Arthritis - An Introduction For Patients

Preserving Your Most Valuable Asset What You Should Know About Arthritis C. Noel Henley, MD 2011

The Asset www.noelhenley.com

The Asset Your Time www.noelhenley.com

The AssetMore speciﬁcally, www.noelhenley.com

The AssetPain-free Time www.noelhenley.com

Who Am I? www.noelhenley.com

Who Am I?• Husband, Father, Board-certiﬁed orthopaedic surgeon www.noelhenley.com

Who Am I?• Husband, Father, Board-certiﬁed orthopaedic surgeon• Specializing in hand, wrist, and elbow www.noelhenley.com

Who Am I?• Husband, Father, Board-certiﬁed orthopaedic surgeon• Specializing in hand, wrist, and elbow• My goal is to restore and preserve function - with surgery or without www.noelhenley.com

Who Am I?• Husband, Father, Board-certiﬁed orthopaedic surgeon• Specializing in hand, wrist, and elbow• My goal is to restore and preserve function - with surgery or without• Orthopaedic surgeons provide surgical and non-surgical care for arthritis patients www.noelhenley.com

What Will You Learn? www.noelhenley.com

What Will You Learn?• What arthritis is www.noelhenley.com

What Will You Learn?• What arthritis is• Where it is www.noelhenley.com

What Will You Learn?• What arthritis is• Where it is• The two common types www.noelhenley.com

What Will You Learn?• What arthritis is• Where it is• The two common types• 3 steps to self-diagnosis www.noelhenley.com

What Will You Learn?• What arthritis is• Where it is• The two common types• 3 steps to self-diagnosis• An overview of treatment options www.noelhenley.com

What is Arthritis? www.noelhenley.com

What is Arthritis?• Arthr- : joint www.noelhenley.com

What is Arthritis?• Arthr- : joint• -itis : inﬂammation www.noelhenley.com

What is Arthritis?• Arthr- : joint• -itis : inﬂammation• Joint inﬂammation that causes pain and stiffness www.noelhenley.com

Is it a Bad Thing? www.noelhenley.com

Is it a Bad Thing?• Most of you know someone with arthritis www.noelhenley.com

Is it a Bad Thing?• Most of you know someone with arthritis• “My mom’s hands were bent and useless - I don’t want to end up that way” www.noelhenley.com

Is it a Bad Thing?• Most of you know someone with arthritis• “My mom’s hands were bent and useless - I don’t want to end up that way”• Pain, stiffness, trouble walking and using your hands or doing what you love www.noelhenley.com

Is it a Bad Thing? www.noelhenley.com

Is it a Bad Thing?• Non-joint effects www.noelhenley.com

Is it a Bad Thing?• Non-joint effects • depression www.noelhenley.com

Is it a Bad Thing?• Non-joint effects • depression • anxiety www.noelhenley.com

Is it a Bad Thing?• Non-joint effects • depression • anxiety • feelings of helplessness, dependence www.noelhenley.com

Is it a Bad Thing?• Non-joint effects • depression • anxiety • feelings of helplessness, dependence • activity limitations, job limitations www.noelhenley.com

Is it a Bad Thing?• Non-joint effects • depression • anxiety • feelings of helplessness, dependence • activity limitations, job limitations • difﬁculty participating in family/social activities www.noelhenley.com

Take-Home Point 1 www.noelhenley.com

Take-Home Point 1Arthritis is a Destroyer of your pain-free time www.noelhenley.com

Where is Arthritis? www.noelhenley.com

Where is Arthritis?• In the joints www.noelhenley.com

Where is Arthritis?• In the joints• Places where two bones meet www.noelhenley.com

Where is Arthritis?• In the joints• Places where two bones meet • ﬁngers www.noelhenley.com

Where is Arthritis?• In the joints• Places where two bones meet • ﬁngers • elbows www.noelhenley.com

Where is Arthritis?• In the joints• Places where two bones meet • ﬁngers • elbows • knees www.noelhenley.com

Where is Arthritis?• In the joints• Places where two bones meet • ﬁngers • elbows • knees • hips www.noelhenley.com

Take-Home Point 2Arthritis is a problem with the joints www.noelhenley.com

Where is Arthritis? Turkey Leg Bone

Where is Arthritis?

Where is Arthritis? Normal Joint

Where is Arthritis?

Where is Arthritis? Arthritic Joint

Where isArthritis?Most Common Locations: ﬁngers knees hips spine

Types of Arthritis

What Types of Arthritis Are There? www.noelhenley.com

What Types of Arthritis Are There?• Osteoarthritis www.noelhenley.com

What Types of Arthritis Are There?• Osteoarthritis• Rheumatoid arthritis www.noelhenley.com

What Types of Arthritis Are There?• Osteoarthritis• Rheumatoid arthritis• Less common www.noelhenley.com

What Types of Arthritis Are There?• Osteoarthritis• Rheumatoid arthritis• Less common • gout and psoriasis www.noelhenley.com

What Types of Arthritis Are There?• Osteoarthritis• Rheumatoid arthritis• Less common • gout and psoriasis • infection-related www.noelhenley.com

What Types of Arthritis Are There?• Osteoarthritis• Rheumatoid arthritis• Less common • gout and psoriasis • infection-related • fracture/trauma-related www.noelhenley.com

Osteoarthritis

Osteoarthritis (OA) www.noelhenley.com

Osteoarthritis (OA)• “Wear and tear” arthritis www.noelhenley.com

Osteoarthritis (OA)• “Wear and tear” arthritis• usually affects ﬁngers, knees, and hips www.noelhenley.com

Osteoarthritis (OA)• “Wear and tear” arthritis• usually affects ﬁngers, knees, and hips• develops slowly with age www.noelhenley.com

Osteoarthritis (OA)• “Wear and tear” arthritis• usually affects ﬁngers, knees, and hips• develops slowly with age• a problem with cartilage in the joint www.noelhenley.com

Osteoarthritis (OA)• “Wear and tear” arthritis• usually affects ﬁngers, knees, and hips• develops slowly with age• a problem with cartilage in the joint • hard, slippery covering over the ends of bone www.noelhenley.com

Osteoarthritis (OA)• Who has it? www.noelhenley.com

Osteoarthritis (OA)• Who has it? • 27 million Americans (about 10% of the population) www.noelhenley.com

Osteoarthritis (OA)• Who has it? • 27 million Americans (about 10% of the population) • more common in women than men after 45 years of age www.noelhenley.com

Osteoarthritis (OA)• Who has it? • 27 million Americans (about 10% of the population) • more common in women than men after 45 years of age • more common in overweight people and in those who stress their joints more (like runners) www.noelhenley.com

Osteoarthritis (OA)• Problem starts in the cartilage www.noelhenley.com

Osteoarthritis (OA)• Problem starts in the cartilage • normally allows bones to glide smoothly together www.noelhenley.com

Osteoarthritis (OA)• Problem starts in the cartilage • normally allows bones to glide smoothly together • the shock absorber in the joint www.noelhenley.com

Osteoarthritis (OA)• Problem starts in the cartilage • normally allows bones to glide smoothly together • the shock absorber in the joint • wears away with OA - becomes rougher - bone eventually grinds on bone www.noelhenley.com

Take-Home Point 3Osteoarthritis starts out as a cartilage problem www.noelhenley.com

Osteoarthritis (OA)• Other changes www.noelhenley.com

Osteoarthritis (OA)• Other changes • extra bone growth happens as the joint wears out (bone spurs) www.noelhenley.com

Osteoarthritis (OA)• Other changes • extra bone growth happens as the joint wears out (bone spurs) • the joint produces more ﬂuid www.noelhenley.com

Osteoarthritis (OA)• Other changes • extra bone growth happens as the joint wears out (bone spurs) • the joint produces more ﬂuid • swelling www.noelhenley.com

Osteoarthritis (OA)• Other changes • extra bone growth happens as the joint wears out (bone spurs) • the joint produces more ﬂuid • swelling • cysts on ﬁngers www.noelhenley.com

Osteoarthritis (OA)• Patterns in the hand and arm www.noelhenley.com

Osteoarthritis (OA)• Patterns in the hand and arm • some genetic (runs in families) component www.noelhenley.com

Osteoarthritis (OA)• Patterns in the hand and arm • some genetic (runs in families) component • small knots form at the end of the ﬁnger www.noelhenley.com

Osteoarthritis (OA)• Patterns in the hand and arm www.noelhenley.com

Osteoarthritis (OA)• Patterns in the hand and arm • bottom (or base) of the thumb gets swollen and deformed www.noelhenley.com

Rheumatoid Arthritis

Rheumatoid Arthritis (RA) www.noelhenley.com

Rheumatoid Arthritis (RA)• “Inﬂammation” arthritis www.noelhenley.com

Rheumatoid Arthritis (RA)• “Inﬂammation” arthritis• The immune system attacks normal joint tissues www.noelhenley.com

Rheumatoid Arthritis (RA)• “Inﬂammation” arthritis• The immune system attacks normal joint tissues• Starts in the joint lining ﬁrst - not in the cartilage www.noelhenley.com

Take-Home Point 4Rheumatoid arthritis starts out as a joint lining problem www.noelhenley.com

Rheumatoid Arthritis (RA)• Pattern is usually symmetrical - equal in both hands www.noelhenley.com

Rheumatoid Arthritis (RA)• Pattern is usually symmetrical - equal in both hands• Patients may have fatigue, fevers, and feel ill more than OA patients www.noelhenley.com

Rheumatoid Arthritis (RA)• Who has it? www.noelhenley.com

Rheumatoid Arthritis (RA)• Who has it? • 1.3 million people in the US (much less common than OA) www.noelhenley.com

Rheumatoid Arthritis (RA)• Who has it? • 1.3 million people in the US (much less common than OA) • more common in women than men www.noelhenley.com

Rheumatoid Arthritis (RA)• Who has it? • 1.3 million people in the US (much less common than OA) • more common in women than men • usually begins in middle age and is more common with increasing age www.noelhenley.com

Rheumatoid Arthritis (RA)• Problem starts in the joint lining www.noelhenley.com

Rheumatoid Arthritis (RA)• Problem starts in the joint lining • inﬂamed joint lining invades and destroys the joint surface www.noelhenley.com

Rheumatoid Arthritis (RA)• Problem starts in the joint lining • inﬂamed joint lining invades and destroys the joint surface • erodes/weakens ligaments around joints, causing large deformities www.noelhenley.com

Rheumatoid Arthritis

SymptomsDo You Have Arthritis?

Do You Have Arthritis? www.noelhenley.com

Do You Have Arthritis?• Pain in a joint is the most common symptom www.noelhenley.com

Do You Have Arthritis?• Pain in a joint is the most common symptom • at rest www.noelhenley.com

Do You Have Arthritis?• Pain in a joint is the most common symptom • at rest • after activity www.noelhenley.com

Do You Have Arthritis?• Pain in a joint is the most common symptom • at rest • after activity• Stiffness, swelling, and crunching www.noelhenley.com

Do You Have Arthritis?• Pain in a joint is the most common symptom • at rest • after activity• Stiffness, swelling, and crunching• Weakness, deformity - may be pain-free www.noelhenley.com

Do You Have Arthritis? www.noelhenley.com

Do You Have Arthritis?• Pain usually comes on slowly; may start with a fall or sprain www.noelhenley.com

Do You Have Arthritis?• Pain usually comes on slowly; may start with a fall or sprain• Stiffness usually worse in the morning www.noelhenley.com

Do You Have Arthritis?• Pain usually comes on slowly; may start with a fall or sprain• Stiffness usually worse in the morning• Initially, pain comes on after activity; later, aching pain may be in the background all the time www.noelhenley.com

Do You Have Arthritis? Common Locations www.noelhenley.com

Do You Have Arthritis? Common Locations• Hand www.noelhenley.com

Do You Have Arthritis? Common Locations• Hand • ﬁngertips www.noelhenley.com

Do You Have Arthritis? Common Locations• Hand • ﬁngertips • thumb www.noelhenley.com

Do You Have Arthritis? Common Locations• Hand • ﬁngertips • thumb• Wrist www.noelhenley.com

Do You Have Arthritis? Common Locations• Hand • ﬁngertips • thumb• Wrist• Elbow www.noelhenley.com

Do You Have Arthritis? Painful Activities www.noelhenley.com

Do You Have Arthritis? Painful Activities• Pinching www.noelhenley.com

Do You Have Arthritis? Painful Activities• Pinching• Gripping www.noelhenley.com

Do You Have Arthritis? Painful Activities• Pinching• Gripping• Writing www.noelhenley.com

Do You Have Arthritis? Painful Activities• Pinching• Gripping• Writing• Sewing/Knitting www.noelhenley.com

Do You Have Arthritis? Painful Activities• Pinching • Twisting• Gripping• Writing• Sewing/Knitting www.noelhenley.com

Do You Have Arthritis? Painful Activities• Pinching • Twisting• Gripping • Opening jars• Writing• Sewing/Knitting www.noelhenley.com

Do You Have Arthritis? Painful Activities• Pinching • Twisting• Gripping • Opening jars• Writing • Turning the steering wheel• Sewing/Knitting www.noelhenley.com

Do You Have Arthritis? 3 Quick Steps to Diagnosis www.noelhenley.com

Do You Have Arthritis? 3 Quick Steps to Diagnosis1.Think www.noelhenley.com

Do You Have Arthritis? 3 Quick Steps to Diagnosis1.Think2.Look www.noelhenley.com

Do You Have Arthritis? 3 Quick Steps to Diagnosis1.Think2.Look3.Touch www.noelhenley.com

Do You Have Arthritis? Step 1: Think www.noelhenley.com

Do You Have Arthritis? Step 1: Think•Is the pain in the knuckles or joints? www.noelhenley.com

Do You Have Arthritis? Step 1: Think•Is the pain in the knuckles or joints?•Did the pain start gradually? www.noelhenley.com

Do You Have Arthritis? Step 1: Think•Is the pain in the knuckles or joints?•Did the pain start gradually?•Are your joints stiff in the mornings? www.noelhenley.com

Do You Have Arthritis? Step 2: Look www.noelhenley.com

Do You Have Arthritis? Step 2: Look•Is your thumb or ﬁnger swollen around the joint? www.noelhenley.com

Do You Have Arthritis? Step 2: Look•Is your thumb or ﬁnger swollen around the joint?•Are your joints bent or crooked? www.noelhenley.com

Do You Have Arthritis? Step 2: Look•Is your thumb or ﬁnger swollen around the joint?•Are your joints bent or crooked?•Is there redness around the joint? www.noelhenley.com

Do You Have Arthritis? Step 3: Touch www.noelhenley.com

Do You Have Arthritis? Step 3: Touch•Does pushing on the joint cause pain? www.noelhenley.com

Do You Have Arthritis? Step 3: Touch•Does pushing on the joint cause pain?•Is there pain when you bend it? www.noelhenley.com

Do You Have Arthritis? Step 3: Touch•Does pushing on the joint cause pain?•Is there pain when you bend it?•Can you feel grinding or crunching? www.noelhenley.com

What Now?

What Now? www.noelhenley.com

What Now?• Doing nothing about arthritis may be appropriate www.noelhenley.com

What Now?• Doing nothing about arthritis may be appropriate• Rarely is arthritis dangerous www.noelhenley.com

What Now?• Doing nothing about arthritis may be appropriate• Rarely is arthritis dangerous • Exception: rheumatoid arthritis in the neck www.noelhenley.com

What Now?• Doing nothing about arthritis may be appropriate• Rarely is arthritis dangerous • Exception: rheumatoid arthritis in the neck• Worst case if you do nothing... www.noelhenley.com

What Now?• Doing nothing about arthritis may be appropriate• Rarely is arthritis dangerous • Exception: rheumatoid arthritis in the neck• Worst case if you do nothing... • slow worsening of function over years www.noelhenley.com

What Now? www.noelhenley.com

What Now?• Best case www.noelhenley.com

What Now?• Best case • a “burning out” of the arthritis pain www.noelhenley.com

What Now?• Best case • a “burning out” of the arthritis pain • stiffness, deformity, and abnormal function may persist with no pain www.noelhenley.com

What Now?• Best case • a “burning out” of the arthritis pain • stiffness, deformity, and abnormal function may persist with no pain • disease may not get much worse www.noelhenley.com

What Now?• Best case • a “burning out” of the arthritis pain • stiffness, deformity, and abnormal function may persist with no pain • disease may not get much worse • no one can predict this for you www.noelhenley.com

When to Get Help www.noelhenley.com

When to Get Help• When pain and stiffness are stopping you from doing what you want to do www.noelhenley.com

When to Get Help• When pain and stiffness are stopping you from doing what you want to do• When you’ve tried treatments on your own that don’t work any more www.noelhenley.com

Who Treats Arthritis? www.noelhenley.com

Who Treats Arthritis?• Primary care doctors and nurses www.noelhenley.com

Who Treats Arthritis?• Primary care doctors and nurses• Specialists www.noelhenley.com

Who Treats Arthritis?• Primary care doctors and nurses• Specialists • Rheumatologists (non-surgeon joint doctors) www.noelhenley.com

Who Treats Arthritis?• Primary care doctors and nurses• Specialists • Rheumatologists (non-surgeon joint doctors) • Orthopaedic surgeons www.noelhenley.com

Who Treats Arthritis?• Primary care doctors and nurses• Specialists • Rheumatologists (non-surgeon joint doctors) • Orthopaedic surgeons• Others www.noelhenley.com

Who Treats Arthritis?• Primary care doctors and nurses• Specialists • Rheumatologists (non-surgeon joint doctors) • Orthopaedic surgeons• Others • physical therapists www.noelhenley.com

How is it Treated? www.noelhenley.com

How is it Treated?• Medication (over the counter and prescription) www.noelhenley.com

How is it Treated?• Medication (over the counter and prescription)• Heat/Ice www.noelhenley.com

How is it Treated?• Medication (over the counter and prescription)• Heat/Ice• Rubs and creams www.noelhenley.com

How is it Treated?• Medication (over the counter and prescription)• Heat/Ice• Rubs and creams• Splints www.noelhenley.com

How is it Treated?• Medication (over the counter and prescription)• Heat/Ice• Rubs and creams• Splints• Exercise www.noelhenley.com

How is it Treated? www.noelhenley.com

How is it Treated?• Steroid injections www.noelhenley.com

How is it Treated?• Steroid injections • very small amounts www.noelhenley.com

How is it Treated?• Steroid injections • very small amounts • much different than steroid pills www.noelhenley.com

How is it Treated?• Steroid injections • very small amounts • much different than steroid pills • PAIN: I numb it up ﬁrst! www.noelhenley.com

How is it Treated?• Steroid injections • very small amounts • much different than steroid pills • PAIN: I numb it up ﬁrst!• Surgery - when is it time? www.noelhenley.com

How is it Treated?• Steroid injections • very small amounts • much different than steroid pills • PAIN: I numb it up ﬁrst!• Surgery - when is it time? • when other things stop working www.noelhenley.com

Surgery www.noelhenley.com

Surgery• Types www.noelhenley.com

Surgery• Types • arthritis removal - take out bone/joint www.noelhenley.com

Surgery• Types • arthritis removal - take out bone/joint • joint replacement (metal or plastic) www.noelhenley.com

Surgery• Types • arthritis removal - take out bone/joint • joint replacement (metal or plastic) • “clean out” surgeries www.noelhenley.com

Surgery www.noelhenley.com

Surgery• Results www.noelhenley.com

Surgery• Results • stops pain www.noelhenley.com

Surgery• Results • stops pain • improves function www.noelhenley.com

Surgery• Results • stops pain • improves function • reliable for most patients BUT - every patient is different! www.noelhenley.com

Making a decision www.noelhenley.com

Making a decision• No treatment or disease is risk-free www.noelhenley.com

Making a decision• No treatment or disease is risk-free • Risks of doing nothing www.noelhenley.com

Making a decision• No treatment or disease is risk-free • Risks of doing nothing • Risks of non-surgical treatment www.noelhenley.com

Making a decision• No treatment or disease is risk-free • Risks of doing nothing • Risks of non-surgical treatment • Risks of surgery www.noelhenley.com

Making a decision• No treatment or disease is risk-free • Risks of doing nothing • Risks of non-surgical treatment • Risks of surgery• No one can decide for you www.noelhenley.com

Making a decision• No treatment or disease is risk-free • Risks of doing nothing • Risks of non-surgical treatment • Risks of surgery• No one can decide for you • Many tools out there (providers and treatments) www.noelhenley.com

Where Do I Start? www.noelhenley.com

Where Do I Start?• Start with the doctor or nurse you know best and trust www.noelhenley.com

Where Do I Start?• Start with the doctor or nurse you know best and trust• Ask friends for recommendations www.noelhenley.com

Where Do I Start?• Start with the doctor or nurse you know best and trust• Ask friends for recommendations• Medicare or insurance may have rules about seeing one doctor or the other www.noelhenley.com

Where Do I Start?• Start with the doctor or nurse you know best and trust• Ask friends for recommendations• Medicare or insurance may have rules about seeing one doctor or the other• They can help you decide if going to a specialist is necessary or wise www.noelhenley.com

Summary www.noelhenley.com

Summary• You know what arthritis is www.noelhenley.com

Summary• You know what arthritis is• You know where it is www.noelhenley.com

Summary• You know what arthritis is• You know where it is• Osteoarthritis and Rheumatoid Arthritis www.noelhenley.com

Summary• You know what arthritis is• You know where it is• Osteoarthritis and Rheumatoid Arthritis• 3 steps to self-diagnosis www.noelhenley.com

Summary• You know what arthritis is• You know where it is• Osteoarthritis and Rheumatoid Arthritis• 3 steps to self-diagnosis• You have heard an overview of treatment options and whom to call next www.noelhenley.com

Final Questions About Treatments www.noelhenley.com

Final Questions About Treatments• Is it wasting your most valuable asset (time)? www.noelhenley.com

Final Questions About Treatments• Is it wasting your most valuable asset (time)? • Is there a more efﬁcient way of treatment? www.noelhenley.com

Final Questions About Treatments• Is it wasting your most valuable asset (time)? • Is there a more efﬁcient way of treatment?• Does it preserve the pain-free, functional time you have? www.noelhenley.com

Final Questions About Treatments• Is it wasting your most valuable asset (time)? • Is there a more efﬁcient way of treatment?• Does it preserve the pain-free, functional time you have? • Does the treatment have a lasting beneﬁt? www.noelhenley.com

Final Questions About Treatments• Is it wasting your most valuable asset (time)? • Is there a more efﬁcient way of treatment?• Does it preserve the pain-free, functional time you have? • Does the treatment have a lasting beneﬁt?• A doctor cannot answer these questions www.noelhenley.com

www.noelhenley.com

Learn more about your hand and arm problems atwww.noelhenley.com www.noelhenley.com

References• Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis Rheum. 2008 Jan;58(1):26-35.• Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum. 2006 Jan;54(1):226-29.• Simon L, Lipman SL, et al. Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis. 2nd ed. American Pain Society. Glenview, IL; 2002. www.noelhenley.com

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Arthritis - An Introduction For Patients

by C Noel Henley MD on Mar 08, 2011

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Arthritis - An Introduction For Patients — Presentation Transcript