. Adam Brown:  Yeah. Gout happens the older you get. It's also in people who are very overweight. Well, not, sorry, didn't mean to say that. People who are overweight have a higher risk of getting it. Some people who are in perfect shape get as well. But, if you're overweight and you eat a lot of meat in your diet, a lot of alcohol; that tends to have a higher risk of developing gout.

Nada Youssef:   Oh, okay.

Dr. Adam Brown:  Also, people who have kidney disease have that have a higher risk of developing gout. Avoidance, keeping your kidneys nice and healthy probably helps prevent gout. Doing that is drinking lots of water, avoiding medications that can be hard on your kidneys is very good.

Nada Youssef:   Good to know. I didn't know. Kidney and gout could be somehow-

Dr. Adam Brown:  Absolutely.

Nada Youssef:   ... linked. Are the treatments for all types of arthritis the same or then completely different?

Dr. Adam Brown:  Very different.

Nada Youssef:   Because one's immune system and one's wear and tear.

Dr. Adam Brown:  Let's talk about the osteoarthritis first, so wear and tear arthritis. Let's say it's on your knees, for example. One of the best treatments is physical therapy, which is working with a physical therapists and learning different exercises to help strengthen the muscles around your joints. Seemingly strengthening muscles around the joints actually helps kind of stabilize the knee, for example, and can really reduce pain significantly. That's one of the best treatments you could do. There's no injections-

Nada Youssef:   Physical therapy.

Dr. Adam Brown:  ... no pills, just doing physical therapy with the person who knows what they're doing.

Dr. Adam Brown:  Next, is a category of medications, nonsteroidal anti-inflammatories like ibuprofen, one of the more common ones that's the over the counter. Anti-inflammatories can really help osteoarthritis. Again, they don't fix it, but they help the inflammation that's happening in the joint. They help calm down the pain in the joint. Tylenol is not in that drug category, but can also be very helpful. The problem with nonsteroidal anti-inflammatories like ibuprofen is the older you get, probably the little bit higher risk you have of having complications from them.

Nada Youssef:   From the NSAIDs.

Dr. Adam Brown:  From the anti-inflammatories, yes. Tylenol's probably safer the older you get.

Nada Youssef:   NSAIDs are considered, those are the anti-inflammatory drugs-

Dr. Adam Brown:  Anti-inflammatory.

Nada Youssef:   ... correct?

Dr. Adam Brown:  Nonsteroidal anti-inflammatory drugs, yes.

Nada Youssef:   Interesting.

Dr. Adam Brown:  Ibuprofen, there's multiple, but ibuprofen's probably the more common one.

Nada Youssef:   How about cortisone shots? Do they accelerate the degeneration of joints?

Dr. Adam Brown:  That's a great question. Cortisone shots are given very often in patients with osteoarthritis. They're pretty safe to give. I haven't had any major complications from steroids, injections before. Again, it's very, very rare to have a major complication from them. The question is if they work, and the answer is everyone's a little bit different. You get a steroid injection, let's say, in your knee, and the goal is that it helps kind of calm down the inflammation and maybe makes you feel great for six months. But, everyone's different. Some people, it doesn't work at all on; it helps for a few weeks and that's it; or helps for a few months, that's it. I have a few patients who come in two to three times a year for an injection and then they go on in their merry way and they're happy. The goal is, again, it doesn't fix the problem, but it helps you stay mobile, stay-

Nada Youssef:   Relieve symptoms.

Dr. Adam Brown:  ... on your legs. Sometimes it helps you get into physical therapy and help kind of get the muscles and get your knee nice and stable.

Dr. Adam Brown:  But, they aren't sure whether or not it reduces the cartilage in between the joint, is a good question. You have the cartilage in between the joint, kind of like the cushion. There's some data showing that steroids in those, in the knee, it might wear down the cartilage a little bit faster, so I usually inform patients about that. But the answers is, we don't know about that for certain yet. We often say, tell patients, "Again, this is low-risk procedure, and it could potentially benefit you greatly. I usually try it at least twice and it doesn't help at all, stop. Stop at that point."

Nada Youssef:   Now, there are creams out there for arthritis. What type of arthritis can you put cream on, and pill versus cream, what is the difference?

Dr. Adam Brown:  One of the creams I give most often is like ibuprofen, so it's called Voltaren Gel and/or it's like a, it's a nonsteroidal anti-inflammatory, but it's cream, so it goes on the skin and it doesn't seem to have the potential side effects of taking-

Nada Youssef:   Pills.

Dr. Adam Brown:  ... ibuprofen often as much. There's capsaicin cream, there's different, there's BENGAY. Usually, these are pretty low risk when you put the creams on, so often I tell patients, "Give it a try. It works, great. If it doesn't, stop doing it."

Nada Youssef:   Are they as strong? Do they penetrate like the skin to go down to the joints? I mean they're as-

Dr. Adam Brown:  Yeah, probably not. Probably not.

Nada Youssef:   That's what I was thinking about.

Dr. Adam Brown:  If you have severe arthritis, it's probably not going to do the trick. If you have very mild osteoarthritis, it may help you a lot.

Nada Youssef:   When is it time for surgery? When is like enough is enough kind of thing.

Dr. Adam Brown:  Usually, the patient will tell you. They'll say, "Hey, look, I tried the injection, I tried the pills, this is driving me nuts." Then, we work with my orthopedic surgery colleagues and they help us decide that.

Nada Youssef:   That's kind of going back to the patient and how they evaluate their own quality of life-

Dr. Adam Brown:  Exactly. How they value-

Nada Youssef:   ... and feeling it's not enough.

Dr. Adam Brown:  Some people should say, "Hey, look, I never want to go the knife. I can deal with it."

Nada Youssef:   I see. It all depends.

Dr. Adam Brown:  It's a discussion you need to have with your physician to not figure out what the best time for you is.

Nada Youssef:   Now, I know you're not a surgeon, so you don't have to answer this if you don't want to, but if after surgery, let's say, someone gets a knee surgery, after surgery, it's been a year or two, and they still have some pain in that area; does it mean they're not moving enough?

Dr. Adam Brown:  Good question.

Nada Youssef:   Do you ever have to redo?

Dr. Adam Brown:  I don't know the answer to that. Sorry

Nada Youssef:   That's okay. That's all right.

Dr. Adam Brown:  I have to work with my orthopedic surgeons, colleagues to figure that one out.

Nada Youssef:   All right, well, I'm going to jump on to some myths that I have read about and I want to kind of-

Dr. Adam Brown:  I didn't talk about the-

Nada Youssef:   Oh, yeah.

Dr. Adam Brown:  ... treatment of the other disease.

Nada Youssef:   Let's go back to that. Sorry about that.

Dr. Adam Brown:  Let's talk about the treatment for the other category of arthritis, which is autoimmune arthritis that encompasses lupus, encompasses rheumatoid arthritis, it encompanies psoriatic arthritis. That's a very different approach than osteoarthritis because, in autoimmune conditions, the problem is the immune system's overactive and for reasons we don't quite know, it's attacking various parts of your body, in particular, your joints. One of the goals of therapy is to help kind of reduce the immune system, which sounds scary, "Wait, why you want to suppress my immune system?" But, we're doing that because the immune system's overactive.

Nada Youssef:   Wow.

Dr. Adam Brown:  We're trying to bring it down. Hopefully, not to the point where you have infections, but that is one of the main side effects-

Nada Youssef:   Side effects.

Dr. Adam Brown:  ... of these medications.

Nada Youssef:   Wow.

Dr. Adam Brown:  It could potentially give you an infection like a pneumonia, urinary tract infection, or just a cold. The majority of times that does not happen. Most people live, hopefully, a normal life and they're doing well without major infections. What I often tell people is, "Get your vaccines while you're on these medications." Some vaccines you can't get while you're on these medications.

Nada Youssef:   Oh.

Dr. Adam Brown:  You speak with your doctor about that. But, most infections are fairly mild. For example, I often tell people is that a cold, for example, you get a upper respiratory tract infection or cold; instead of lasting five days, while you're on this immunosuppressants, maybe it will last eight days? It just often, it takes your body a little bit more time to get rid of these infections. That's one of the potential side effects. That's the most obvious one because that's the goal of therapy is to lower your immune system.

Dr. Adam Brown:  But, it's not to the point of where you hear about patients with cancer getting chemotherapy where they can suppress your immune system pretty profoundly, they're wearing masks, and they can't go to movie theaters and get on airplanes. The immunosuppression we're talking about for these conditions is much, much less than that.

Nada Youssef:   Much milder than that.

Dr. Adam Brown:  Exactly. People live, they go to movies, they get on planes, they travel, hopefully, live as normal life as possible with this medications. That's kind of the great thing about being a rheumatologist in this day and age is we have access to these medications that make a profound difference in people's lives, and hopefully with minimal side effects.

Dr. Adam Brown:  In contrast to that, we have the crystalline disease like gout, most commonly. That is a condition where your blood levels of uric acid is elevated. Uric acid actually forms crystals in the joints. That's why it's called crystalline disease. When that happens, it really pisses off your immune system, it starts getting really big, inflamed, it really attacks the joint, and you get a really huge, swollen joint. That's what gout is. There's ways to control the uric acid, particularly with diet, which is eating less meat, drinking less alcohol. There's a whole laundry list of things to avoid if you have severe gout.

Dr. Adam Brown:  With that said, most people with severe gout need medication on top of just the dietary changes, and those medications are aimed at reducing uric acid. Again, there's a handful of medications that do that, most commonly, allopurinol is one of the more common medications that can help kind of lower, reduce the uric acid to the point where hopefully, you never have a gout flare again. That's why it's one of the medications, that if you control the uric acid, we know the problem is that uric acid, if we control that, we can really help control the disease.

Nada Youssef:   When gout does flare up, how long does it usually go for?

Dr. Adam Brown:  If you don't take any medications, it often lasts from one to three weeks.

Nada Youssef:   Really?

Dr. Adam Brown:  Yeah.

Nada Youssef:   With that much pain for three weeks?

Dr. Adam Brown:  It's miserable. It's probably the, it actually is the most painful condition that I treat.

Nada Youssef:   Wow.

Dr. Adam Brown:  Patients with gout will tell you it's miserable. It's extremely painful.

Nada Youssef:   Wow.

Dr. Adam Brown:  Once we recognize it and have patients treated, hopefully, they don't have any flares, but if they do, patients can then take a medication to get rid of the flare right away.

Nada Youssef:   Right away?

Dr. Adam Brown:  Yeah.

Nada Youssef:   Never wait.

Dr. Adam Brown:  Exactly. They take steroids, they take the drug called colchicine, or they take high dose ibuprofen to really kind of eliminate the flare. Those are the ... You can take a medication for an acute flare, and then another group of medications to help prevent the flare.

Nada Youssef:   It's kind of like two different things here.

Dr. Adam Brown:  Exactly right.

Nada Youssef:   All right. Well, thank you for going back to that. Now, we're going to go to the myths. There are a lot of misconceptions about arthritis. I want to kind of bring it up, have a chance for you to clear the air on some of these things. Arthritis only affects your joints.

Dr. Adam Brown:  Osteoarthritis particularly affects the joints, the wear and tear up the joints. But, autoimmune conditions like rheumatoid arthritis, psoriatic arthritis, lupus; they're what we call multi-systemic, meaning that they involve not just the joints, they involve many parts of your body. That's why I like being a rheumatologist, is because I'm not just focused on just one thing. You still focus on the lungs, you focus on the kidneys, you focus on the heart because these conditions can affect all of them.

Dr. Adam Brown:  You have to work with your rheumatologists and rheumatologist has to, once they recognize the condition, they can help you know what to watch for. Okay? For example, lupus, which is much more common in women, especially young women, can involve the lungs and particularly involve the kidneys. The kidneys you don't often have symptoms from, so you have to work with the rheumatologists to check your blood levels to watch how your kidney is doing and do urinalysis, where they kind of measure different aspects of your urine to see if the kidneys are involved from the lupus. To your answer question, depending on the type of arthritis, no. Osteoarthritis does affect primarily the joints, but autoimmune conditions can affect any part of the body.

Nada Youssef:   All right, thank you. Then, this is an old person disease.

Dr. Adam Brown:  False. Again, the longer you live, the harder you are on the joints and the more wear and tear you're going to get on the joint. To a degree, osteoarthritis, you can get it when you're younger, but the vast majority of people have it the older they get. But, also, you have like nine-year-olds with types of inflammatory autoimmune conditions causing arthritis. No, it's not, depending on the type of arthritis you're talking about. Autoimmune conditions can happen at any age.

Nada Youssef:   All right. Arthritis is induced by a cold and wet climate.

Dr. Adam Brown:  I get that question a lot and the answer is weather can absolutely make a difference on the different types of arthritis. In my experience, what patients tell me is that the change in weather, for example, if it's going from 30 degrees to 60 degrees in a day, it can make them ache. But, once the weather is stabilized, whether it's hot or cold, they're at least more stable, the joint aches a little bit less. In my opinion, what I've seen from patients is that it seemed to be a kind of a rapid change in weather can make the biggest difference. It's probably pressure related. The pressure in the atmosphere that changes with weather can affect the pressure in your joints and it causes some pain. But, the whole saying that I can feel a storm coming's true. The patients tell me that a lot. They knew when the weather was going to change.

Nada Youssef:   Oh, that's amazing.

Dr. Adam Brown:  Yeah, it is.

Nada Youssef:   Warmth, like maybe a hot bath or just warm climates, can help the symptoms of arthritis, but it doesn't help cure it-

Dr. Adam Brown:  Cure it, exactly.

Nada Youssef:   ... obviously, or anything like that.

Dr. Adam Brown:  Patients often ask me whether cold packs or hot packs are better for their joints, and-

Nada Youssef:   That's a good one.

Dr. Adam Brown:  ... considering inflammation, warmth brings about inflammation. If you put like a hot pack on your hand and get a little bit of red, right?

Nada Youssef:   Yes.

Dr. Adam Brown:  That's usually inflammation, inflammatory cells coming into the surface. It makes sense to use cold to the decrease inflammation. But in reality, I've had patients swear by putting warmth on their joints and then making it feel better.

Dr. Adam Brown:  The answer is, do what makes you feel better.

Nada Youssef:   Wow, that's very interesting.

Dr. Adam Brown:  If cold makes it feel better, great. If hot makes it feel better, great. Some people alternate cold then hot-

Nada Youssef:   Really?

Dr. Adam Brown:  ... cold then hot on the joints, make them feel better.

Nada Youssef:   Just listen to your body-

Dr. Adam Brown:  Listen to your body.

Nada Youssef:   ... and do it actually feels good?

Dr. Adam Brown:  Exactly, try it.

Nada Youssef:   Excellent. Then, many think of this disease as a hopeless one since there is no cure.

Dr. Adam Brown:  No, that's not true. From osteoarthritis standpoint, we have lots of things to hopefully keep you moving and living you a normal life as possible. That may up being surgery to replace the joint. That's "curative" because you get rid of the joint and you put something, a hardware in there to take their place of the joint. People often do very, very well, even if they do get surgery.

Dr. Adam Brown:  In autoimmune conditions, a hundred years ago, I would say, "Yes, it was pretty bad," but now we have so many things we can do to help you and we have so many options in many of these conditions we can make a huge, huge difference in people's lives with these medications. It's definitely not hopeless. There's a lot of things we could do. You have to work with your rheumatologists closely to find out what medications are right for you. Often, we don't just have one option, we have multiple options, so we have to sit down as a team and say, "Which one's the best for you? This one has this side effects. This one has this potential side effect." Work together.

Nada Youssef:   Just like you said, there's physical therapy even before pills-

Dr. Adam Brown:  Absolutely.

Nada Youssef:   ... and then there's surgery after.

Dr. Adam Brown:  Absolutely.

Nada Youssef:   Right?

Dr. Adam Brown:  Yeah.

Nada Youssef:   Just kind of out of curiosity, is there no way to measure bone? Is there like a bone density test, something that you can take to find out if your bones are degenerating or anything like that?

Dr. Adam Brown:  Yeah. The X-rays will show if-

Nada Youssef:   X-ray.

Dr. Adam Brown:  ... you have osteoarthritis. They also can show if you have severe rheumatoid arthritis. Osteoarthritis is much more clear on X-ray. It shows that, for example, there should be a nice big space in between your bones, where they come together to form the joint, where the cartilages; but as you lose cartilage and you get wear and tear in that joint, those bones come together, so there's less space in between them.

Nada Youssef:   I see.

Dr. Adam Brown:  What you're talking about with bone-

Nada Youssef:   Density.

Dr. Adam Brown:  ... like a bone scan and bone density is what we're looking for osteoarthritis, which just means like weakening of the bone. That's a different category. It's not really a joint disease. It's more of like the-

Nada Youssef:   The actual bone, itself.

Dr. Adam Brown:  ... the actual bone itself.

Nada Youssef:   I see.

Dr. Adam Brown:  You hear of osteoporosis, they get a bone scan to look for that, and it tells you whether or not your bones are weak and you have a higher risk of having a fracture.

Nada Youssef:   Because you're more looking at the space or the cartilage in between the bones versus-

Dr. Adam Brown:  For the X-ray.

Nada Youssef:   ... the X-ray. For the X-ray versus-

Dr. Adam Brown:  For the X-ray, exactly.

Nada Youssef:   ... the bone density.

Dr. Adam Brown:  But, for the bone, actual the strength of the bone, that's called a DEXA scan and that's looking at-

Nada Youssef:   DEXA scan.

Dr. Adam Brown:  ... bone density and that's looking for osteoporosis, risk of fractures. X-ray is when you're looking for osteoarthritis or inflammatory arthritis, sometimes even gout you can see on the X-ray; but the bone density scan, that's for looking at the strength of the bone and the risk of fractures.

Nada Youssef:   Dr. Brown, you've been amazing. You answered all my questions.

Dr. Adam Brown:  I'm happy to be here.

Nada Youssef:   Thank you so much. Thank you for being here today. Thanks again to all of our viewers and listeners who joined us today. We hope you enjoyed this podcast. To learn more about arthritis and treatment options, please go to ClevelandClinic.org/arthritisguide and download our free treatment guide. To listen to more of our Health Essentials Podcast from Cleveland Clinic experts, make sure you go to ClevelandClinic.org/HEPodcast or you can subscribe on iTunes. For more health tips, news, and information from Cleveland Clinic make sure you're following us on social media, on Facebook, Twitter, and Instagram @ClevelandClinic, just one word. Thank you, and we'll see you again next time.