Treating Osteoarthritis of the Knee - Episode 3
Peter L. Salgo, MD: Let’s just back off for a minute. Before we go any further, how do they present? What are the common symptoms of osteoarthritis?
Richard Iorio, MD: Simply, it’s pain, swelling, and stiffness, to some degree. And, obviously, it’s going to be less serious early in the disease than later, and can depend on whether or not trauma is involved. But, essentially, arthritis symptoms are sinusoidal in nature. They come and go, depending on activity, weather, barometric pressure, and things like that‑and activity level. Later on in the disease, as it gets more serious, perhaps ligaments can be involved. There can be instability or loose bodies that cause the joint to give way. Then, deformity can result, which leads to increasing disability as it accentuates the process going forward.
Peter L. Salgo, MD: When you talked about pain, swelling, and stiffness, I’m thinking, “Well, this could be rheumatoid arthritis.” How do you make the distinction at the bedside? Can you?
Paul Lachiewicz, MD: You know, I actually see patients with different complaints, Peter. The patients that come to me, they’re more like, “I can’t ski moguls anymore. Why can’t I do that?” You take an X-ray and find out that they have osteoarthritis. Or, “I’m having trouble walking the dog.” I think that it’s more of a disability than pain, actually. People have different reactions to their discomfort, and they’ll say stiffness rather than pain. So, from what I see, it’s a functional problem more than a pain issue, in some patients.
Peter L. Salgo, MD: Was it Mark Twain who said, “I do think about exercise. And whenever I do, I sit down till the thought passes?” I don’t know if he ever had osteoarthritis, but it’s a good thought.
Richard Iorio, MD: Exercise is good, up to a point. My mother used to say, “Everything in moderation.” You can exercise too much, if it causes injury to your joints. But, obviously, keeping your joints moving is a key part to living with arthritis. That’s what we’re talking about today, right? We’re trying to help people live with a disability that affects a great number of us.
Andrew Spitzer, MD: From a functional standpoint, to push that 1 step further, is to talk about what you said before, Rich. What we’re really aiming at is keeping the heart healthy. And so, to the extent that knee osteoarthritis creates disability and diminished mobility, we are creating a strain on the cardiovascular system. Even 15 minutes of moderate exercise, every day, decreases overall mortality, substantially. But, if you have a knee problem that is preventing you from doing those 15 minutes of exercise, then you’ve got a serious problem. So, ultimately, the diagnosis—whatever the patient’s complaining about—I think the key part is looking at how it’s functionally limiting them.
Peter L. Salgo, MD: So, again, it’s what’s it doing to your patient—not in the abstract, but at the clinical level (at the bedside level). That is an important takeaway.
Paul Lachiewicz, MD: That’s right. So, ladies will say, “I can’t walk my dog anymore. I used to be able to walk my dog, now I can’t do that.” Or, “I can’t go up and down to the attic anymore.” “I can’t go down to the basement.” Those are the complaints that I get.
Richard Iorio, MD: It’s interesting. To Paul’s point, golf is a typical analogy. “I used to be able to walk 36 holes a day, and play golf. Now, I can only walk 18 holes a day.” “Now, I can only walk 9 holes a day.” “Now, I can only take a cart.” Then, when they can’t take a cart and play, that’s when they have their intervention.
Transcript edited for clarity.