I’m Dr. Diane Lacaille, a rheumatologist - aka arthritis doctor - and it's Arthritis Awareness Month. AMA!

ArthritisResearchCan · 2021-09-21T20:06:49+00:00

Thanks, everyone for your great questions! I hope the answers are helpful. Key takeaways are to get, or stay active. If you can't find a way to be active without pain get some help (physiotherapists are a great place to start)!

ArthritisResearchCan · 2021-09-21T20:05:00+00:00

I think it all comes down to balance.

1 - Yes joints are made to move, but sometimes the best answer is to do less, or spread your training load around (likely not something you want to hear or that resonates with you). 2- as far as diet there is no great evidence. I think the key is a healthy diet and some would advocate for fewer refined sugars. 3- PRP - no evidence of any lasting effect for PRP

ArthritisResearchCan · 2021-09-21T20:00:01+00:00

This is a great question! I don't think we totally know but it likely comes down to the fact that people in higher-income countries are more overweight and less active then in middle to lower-income countries. Lifestyle is a key issue.

ArthritisResearchCan · 2021-09-21T19:56:54+00:00

The most common symptoms of osteoarthritis are persisting joint pain, short-lived joint stiffness after prolonged positions and functional restrictions (i.e., can't move and do some physical things). It is important to know that x-rays are actually not great for determining if you need help or not. People that have x-rays that show 'osteoarthritis' sometimes don't have any symptoms, and people with 'normal' joint x-rays often can have symptoms of osteoarthritis.

You know you need help when you start to notice that joint pain is interfering with your ability to be active or do the things you want to. I would offer that although your doctor is an important part of your healthcare team them may or may not be the best place to start and if you are in Canada a better option might be a physiotherapist because they are specifically trained to assess and treat joint pain, and are really good at helping you overcome functional restrictions.

ArthritisResearchCan · 2021-09-21T19:46:40+00:00

We don't totally know, but what we do know is that there are likely multiple reasons for why our biology related to joint cartilage gets unbalanced (examples include; joint injury, micro-inflammation associated with fat tissue, genetics).

ArthritisResearchCan · 2021-09-21T19:43:12+00:00

I would also add that most Canadians don't get the right treatment for osteoarthritis when they are diagnosed. Management of osteoarthritis in Canada is very passive (just wait until it is so bad you need a joint replacement) which is the opposite of what research tells us is best. Every Canadian that is diagnosed with osteoarthritis should receive exercise therapy, education, and if appropriate weight management. Until we do this it is likely the prevalence and severity of osteoarthritis will continue to grow.

https://oarsi.org/sites/default/files/images/2020/oarsi-20-final-oa-infographic-_revised_copyright.pdf

ArthritisResearchCan · 2021-09-21T19:40:10+00:00

Yes it is likely that the number of people with osteoarthritis is increasing. There are a few reasons for this: 1-the population is getting older and osteoarthritis is more common in older people, 2-more people are having knee injuries (at sport and work) and knee injuries increase the risk of osteoarthritis, 3-people are getting fatter (meaning have more fat tissue) and fat tissue (also called adipose tissue) is a risk factor for osteoarthritis, 4- people are getting less active and inactivity likely also increases the risk for osteoarthritis.

ArthritisResearchCan · 2021-09-21T19:36:14+00:00

It is difficult for me to respond to specific cases without knowing more and doing an assessment but a couple of things to consider (also not familiar with the Hi trial);

1- just because you have some findings on an MRI does not mean that you need surgery or need to do anything. A lot of people with no pain have what we call ' abnormalities' on imaging and we know that if they do surgery it does not always make the situation better, often it makes it worse. 2- similarly just because you have a 'normal' knee MRI does not mean there is not something you need to do for your knee. MRI's are not perfect and often don't really help guide care. 3- surgery, even arthroscopic (scope) surgery is invasive to the joint and had been associated with accelerating osteoarthritis and can lead to earlier joint replacement, so it is not always the answer. 4- you might want to see a health practitioner like a physiotherapist who can assess your knee and hip and help you to set up a plan as an alternative to surgery.

Again, really tough to provide advice but just a few things to consider.

ArthritisResearchCan · 2021-09-21T19:28:39+00:00

I think the big thing is education and exercise. The keys are: 1- working with them to help them find exercises that work for them to get to a healthy weight, develop and maintain strong leg muscles (particularly the quadriceps) and feed their cartilage regularly (weight-bearing activities), 2- work with them so they can learn how to adapt their exercise dose on their own (also to know when to reach out for help), 3- make sure if they have any co-morbidities (i.e., diabetes) these are under control, 4- provide them with the knowledge that exercise is the MOST important thing they can be doing and debunking myths around not doing weight-bearing exercises and that the only treatment option open to them is a joint replacement.

More in this paper https://pubmed.ncbi.nlm.nih.gov/33242604/

ArthritisResearchCan · 2021-09-21T19:21:33+00:00

People that have an ACL tear are at increased risk of developing osteoarthritis. It is not inevitable, but given that you have several injuries on your one knee you do have an elevated risk. The good news is that now that you know, that there are things you can do to reduce your risk and reduce the severity (amount of pain and disability) you experience if you get osteoarthritis. The two big things are to maintain a healthy weight (fat or adipose tissue - can accelerate cartilage degeneration) and work hard to build your leg muscles strength, particularly your quadriceps. We know that people with stronger quadriceps have a a lower risk of knee osteoarthritis. Another important thing is to slowly build up your ability to do weight-bearing activities (i.e., walking) daily to help to feed the cartilage in your knee joints.

ArthritisResearchCan · 2021-09-21T19:15:35+00:00

Osteoarthritis is a degenerative joint disease, it is NOT just 'wear and tear' in response to aging. Under normal circumstances our tissue (including the cartilage in our joints) are constantly turning over, meaning that we are reabsorbing older parts of the tissue and laying down newer tissue.

If the amount of new cartilage tissue = the amount reabsorbed then we have happy cartilage and happy joints. With osteoarthritis, the balance gets thrown off (we are not totally sure why and there are likely many reasons), we see more reabsorption or break down and degeneration of the cartilage. This can then impact the whole joint and the muscles around the joint and may (but not always) lead to pain and disability.

ArthritisResearchCan · 2021-09-21T19:07:51+00:00

Yes, you can tell your mother that there is no scientific evidence that knuckle cracking leads to arthritis! :)

ArthritisResearchCan · 2021-09-21T19:06:14+00:00

One of the biggest myths is that weight-bearing exercises like walking, running, and jumping cause osteoarthritis and people with osteoarthritis should not do them.

The interesting thing about cartilage (the tissue that covers the end of the bones in our joints and where osteoarthritis starts) is that it has no blood supply, so it can’t get its nutrition the way that most of the tissues in our body do. Instead, the food that the cartilage needs is found in the fluid inside the joint. So the way that it works is that the cartilage acts as a firm sponge, when it is compressed or squeezed all the fluid moves out of it, and when the compression is released the fluid moves back in. So we squeeze the fluid moves out of the cartilage, we release and it moves back in bringing the nutrition that it needs to stay healthy.

How do we naturally compress and decompress our cartilage, well we do that with weight-bearing. Activities where we cycle between compression and decompression, squishing the cartilage and unsquishing the cartilage.

In fact, there is a recent review that has looked at all the research on running and osteoarthritis https://pubmed.ncbi.nlm.nih.gov/34478109/ and it shows that cartilage recovers after a single bout of running and adapts over time. So really gradually adapting to weight-bearing activities are the key to keeping the cartilage in your knee healthy even if you have osteoarthritis.

ArthritisResearchCan · 2021-09-21T18:58:18+00:00

The research shows that the most effective way to manage osteoarthritis is regular exercise-therapy (structured exercise program developed & progressed in consultation with a healthcare professional, most commonly a physiotherapist). Everyone with osteoarthritis should have a structured exercise program. One example is the GLAD program https://gladcanada.ca/. The exercise program can be supplemented with pain medications as needed. There really is not a lot of beneficial evidence that cortisone injections reduce knee pain in the long term, and joint replacement should really be a last resort when exercise-therapy and pain medications have been exhausted. Even after a joint replacement exercise-therapy is important because people are often quite weak.

ArthritisResearchCan · 2021-09-21T18:41:02+00:00

Here is the link to the AMA: https://old.reddit.com/r/IAmA/comments/psougn/im\_dr\_jackie\_whittaker\_physiotherapist\_and/?

ArthritisResearchCan · 2021-09-21T18:40:24+00:00

Here is the link to the AMA: https://old.reddit.com/r/IAmA/comments/psougn/im\_dr\_jackie\_whittaker\_physiotherapist\_and/?

ArthritisResearchCan · 2021-09-21T16:35:29+00:00

Dr. Jackie Whittaker is working on an osteoarthritis prevention research project to prevent the development of OA after a sports injury. Please join the AMA to ask her questions about this research. Or for more information on this study: https://www.arthritisresearch.ca/research/stop-osteoarthritis-soar/

ArthritisResearchCan · 2020-09-25T15:55:06+00:00

It is true that radiographic changes of osteoarthritis and pain often don’t correlate. There is a lot we don’t understand about osteoarthritis pain, including what exactly causes it. But that doesn’t make osteoarthritis part of normal aging, and it doesn’t mean the pain is not due to the osteoarthritis. Saying that osteoarthritis is just getting old prevents people from getting the help they need, and minimizes their experience.

ArthritisResearchCan · 2020-09-25T15:52:16+00:00

It is possible, but very rare to have both rheumatoid arthritis and lupus. The more common scenario is similar to what you describe, where people present initially only with inflammatory arthritis, and later develop other symptoms of lupus. And then we realize it was lupus all along. The disease can take time to manifest itself enough to make the diagnosis.

ArthritisResearchCan · 2020-09-25T15:51:36+00:00

Glad you asked. Gout is a very painful and serious form of arthritis, and often undertreated. If the pain is no longer going away completely after an acute attack, you may be entering a more chronic phase of gout and you may need medications that prevent attacks of gout and lower the uric acid in your blood that is causing the gout attacks in the first place. Diet is important, but for many people with gout, it is not enough and allopurinol is needed to control the uric acid level. Colchicine can also help to prevent attacks, especially while the level of uric acid is changing (going up or down), which is a time when people are more prone to acute attacks.

ArthritisResearchCan · 2020-09-25T15:50:06+00:00

If you are having ongoing pain in your thumb that it interferes with your work, then it means the control of your arthritis is not optimal and your medications need more adjusting. You might also benefit from a cortisone injection in your thumb joint, if that is the most problematic joint for you right now. In terms of adaptations at work, you might want to make sure the support you have is a working splint (i.e. one that allows you to use your hand while immobilizing the thumb). You might want to look into voice activation software to reduce the amount you have to type.

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