Today I was able to talk to an arthritis expert:
Dr. Rebecca Burns, a rheumatologist at the Columbus Veterans Association.
Rebecca shared great insight into the pain points and symptom-relief tactics surrounding various types of arthritis. <\/p>\n\n\n\n
Dialogue has been edited for clarity.<\/em><\/p>\n\n\n\n I was reading about the importance of exercise for\nindividuals with arthritis. I know a lack of usage can lead to muscle loss and\na decrease in the range of mobility; However, I know it can be painful and even\nharmful if individuals over-use areas of their body affected by arthritis. How\ndo you discuss getting enough\u2014but not too much\u2014exercise with patients?<\/strong><\/p>\n\n\n\n \u201cGreat, so first of all it depends on the type of arthritis.\nSo, if they have osteoarthritis, we know it\u2019s good to keep using those joints\nand those muscles. For instance, if those patients\u2026Let\u2019s say they have knee\narthritis and they go to a physical therapist for knee pain. The therapist will\nactually focus on strengthening the muscles around the joint which kinda takes\nsome of the \u201cbad forces\u201d off of the knee, for instance, which can alleviate\nknee pain. So, we know that it\u2019s important to strengthen muscles around the\nknee joint. We certainly don\u2019t want these patients sitting around all day and then\ntheir muscles atrophy and they just become weak and debilitated. We also know that\nits healthier for the joints to get some exercise. Like anytime you\u2019re\nexercising and putting some load or gravity on that knee joint, it actually squeezes\nthe cartilage. It helps to nourish the joint. It makes them healthier. Again, we\nwant to make sure they\u2019re doing exercise and keeping those joints and muscles\nhealthy. That being said, you know there are some patients who will overdo it.\nThey may be deconditioned, and they go into it too much instead of working\ntheir way up. They pull muscles and tear things\u2026 They knock things loose, I\nguess you would say, and so that\u2019s not good for them either. I typically tell\npatients if it\u2019s hurting while you\u2019re doing it that means you\u2019re doing too\nmuch. You need to start slower and build your way up so you\u2019re not causing more\ninjury. But we usually do recommend a graduated exercise program for most of\nthese patients, especially if they\u2019re deconditioned to get back into it.\u201d<\/p>\n\n\n\n Thinking specifically of arthritic cases that have\naffected the upper body (hands, elbows, shoulders, etc.), what are some\ntechniques you give patients for regaining function that you\u2019ve personally\nfound to be successful? <\/strong><\/p>\n\n\n\n \u201cSo, I mean the first thing, especially from my standpoint,\nis to try to get some of their pain under control. Again, if this is like\nosteoarthritis we\u2019re talking about.. it might be an oral pain medication or there\u2019s\na lot of topical medications, creams and things like that.. There\u2019s topical EDSs\u2026\nSo, we try to do that to alleviate some of their pain. If it\u2019s something like rheumatoid\narthritis, then we try to treat the disease with immunosuppressant medications.\nAnd anytime we\u2019re decreasing the inflammation and pain, they\u2019re better able to\nregain function. As far as building back up once we have the pain and\ninflammation under control there are a lot of exercises. Like for the hand, the\nsqueeze balls and things like that are helpful and very effective. Paraffin wax\nbaths can help. They can do some light weights and things like that on their\nown, and then physical therapy is very effective especially when you\u2019re getting\ninto the elbows and shoulder and things like that. Here it\u2019s actually more occupational\ntherapy that does it, but they do similar exercises to a physical therapist and\nit helps them regain a lot of function.\u201d<\/p>\n\n\n\n And so I know through reading online that there\u2019s a ton\nof discussion around using hot compresses versus cold compresses, and I keep\nseeing individuals talk about morning routine where\u2014if they have it in their\nhand for example\u2014they need to dip their hands in water. Can you talk about\ntreating that stiffness in the morning with either hot or cold? The CDC says that 1 in 5 adults with arthritis have\nsymptoms of anxiety or depression. I know your job as a rheumatologist is to\ndiagnose and treat arthritis, not mental health concerns, but are there any\nforms of treatment you suggest or tips you give to clients who are struggling\nwith anxiety, depression, or poor body image in addition to their arthritis?<\/strong><\/p>\n\n\n\n \u201cYeah, so I think it definitely coexists. Here at the VA\n[Veteran\u2019s Association], it seems like more than 1 in 5 adults have anxiety or\ndepression just at baseline. So I think that we\u2019re really impacted by that. For\nsome patients, if its mild or it\u2019s just encouragement, if they come in with\nrheumatoid arthritis its just encouragement at first \u2018We have good medications for\nthis. We can help you get better. In a few month\u2019s you\u2019ll probably be doing\nbetter so there\u2019s hope.\u2019 With osteo it\u2019s a little tougher because there\u2019s not good\ncure for it. With rheumatoid there\u2019s no cure either, but we have good\ntreatments for it. I\u2019m quite often addressing things, like asking them how they\nfeel mentally or asking them if they\u2019re suicidal. We do have a very close\nrelationship with mental health. Most of our patients are seeing someone for\nmental health it seems like, and I\u2019ve been the one to send them sometimes.\nThese patients go for counseling or anti-depressant medication. There\u2019s also\npain relief with anti-depressant medication. Things like Cymbalta or Savella.\nThese are medications that treat things like anxiety and depression, but\nthey\u2019ve also been shown to treat pain form arthritis. So there\u2019s some\nconnection there too. Sometimes we\u2019re treating both there with the medication.\u201d\n<\/p>\n\n\n\n I keep reading about this connection between rheumatoid\narthritis and oral health. Can you expand upon this? Is this connection just\nwith Rheumatoid Arthritis?<\/strong><\/p>\n\n\n\n \u201cSo that was actually a really interesting question. I had\nto actually look into that a little bit in order to properly answer that. I\u2019m u\nable to find anything aside from rheumatoid arthritis, although I\u2019m sure there\nprobably is a connection with some other autoimmune diseases. I think a lot of\nthis was coming out when I was in my fellowship\u2014maybe like 10 years ago or\nsomething. I\u2019ve heard only about rheumatoid arthritis, but I suppose\u2014the\nmechanisms\u2014it makes sense that it could also be some other autoimmune diseases.\nFor one thing, it\u2019s hard for these patients to have good oral hygiene if they\ncan\u2019t work their hands very well, which is why they could have periodontal\ndisease. A lot of our patients with rheumatoid arthritis are on immunosuppressant\nmedication which can cause poor dental health and increase bacteria. Increase\ninfections. A lot of our patients co-existing Sjogren\u2019s Syndrome. <\/p>\n\n\n\n Yes, so those patients have extremely dry mouth and saliva\ncontains a lot of enzymes that are antibacterial. So those patients lack\nsaliva, they lack the enzymes. So they\u2019ll get a lot of dental carries, things\nlike that\u2014periodontal disease. So I guess that is obviously another\nimmunosuppressant state, so it\u2019s not just RA, it\u2019s Sjogren\u2019s as well. Some\nother things, at least from my learning and understanding, a lot of the pro\ninflammatory cells and cytokinds and things that are present in joints of\npeople with RA are also present in the mouth. I don\u2019t know if anyone knows for\nsure, but that would by my answer to that question anyway.\u201d<\/p>\n\n\n\n Great, then is there any current tips or tricks that you\nknow of\u2014I know you\u2019re not a dental expert but are there any products out there\nor forms of treatment that you would advise to patients to make sure they keep\nup their oral health?<\/strong><\/p>\n\n\n\n \u201cYeah, so first off if they have any dryness at all we\nrecommend artificial salivas. Bioteene is one of the ones patients will get\nover the counter or dentists will give to them. Those come in gels or\nmouthwashes and things like that. Other than that it\u2019s just common sense stuff.\nMake sure you\u2019re brushing at least twice a day, if not more. Make sure you\u2019re\ndoing a really thorough job. Mouthwashes. Make sure you\u2019re going to the dentist\nvery frequently. Tell them that you\u2019re having these issues so that they can\nreally screen you for dental carries and things like that.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":" Today I was able to talk to an arthritis expert: Dr. Rebecca Burns, a rheumatologist at the Columbus Veterans Association. Rebecca shared great insight into the pain points and symptom-relief tactics surrounding various types of arthritis. Dialogue has been edited for clarity. I was reading about the importance of exercise for individuals with arthritis. I […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[24],"tags":[139,228,227],"class_list":{"0":"post-1637","1":"post","2":"type-post","3":"status-publish","4":"format-standard","6":"category-voices","7":"tag-arthritis","8":"tag-interview","9":"tag-rheumatology"},"_links":{"self":[{"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/posts\/1637","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/comments?post=1637"}],"version-history":[{"count":2,"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/posts\/1637\/revisions"}],"predecessor-version":[{"id":1784,"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/posts\/1637\/revisions\/1784"}],"wp:attachment":[{"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/media?parent=1637"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/categories?post=1637"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/tags?post=1637"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\n<\/strong>
\n\u201cYeah, so that\u2019s an interesting question and a lot of people ask that for\ninjuries too. So I think that for most patients, if something like an acute injury\nor an acute type of swelling or an acute flare up, sometimes cold is effective.\nBut in general for most of my patients, it\u2019s heat that feels better. And I\ndon\u2019t even know if this is scientific or not, but I think this is just general\nexperience in terms of what feels better. Most of my patients will say that\nit\u2019s like the hot shower or hot bath\u2014dipping their hands in hot water\u2014that\nmakes it feel better and gets their joints loosened up and working better than\ncold. In general for my patients, heat is better than cold unless it\u2019s a case\nof an acutely injured joint or something like that.\u201d<\/p>\n\n\n\n