>>>: Welcome to Cleveland Clinic Online Health Chat
Moderator: You may submit your questions early by typing in the box below. All questions related to joint pain and arthritis will be addressed live May 15th at 12 noon Eastern Time. If you have questions related to another topic, please email ■■■■■■■■■■■■■■■
Moderator: Waiting for the chat to start? Here is a link for more information from our Center for Consumer Health Information ...... http://my.clevelandclinic.org/disorders/Arthritis/hic_Arthritis.aspx
Looking forward to chatting with you at noon!
Moderator: Today's Online Health Chat "Ask the Arthritis Expert" with Qingping Yao, MD will begin at noon (ET). Please submit your questions by typing in the box below and then click "Submit Question”.
Moderator: Take advantage of this rare opportunity to chat live with Cleveland Clinic expert Dr. Qingping Yao. Get answers to the most frequently asked questions regarding Arthritis. Bring your own questions to the web chat. This is your time to ask!
Moderator: Welcome to our "Ask the Arthritis Expert" online health chat with Dr Qingping Yao. We are very excited to have him here today! Let's begin with some general information while Dr. Yao begins answering your questions.
Moderator: Arthritis, or joint inflammation, causes painful, limited movement of joints. The three most common types of arthritis are osteoarthritis, rheumatoid arthritis and gout
The causes, symptoms and risk factors for each of these forms of arthritis may differ. You may suffer from more than one type of arthritis—for example, gout and osteoarthritis. Arthritis sufferers may also have associated medical conditions, such as cardiovascular disease with rheumatoid arthritis.
Fortunately, there is hope. With proper, early medical treatment, the pain and limitation of movement of arthritis can be improved.
Moderator: The Orthopaedic & Rheumatologic Institute at Cleveland Clinic offers expert diagnosis, treatment and rehabilitation for adults and children for bone, joint or connective tissue disorders. The Institute blends the strengths of Cleveland Clinic’s Orthopaedic and Rheumatologic Programs, both ranked first in Ohio and among the top three nationally by U.S.News & World Report.
Cleveland Clinic’s Arthritis & Musculoskeletal Center within the institute is a multidisciplinary clinic combining the expertise of nonoperative orthopaedists and rheumatologists in one location. Our evaluation and treatment center brings together experts so the cause of your joint pain can be quickly and appropriately diagnosed. Our team includes rheumatologists, nonoperative orthopaedic physicians, musculoskeletal radiologists, physical and occupational therapists, brace technicians and musculoskeletal patient educators.
Cleveland Clinic’s Department of Rheumatic & Immunological Diseases provides state-of-the-art diagnosis, treatment and rehabilitation for adults and children for diseases ran including rheumatoid arthritis, osteoarthritis, bursitis/tendonitis, osteoporosis, gout, pseudogout and multiple other forms of arthritis, systemic lupus, vasculitis, fibromyalgia and other diseases.
Moderator: Qingping Yao, MD, is a board-certified rheumatologist at Cleveland Clinic in the Orthopaedic & Rheumatologic Institute. He specializes in arthritis, lupus, and autoinflammatory disorders.
Dr. Yao completed his fellowship in rheumatology at University of California Los Angeles Medical Center, after his residency and internship in internal medicine Capital Health System – Fuld Campus, in Trenton, NJ. He received his doctorate at Peking Union Medical College, in Beijing, China. He graduated from medical school at the Inner Mongolia Medical College, in China.
savtaro: I am a 73 year old woman and I believe I have osteoarthritis. Pain in the knees is my worst symptom lately but it started years ago with an inability to stand for long periods of time without pain. I am now finding stairs very difficult whereas I used to go up and down easily and effortlessly. I am also very very stiff on rising, especially from a sitting position. A few months ago I tripped and broke my shoulder so all the focus of physical therapy and orthopedics has been on the shoulder but the leg symptoms are actually more troublesome. What can be done?
Qingping_Yao,_MD,_PhD: Your knee problem may likely represent osteoarthritis or degenerative changes. I would recommend trying knee quadriceps strengthening exercises and knee braces with heel wedges. But these would be best assessed by a rheumatologist and instructed in person. Thanks.
Chris04: Question- What preventative treatments do you recommend to help slow down or even prevent arthritis in general? What vitamin's and I am wondering how menopause affects arthritis?
Qingping_Yao,_MD,_PhD: Arthritis is a general term and includes many different forms of joint conditions. For osteoarthritis or degenerative changes, physical exercises, glucosamine and chondroitin would be helpful in some cases.
For rheumatoid arthritis which is a type of inflammation, hormonal changes could affect the disease process.
bav_patient: Thank you for kindly sharing your experience.
Last September, I was diagnosed with rheumatoid arthritis, and started taking a DMARD (sulfasalazine, 2 grams daily). In February this year, I have achieved remission with almost no pain, and no longer take NSAIDs often. About two month ago, my doctor reduced the dose of sulfasalazine to 1 gram a day. So far, the reduced dose did not lead to re-emergence in my symptoms. My blood tests for inflammation (ESR, CRP) also returned to normal.
I would like to ask you two questions. First, is it possible to completely stop taking sulfasalazine sometime in the future, or sulfasalazine has to be continuously taken at some maintenance dosage? Second, based on your experience, how common it is to have a rebound of arthritic pain after the DMARD therapy achieves the remission of rheumatic pain?
Qingping_Yao,_MD,_PhD: It is possible to completely stop sulfasalazine but folks with rheumatoid arthritis could be at a risk of recurrence. I would continue sulfasalazine 1 g a day (very small dose) for at least a couple more years.
About 15% of patients with rheumatoid arthritis could go clinically into remission completely without recurrence, but the remaining of the patients have intermittent disease course. Therefore, majority of people with rheumatoid arthritis may have recurrence sooner or later after stopping the medications. Therefore, it is reasonable to continue maintenance therapy.
GroKenHaMMer: Is all arthritis pain in the joint or can it be in the bone?
Qingping_Yao,_MD,_PhD: It could cause adjacent bone pain. It is really dependent on the type of arthritis you are referring to. The document linked above explains many of the diifferent types of arthritis. http://my.clevelandclinic.org/disorders/Arthritis/hic_Arthritis.aspx
Moderator: For those now joining us, we are currently chatting with Dr. Qingping Yao about Arthritis. To ask a question, type in the box below and then click 'Submit Question'.
Retired Dan: What new treatments are there in arthritis in the joints of fingers?
Qingping_Yao,_MD,_PhD: Arthritis is a general term and includes many different forms of joint conditions. The treatment is dependent on the condition. Thanks.
GroKenHaMMer: Is it possible to shatter a nodule on a thumb joint in the same manner as a spur on a heel?
Qingping_Yao,_MD,_PhD: If the nodule bothered the functionality of the thumb too much, a surgery could be done. If it was mild, I would just treat the pain and improve the function.
lutsk: In your opinion, is it beneficial to take supplements for osteoporosis as an additional therapy for rheumatic arthritis, particularly at the remission stage? Thank you!
Qingping_Yao,_MD,_PhD: Any supplements with vitamin D. and calcium components would be helpful.
enjoylife: Will arthritis progressively worsen as we age?
Qingping_Yao,_MD,_PhD: Arthritis has different kind of forms. If you had osteoarthritis, then the joints could become worse with age. However, if you do physical exercises to improve the functionality of joints, your joints might be stable.
Thank you.
Moderator: We are receiving many great questions so far! If you have a medical question not related to our chat about arthritis, please follow-up with your personal health care provider or use our contact link clevelandclinic.org/webcontact to submit your questions.
enjoylife: What are the signs and symptoms? Is there a cure or is it managed? Are there pain management techniques that truly work?
Qingping_Yao,_MD,_PhD: Did you mean rheumatoid arthritis or osteoarthritis? because the treatment is different.
Thank you.
sinaihospital: I have very bad arthritis in my right knee and also in right ankle. I tried shots therapy braces but it did not help me in the past by my foot and bone and joint doctors. Can surgery help me in this case for it?
Qingping_Yao,_MD,_PhD: What is the diagnosis of the joint condition?
Did you have trauma or injuries to the joints before?
I would recommend you to see an orthopedic surgeon.
Thank you.
kellwill: I know that I have osteo arthritis but at age 76 I am unable to tell whether my pains are attributable to that or something else. I have pains at night that wake me. They are not joint pains nor muscle cramps as far as I can tell. They occur in the thigh and calf and respond well to massage. But I do not know what causes them. Are these symptoms common with arthritis? If not, what should I consider?
Qingping_Yao,_MD,_PhD: Your pain in the thighs and calves could represent soft rheumatism other than joint condition?
Aquatic therapy might be helpful as is massage.
Thank you.
ernest: I hear conflicting things about lupus, especially when it comes to diagnosis. How difficult is it to definitively diagnose SLE? Is a positive ANA at a specific dilution level required?
Moderator: To register for an upcoming chat about Lupus - please go to this linkhttp://chat.clevelandclinic.org/chatpage.aspx?chatid=1464
Qingping_Yao,_MD,_PhD: There is no difficulty making a diagnosis of lupus generally speaking.
Positive ANA can be an adjunct in the diagnosis of lupus, but it can also be seen in normal healthy people. I would recommend you to see a rheumatologist.
Thank you.
redwoodpec: Are their diet items to be used or avoided? If so, what mushrooms for example?
Moderator: This question is best addressed by a nutritionist. But - Dr. Golubic did refer to the anti-inflammatory diet in his chat this past January. The transcript can be found at the following link. http://my.clevelandclinic.org/multimedia/transcripts/1444_lifestyle-choices-root-causes-of-chronic-diseases.aspx
ernest: What are the major diagnostic indicators you use when determining the specific type of inflammatory arthritis a person has? How important is that information to treatment? For example, does it help to know you're dealing with psoriatic arthritis rather than a generic inflammatory arthritis? Thank you sir.
Qingping_Yao,_MD,_PhD: Arthritis has different kinds of forms. There are blood markers available to help us differentiate between them. The markers could be used to differentiate between psoriatic arthritis and other inflammatory arthritis, such as rheumatoid arthritis and lupus related arthritis.Thank you.
Moderator: Just joining us? Please use your scroll button to view what you may have missed. If you would like to view the entire transcript of this chat after the event, it will be available online at clevelandclinic.org/webchat a week to ten days after the date of the chat.
Jaenin: I have Hashimoto's thyroid disease. Is there any way to head off things like rheumatoid arthritis and lupus? It is possibly too late as I am starting to get swelling of my joints as I sleep?
Qingping_Yao,_MD,_PhD: Sometime arthritis can be seen in people with Hashimoto thyroiditis.
There are ways to tell whether you have rheumatoid arthritis or lupus.
Your complaint of the symptoms might point to other forms of arthritis such as osteoarthritis. I would recommend you to see a rheumatologist.
Thank you.
Moderator: If you are interested in additional arthritis related chats, you may find the transcripts at http://my.clevelandclinic.org/multimedia/transcripts/default.aspx Once on the transcript page, just look under the category 'Arthritis'.
Chris04: Is there a genetic test for rheumatoid arthritis?
Qingping_Yao,_MD,_PhD: Genetic testing has been done for research purposes, but it is not clinically useful.
robtoby: Are there any dietary (or other) changes one can make for an occasional (and I mean once every few years) gout flareup? It's so painful (as you know) and I wind up on a Medrol dose pack to alleviate the pain. It's obviously not recurrent enough to go on any type of medication.
Qingping_Yao,_MD,_PhD: Diets are very important in the management of gout. I would recommend you avoid food such as mushrooms, fat meat, internal organ meat, and seafood. Certainly, alcohol reduction will be also helpful.
SeaWolf: Arthritis seems to be a fairly common problem for people in their 70s and older. Do you have any suggestions for lifestyle activities that help to limit the worsening of the arthritis symptoms such as diet and exercise? For instance, I participate in an aerobic exercise class in a warm water pool and that reduces the pain from my arthritis. What else can I do?
Qingping_Yao,_MD,_PhD: Physical exercise is helpful in relief of osteoarthritis related pain.
Each individual joint would require individual exercise. For example, for knee osteoarthritis, quadriceps strengthening exercise is advised.
Supplements such as glucosamine/chondroitin might be helpful in some cases. I would urge you to continue to do the warm water pool therapy.
Thank you.
Jaenin: My joints have been swelling at night. I have Hashimoto's thyroid disease. What sort of tests would I need to have done to diagnose whether it is rheumatoid arthritis or perhaps lupus?
Qingping_Yao,_MD,_PhD: Inflammatory arthritis can be associated with Hashimoto's thyroid disease. There are blood tests which can be used to differentiate between lupus and rheumatoid arthritis. I would recommend you to see a rheumatologist to find out.
Thank you.
Jaenin: I do a lot of lifting of buckets as I care for farm animals, and I go up and down stairs often. Should I cut back on my manual labor if I am diagnosed with Rheumatoid Arthritis or Lupus?
Qingping_Yao,_MD,_PhD: People with rheumatoid arthritis or lupus can do physical activities or labor work, depending on his or her symptoms. The exercise will be tailored to each individual and the degree of the exercises should be based upon its individuals tolerability.
nystrom: Can cracking knuckles cause arthritis?
Qingping_Yao,_MD,_PhD: Trauma or injury can cause traumatic osteoarthritis.
nystrom: Are there any exercises recommended for improving arthritis pain?
Qingping_Yao,_MD,_PhD: Yes, there are. For example, for knee osteoarthritis, quadriceps strengthening exercise is advised. The exercise could relieve pain and increase endurance or stamina.
Nellie: I know I have osteoarthritis beginning in my thumb joints and will eventually need surgery. But is it possible to also end up with rheumatoid arthritis? And is rheumatoid ever just confined to one area or does it effect the entire body?
Qingping_Yao,_MD,_PhD: Osteoarthritis or degenerative changes do not evolve into rheumatoid arthritis. However, advanced rheumatoid arthritis can cause degenerative changes or osteoarthritis.
Rheumatoid arthritis usually affects small joints in a symmetrical way. Certainly any joints could be affected including large joints such as knee.
Thank you.
Moderator: We have approximately 15 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.
jello: If you’ve had a DVT do you still consider knee replacement? What if your OA is very painful? Basically what are the real deciding factors to consider for knee joint replacement?
Qingping_Yao,_MD,_PhD: For knee replacement, people with knee osteoarthritis or other forms of arthritis have refractory pain and difficulty functioning. Therefore, to ease refractory pain and improve functionality, the knee joint placement would be needed.
For acute DVT, treatment with blood thinner such as Coumadin is necessary. During this period of time, it would be ideal to avoid surgery.
Thank you.
sallyp: What foods help arthritis? What are the pro and cons of fish oil supplement?
Qingping_Yao,_MD,_PhD: Fish oil and low sugar diet might be helpful in some cases. Glucosamine and chondroitin might be helpful for osteoarthritis in some cases. I would avoid overtaking Fish oil too.
north town: I have severe arthritis, constant pain. Should I exercise, walk?
Qingping_Yao,_MD,_PhD: Arthritis has many different forms. Generally speaking, no physical exercise would be encouraged while people have active joint pain.
However, physical exercise including joint exercise can ease pain for people with mild pain.
Thank you.
cliff: I was told to take Tylenol as needed on a daily basis. Couldn’t this be harmful to the kidneys?
Qingping_Yao,_MD,_PhD: Tylenol is generally safe for kidneys, but it could be a harmful to the liver if people take over 4 gms a day.
Thank you.
nystrom: Are people with arthritis more susceptible to common diseases like the flu?
Qingping_Yao,_MD,_PhD: Arthritis has different forms. If people have inflammatory arthritis, they could be susceptible to infections including flulike symptoms either from the disease itself or from the medications the patient might take.
Thank you.
kit and kaboodle: I’ve heard you can’t kneel after surgery; is this permanent or short-term?
Qingping_Yao,_MD,_PhD: Did you mean knee replacement surgery?Physical therapy to recover knee after knee replacement would be required for at least 3 months.Physical therapy will be guided by a physical therapist. Inappropriate kneeling would not be helpful in the recovery.Thank you.
Moderator: We are getting ready to close for today. A large number of questions were received and we apologize if we did not get to your question. We will try to answer as many questions as possible in these last few minutes. If you have additional questions, please go to clevelandclinic.org/health/livepersonchat to chat online with a health educator.
little b: Had a knee replacement (knee replacement was recalled) I have pain 75% of the time. Would I still feel pain from arthritis in that knee?
Qingping_Yao,_MD,_PhD: People with knee replacement could feel pain for a short period time such as several months. If the knee pain continues after 6 months, then the knee should be assessed by the orthopedic surgeon for possible mechanical issue or loosening.
Thank you.
Moderator: I'm sorry to say that our time with Cleveland Clinic expert Dr. Qingping Yao is now over. Thank you Dr. Yao for taking your time to answer our questions today about Arthritis.
Qingping_Yao,_MD,_PhD: Thank you so much for all of your questions today.
Moderator: To make an appointment with Qingping Yao, MD or any of the other specialists in our Department of Rheumatic and Immunologic Diseases at Cleveland Clinic, please call toll-free at 866.275.7496. You can also visit us online at clevelandclinic.org/rheum
Moderator: This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. . (c) Copyright 1995-2013 The Cleveland Clinic Foundation. All rights reserved.
Moderator: If you would like to view the entire transcript of this chat, it will be available at online at clevelandclinic.org/webchat in about a week to ten days after the date of the chat.
Moderator: Mark your calendar to chat with Cleveland Clinic expert George Thomas, MD, who will answer your questions about 'Resistant Hypertension: Get Your Questions Answered' on Wednesday, May 22, 2013 from 12:00 pm to 1:00 pm (EST). You may begin to ask your questions at 2:00(EST) today.