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Osteoarthritis Treatment

Posted Aug 24 2008 1:49pm
DAVID MARKS, MD: Hi and welcome to our webcast. I'm Dr. David Marks. Thank you all for sending in your questions about arthritis. We're going to try to answer them today.

Joining me to do that is Dr. Allan Gibofsky, Professor of Medicine and Public Health at Cornell, and a rheumatologist at the Hospital for Special Surgery. Thanks for helping us out.

DAVID MARKS, MD: The question is from Norma Fernell, it says, "I have osteoarthritis, and my hands are getting very disfigured, stiff and sore. Would surgery help this? If so, would my fingers still be stiff and painful?"

ALLAN GIBOFSKY, MD: An excellent question. Again, it's difficult to answer without knowing the degree of disability. There are a variety of surgical techniques for the patient with osteoarthritis. The questioner hasn't told me whether it's osteoarthritis of the wrist, osteoarthritis of the thumbs, osteoarthritis of the fingers or what-have-you.

We have to carefully differentiate between the gnarled knuckles of our grandparents, which are cosmetically problematic, but not functionally problematic, and those joints which are a result of chronic wear and tear have become degenerative.

In some instances, we can replace certain of the finger joints. In other instances, the degeneration may not be advanced enough to require that kind of surgery. In other instances, the degeneration may be too far advanced to resort to surgery for any one joint. There are several dozen joints in the hand, and it would not be possible to replace or repair all of them.

DAVID MARKS, MD: But if a joint is replaced, will that joint be painful and stiff and sore?

ALLAN GIBOFSKY, MD: One thing we do know is that replacement of a joint takes away pain. You cannot have pain in a joint that's been replaced by a piece of plastic or two pieces of metal. As far as range of motion, that too may be improved, but depending upon the deformities in the other joints around the joint, it may not be possible to get back to regular function.

Let me give you one anecdote. I had a patient with severe rheumatoid arthritis, a condition different from what the questioner is talking about, who had very deformed hands. She worked as a typist. Because of the deformities in her hands, she had trained herself to hit the keys with fingers other than the ones we traditionally teach people to use.

When she came in and had her fingers repaired, she was no longer able to work as a typist because by realigning her fingers, she couldn't train herself, again, in enough time to hit the keys the right way. So sometimes we have to be aware that not everything we do has the desired outcome.

DAVID MARKS, MD: Very interesting. The next question says, "How do you treat moderate osteoarthritis of the knee? What about cortisone injections every three months?"

ALLAN GIBOFSKY, MD: Moderate osteoarthritis of the knees has a variety of therapies available to it. We try to use them all in a staged, sequential, but sometimes concurrent fashion. We may prescribe medications to relieve pain. We may prescribe medications to relieve swelling. Or, if there is acute swelling - meaning that the knee itself is blowing up and collecting fluid - we may put a needle in, drain the fluid that's collected, and leave behind a little bit of prednisone or cortisone, which is a very powerful anti-inflammatory medication.

We don't like to do this more than three or four times per year, if that, because it is not a benign procedure. There is a risk of infection. There is a risk of leaving behind crystals which can cause further inflammation. So I think we try and tailor this to the individual. If an individual needs many more than three shots in their knee, it may well be time to see the orthopedic surgeon about removing or replacing that knee with a more appropriate structure and one that will be less painful.

DAVID MARKS, MD: Thank you for your questions, and thank you for joining our webcast. I'm Dr. David Marks. Goodbye.

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