Rheumatoid arthritis and osteoarthritis are very different types of arthritic conditions. This video will answer for you what is rheumatoid arthritis and what is osteoarthritis.
Rheumatoid arthritis and osteoarthritis can both be very significant, debilitating conditions that can cause significant pain and reduction in your physical ability. They’re different however. They’re different in what causes them. They’re different in how they’re expressed, the kind of symptoms that you have, and they’re different in how you treat them. It’s important to understand the difference because a correct diagnosis will get you on the path to a correct treatment program, which can then get you better in terms of your pain and get you back to doing the things that are important to you with the people that you care about. Rheumatoid arthritis is a type of inflammatory arthritis. What that means is that your immune system is being overly active and causing inflammation in the joints. How that works is your immune system, which is normally meant to defend your body against bacteria and viruses, in some cases can accidentally start to recognize your own body as foreign and then start causing inflammation by attacking those structures. In the case of rheumatoid arthritis your immune system recognizes your own joints and tendons and sometimes other organs as well. Basically attacks them, causes inflammation, which then causes pain, dysfunction, and destruction to the joints. Osteoarthritis on the other hand is a type of degenerative arthritis. What that means is that you have chronic instability in the joint which then leads to stress on the bone and the joint itself, which is what causes that degeneration to occur. You can get a mild component of inflammation in the joint but that’s not because the immune system is being overly active like you see in rheumatoid arthritis. Rather it’s because in osteoarthritis, you have chronic instability in the joint which leads to that chronic inflammation and stress on that structure. There are a number of other differences between these conditions as well. Such as Rheumatoid arthritis is a systemic condition while osteoarthritis is a local condition. That means is in rheumatoid arthritis you can also find other types of symptoms that are generally affecting the rest of the body. For example that condition can also present with fevers, weight loss, severe fatigue as well. In addition you can also have other organ systems that can be involved as well. Since it’s a condition where the immune system is overly active that overactivity can also affect other areas such as inflammation in the eyes, inflammation in the skin, amongst other areas as well. That’s not something you would expect to see in osteoarthritis. Stiffness is another interesting symptom that you can see in a lot of people that have arthritis in general. But it’s different in terms of how it presents in rheumatoid arthritis versus osteoarthritis. In general the stiffness that you see in osteoarthritis will last less than one hour. On the other hand the stiffness that you see in rheumatoid arthritis can last for several hours if not the whole day. That’s different because the systemic nature of rheumatoid arthritis leads to that overall feeling of stiffness that can be very profound and last for a very long period of time. Another interesting difference between these conditions is the effect of activity on the level of pain. In osteoarthritis, because the condition is caused by instability and stress on the joint, activity will make that condition feel worse. It’ll make the pain feel worse. On the other hand in rheumatoid arthritis activity generally actually will make the pain and the symptoms feel better. The reverse when it comes to rest. Rest in the setting of rheumatoid arthritis very much significantly makes that feel worse. While on the other hand in osteoarthritis rest and activity minimization generally makes the joint pain feel better. Swelling in the joint is another similar factor that you can see in all arthritis patients, but can be a bit different in rheumatoid arthritis versus osteoarthritis. In osteoarthritis you don’t always see swelling in the joints, sometimes you do. On the other hand in rheumatoid arthritis swelling is a hallmark and defining factor with how this condition presents. In addition because it’s severe inflammation the joint itself will actually feel warm. It can also look red in an inflamed state. You don’t see that level of inflammation in osteoarthritis. It tends to be a milder level of inflammation and swelling while in rheumatoid arthritis it’s significantly more inflamed and aggressive in that regard. Another important aspect to understand is that it’s possible to have a primary rheumatoid arthritis and then secondarily you also develop osteoarthritis. In that sort of condition the active inflammation may be under control, but you may have developed some chronic damage and some chronic secondary osteoarthritis. An appropriately trained musculoskeletal health and wellness physician will be able to differentiate between the two and should be able to get you on the right path for both the inflammatory component and for the wear and tear osteoarthritis component as well. Now that you understand the difference between rheumatoid arthritis and osteoarthritis, you can get yourself on the right track to treat your musculoskeletal condition in the right way, the ideal way, to get the best result possible. If you’d like to learn more about those treatment options, check out my additional content. If you found this information useful and interesting consider subscribing to my channel, subscribe to my email list. I hope this was helpful. Have a good day and live well, bye bye.
Today’s blog is a high-level, but significant overview, of what are the significant, non-surgical treatment options available for knee osteoarthritis. So, knee osteoarthritis is without a doubt one of the most common things that I see every single day in the clinic, and it’s significant enough where there’s quite a few different treatment options available. It’s a matter of understanding what works, what doesn’t work, what’s worthwhile for patients to pursue, and what, as physicians, can we really offer to maximize the health and wellness for our patients.
There are a couple of very initial things that every single individual that has knee osteoarthritis should be focused on before they even start getting treated from a medical perspective. Without a doubt, if there is any degree of excess body weight, weight loss and getting to an ideal body weight is of critical emphasis. Every pound that’s reduced can help reduce the weight on the knees by three to four pounds, so that can be significant in terms of reducing pain. If an individual has to lose 10 pounds, that’s a significant amount of stress reduction on the knees.
In a somewhat related fashion, improving the biomechanics is also essential. Strengthening, via either physical therapy or with a trainer or on one’s own, in particular, focusing on hip and core strengthening. The reality is that the knee, the hip, the back, the ankle, these are all connected in a very finely-coordinated motion that we’ve developed over thousands, if not tens of thousands of years. The way that we live in modern society is we’re too sedentary. Sitting too much leads to many people, if not most people, having some degree of hip weakness and core weakness. In the normal course of daily activity, walking, gait, running patterns, then leads to excess stress on the knees. The normal transfer from the trunk and hips down to the knees because of that weakness leads to more stress on the knees. Anything that can help to strengthen the hip and the core can also help with knee arthritis-related pain as well.
Also essential is improving posture and symmetry. This may sound relatively minor, but the reality is that we all have a slight degree of asymmetry from one side to the other side. We all have slight deviations in posture from the ideal. Those slight deviations, when applied over months to years to decades, leads to more stress on individual body parts including the knees. Trying to correct those kind of issues is of essential importance as well. Egoscue is a nationwide clinic that has a focus on posture-related stuff and I think that’s very helpful also.
Additional things that can be tried even before you get into my office would include maximizing joint healthy supplements that we know can help with osteoarthritis pain. That incudes glucosamine chondroitin, which can help roughly 50% of people that take that. Omega-3 can help with the mild degree of inflammation that you see in osteoarthritis as well. And turmeric, which has curcumin, can also help in terms of pain and some of the mild inflammation that you see in osteoarthritis. The benefit of these is that if that means an individual requires less pain medication, less anti-inflammatory medication, and that allows them to function more, do a bit more exercise, maintain their strength, reduce their weight. These are low-risk supplements. I like the idea of utilizing those in place of chronic anti-inflammatory medications. Other complementary treatments, including chiropractic, acupuncture, massage, and other low-risk options that can help with pain relief are certainly worthwhile trying for knee osteoarthritis.
Despite the above treatments, if an individual is still having pain in their knees, what’s next? From a non-surgical standpoint, the traditional injections include steroid injections or viscosupplementation injections, or gel injections. I’m not a fan of steroid injections for wear-and-tear arthritis for a number of reasons. Number one is that they’re short-lived in terms of benefit. Number two, they have the potential, if utilized too often, to actually damage cartilage, bone, and soft tissue. In addition, they don’t even help with improving things like stability and other other key physiologic issues that affect the knee.
Viscosupplementation injections can help in mild to moderate osteoarthritis. They tend to be a mild treatment option but are low-risk and can help as well. The next set of injections that I think are worthwhile really thinking and focusing on for knee osteoarthritis are orthobiologic treatments.
While this discussion is not about surgery, it is useful to understand the a few issues regarding knee surgery. Total knee replacement is a separate discussion, of course, and I think most knee osteoarthritis patients can be treated relatively well with the potential to avoid total knee replacement, but there is that need in some people. Arthroscopy, however, is one of the most common knee surgeries done for knee osteoarthritis. The reality is that there are multiple studies showing that routine knee arthroscopy, or a clean out surgery, is no better than just physical therapy. This is not recommended by the largest orthopedic professional associations. It’s actually not even allowed in certain countries where they try to manage healthcare costs because there’s no evidence that it’s of significant benefit in most people compared to just improving biomechanics via physical therapy.
A better option are the orthobiologic treatment options. Orthobiologics essentially means, ortho meaning related to the musculoskeletal system and biologics meaning treatments that are coming from cell-based treatments and biologic tissues. There are a number of different options. What’s nice about orthobiologic treatment options is number one, they can help with pain, they can help with inflammation, they are generally autologous, meaning coming from oneself, and so they are low-risk in terms of infection and reactions. In addition, besides treating pain, utilized in an appropriate fashion, they can actually help improve stability and function as well. You can do that because under image-guidance, you can inject orthobiologic treatments into tendons and ligaments. And if you can improve the chronic laxity, degenerative laxity, that occurs in a degenerative knee osteoarthritis condition, you can actually improve the stability in that knee joint as well, which will improve function and it will improve pain as well.
In terms of orthobiologic treatments, there are a number of different ones that are available right now. There are three very common ones that you may hear about. Platelet-rich plasma is probably the most common one that’s used at this time. This is essentially a treatment where you take a quantity of blood from an individual, from a blood draw, concentrate that down into a high concentration of one’s own platelets and then inject that into the tissue that needs to be treated. Whether that’s just a joint or the soft tissue structures as well, the data out there shows that this is a better treatment option than the viscosupplementation or gel injections. It gives not only more pain relief, it gives longer-lasting pain relief. This is a good moderate-level treatment option for knee osteoarthritis. I’ve had good results even in more advanced knee osteoarthritis. But certainly, a fairly reliable treatment option for mild-to-moderate knee osteoarthritis.
You can then escalate to what’s called bone marrow aspirate concentrate-derived stem cells. This is essentially a treatment where you take an individual’s own bone marrow from the back of their iliac crest over their pelvis, concentrate that down into a very high-concentrate of a number of different cellular materials, including mesenchymal stem cells, hematopoietic stem cells, and a number of other cell lines and growth factors which can then be injected into the joint, soft tissue, bone, and other parts of that degenerative knee condition. This is a good option for moderate to more advanced knee osteoarthritis. In my experience, but also in the published literature, this is a treatment option that can work in even advanced knee osteoarthritis. It’s not uncommon that patients come in and say that they’ve been told that they have bone on bone knee arthritis based on a X-ray, and yet when you have them flex and extend their knee, they are able to still get pretty good range of motion. That kind of individual can still respond quite well in terms of pain, in terms of reducing chronic inflammation, in terms of improving function, and maintaining a high-quality life as well.
The last one to mention are the birth cord fluid treatment options that people are hearing about. That includes amniotic fluid and umbilical cord fluid. These have been miscategorized as stem-cell treatments. The reality is that multiple sources have looked at whether there are any live cells in these products and the reality is that there are no significant live cells in these products in order to be sold in the United States. And that’s because, for safety reasons, in order to be utilized by physicians in patients, since it’s a foreign material, these are processed in a manner that essentially kills off all the cells and then, when it’s rehydrated to be used at the bedside, it will further kill off any remaining cells that were able to survive that initial screening process. While the birth cord fluid products are not a true stem-cell treatment, because they don’t have any live cells, they do have growth factors and they’re likely equivalent to a platelet-rich plasma injection, except coming from somebody else. These treatments can still be helpful, but I still think those first two options, platelet-rich plasma and bone marrow aspirate concentrate stem cells, are better orthobioligic treatment options.
That is really just scratching the surface but it’s a pretty good high-level overview in terms of what’s available from a non-surgical treatment standpoint. The reality is that compared to where we were 10 years ago, we’ve really come light years forward. With ongoing data collection efforts, and now results being published in the peer-reviewed literature showing effectiveness of these treatments. As time goes on, you will be hearing more and more about these treatments. They have a legitimate use. They need to be regulated in a appropriate way professionally, but these are good treatment options for knee osteoarthritis and for people that have chronic pain, knee pain that’s preventing them from functioning at a higher level. These are excellent treatment options to consider in anyone who has knee osteoarthritis.
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