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Treating Arthritis and More

March 20, 2019 12:00 PM with Dr. James Grober

The pain of arthritis can be debilitating but there are treatments that can help you manage pain.  From non-surgical arthritis treatments and pain management, physical therapy and diet, to medications and integrative therapies James Stephen Grober, M.D. will be answering any questions asked. Submit your questions early.

Knee exam

Ben (Moderator) - 10:22 AM:
Get your questions in now, we will be starting the chat in about an hour and a half. Ask early to make sure your questions are in the queue.

Ben (Moderator) - 12:00 PM:
Welcome to the Treating Arthritis and More chat. The chat is now open and you can submit your questions at any time.

  Pat (Chicago, IL) - 12:04 PM:
I'm an 89yo F 5ft 200lbs with severe arthritis pain in my knees & hips and spinal stenosis. I've been taking Norco fives daily for years but the pain is so severe that I barely walk with a walker inside my home and no longer go outside. My comorbidities suggest I am too ill for surgery like a knee replacement and my chronic pain is so debilitating and exhausting that it consumes my life. What are some realistic options I should look into? Thank you
James Grober
Hi. Sorry, you are having such a tough and painful time. One of the challenges in a situation such as yours is to determine the source of the greatest pain and/or disability? Is it the radiating pain of stenosis, or localized hip or knee arthritis pain, or some combination thereof? Local injections of cortisone near the spine (epidural) might help, as well as injections into the hip and knee joints. Also, lubricating gel injection to knees is another option. For pain control beyond Tylenol, you and your doctor might consider Cymbalta, an antidepressant that has been separately studied and approved by the FDA for treating arthritis pain.

  Joan (Mundelein, Il) - 12:08 PM:
Hi, I've pain I knee and hip flexors. Will yoga warrior 1 help loosen those things and reduce the intermittent pain?
James Grober
Hi. Pain in the flexor tendons and muscles is often due to tightness or suboptimal flexibility. So, yes, yoga and other forms of stretches could be very helpful in addressing that. Remember to hold the stretches 20-30 sec to get the greatest benefit. Effective and safe stretches should feel like tightness or pulling and shouldn't hurt.

  Tom (Winnetka, IL) - 12:12 PM:
Is medical marijuana considered an effective alternate option to Celebrex and other NSAIDs? Less potential for adverse impact on organs? Can I take something other than OTC CBD and not violate an employer's drug policy?
James Grober
As you know, the use of medical marijuana to treat certain musculoskeletal conditions is on the rise in many states. The federal government strictly limits the extent of research on this, which makes it a bit challenging to talk about risks and benefits with the degree of confidence that we can with approved medications. That being said, I am not aware of any proven risks posed to internal vital organs. The primary concern relates to possible temporary adverse effects of THC on neurological functions such as cognition and reflexes. Pure CBD products do not raise such a concern. I do have a number of patients who are doing very well on medical marijuana products. You should check the details of your employer's drug policy before using any marijuana product which contains THC.

  Patti (Northbrook) - 12:21 PM:
I have fibromyalgia. What treatment do recommend and are you the doctor that helps with that?
James Grober
The mainstays of treating fibromyalgia are exercise (stretching, aerobic), proper sleep hygiene (such as keeping the bedroom cool and dark, no electronic devices in bed), and often medications such as muscle relaxants that have sleep-facilitating and pain-relieving properties. It's also important to be sure there is no underlying primary sleep disorder such as sleep apnea or restless legs, as these conditions require different approaches. Rheumatologists are well-qualified to diagnose fibromyalgia and offer guidance for treatment. Many patients can then do very well with ongoing management by their primary care physicians.

  Marian (Lake Forest, IL) - 12:27 PM:
When is it appropriate to see a rheumatologist for joint pain and arthritis?
James Grober
If you have joint pain and stiffness that's worst in the morning and doesn't ease up for more than an hour after getting up, then you might have one of the many forms of inflammatory arthritis such as rheumatoid arthritis or the arthritis of psoriasis (psoriatic arthritis) and should see a rheumatologist. Generally speaking, if you have widespread joint pain, that might be another indication of inflammatory arthritis. Also, if you or your primary doctor feel that your joint symptoms are not adequately controlled or have concerns about declining function, then seeing a rheumatologist might be helpful in clarifying a diagnosis and guiding treatment.

  Michele Gregory (Mundelein il) - 12:34 PM:
I have read about stem cell therapy for your knees. Does it work?
James Grober
The short answer is: I don't know but I sure hope so. There are a number of exciting but limited lines of evidence to support that it's effective for osteoarthritis (the most common type of arthritis), but we need more research - especially placebo-controlled clinical trials - before we can say so with confidence.

  Cas (Lindenhurst , IL) - 12:38 PM:
My thumb has severe pain when anything touches it, even water. Also if I reach out my hand, the thumb hurts. It is like a biting pain. Could this be arthritis?
James Grober
It could be, but I would also consider tendinitis. Osteoarthritis of the thumb typically involves the joint that is about halfway between the base of your thumb and your wrist. If you have severe pain at the base of your thumb that extends to your wrist with merely extending your thumb, you might have a kind of tendinitis called "deQuervain's tenosynovitis". Another thing to consider if water or only light touch is so painful would be some type of nerve irritation or pinching.

  Joan (Mundelein, Il) - 12:43 PM:
What are the top 3 foods to eat to reduce or at least not trigger arthritis pain? I just found that the nightshade veggies, which I love trigger pain!
James Grober
This whole topic of "anti-inflammatory diet" is very hot, as you probably know. As is the case with many things, however, sometimes the claims and the marketing outpace the science. That being said, proponents of dietary control of inflammation usually suggest avoiding gluten, dairy, and refined sugar and flour. Some also prohibit red meat and alcohol. The nightshade vegetables have also been implicated. I can tell you that I have some patients who feel very strongly that their diet changes have made a huge difference in their joint symptoms. I also have many patients who have tried most or all of the above measures without even a hint of benefit. And I'm not able to predict who will fall into either category. Two more dietary points: (1) patients who have true celiac disease (which is an autoimmune inflammatory reaction to gluten) absolutely MUST avoid gluten which is found in many food items besides wheat products. (2) turmeric has been shown to have antiinflammatory effects

  Kara (Evanston) - 12:51 PM:
Hi Dr. Grober What are your thoughts on the mind/body connection to pain management? I'd like to see more of an initiative of practitioners in discussing this with their patients and connecting them with mental health care providers, integrative medicine and support groups. Thank you! Kara
James Grober
The mind-body connection is relevant for pain in everybody but definitely seems to be stronger in some people. Did you know that in some arthritis pain studies, the placebo response rate (the percentage of people in the placebo group who report pain relief) exceeded 50%? Also, being sad or stressed can amplify pain in many people. I agree that all physicians should keep this important issue in mind. How best to address it is something that is probably best individualized from patient to patient. But I also agree that mental health professionals, support groups, and Integrative Medicine can be very helpful with this.

  Julie (Evanston, IL) - 12:57 PM:
Can cracking your knuckles cause arthritis?
James Grober
I'm happy to tell you that the answer is no :)

  Cathleen (Northbrook IL) - 12:58 PM:
Is cortisone the only injectable med option for knee pain relief?
James Grober
No. Other options include several forms of hyaluronic acid (often referred to as "gel injections") which is a component of normal joint fluid that confers a lubricating effect. Some practitioners offer injections of platelet-rich plasma (PRP) which includes growth factors that may be helpful, although more studies are needed to define the role of this approach.

Ben (Moderator) - 1:02 PM:
That's all the time we have today. Thank you, Dr. Grober, for all your expertise.

James Grober - 1:03 PM:
My pleasure. Thank you all for your questions.
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