Arthritis Treatment Update (cont.)

SMITH:
Joint replacement for the ankle has not been successful. That's why we often opt for joint fusion for the ankle. This will greatly limit your mobility in the joint but it also will likely eliminate the pain.

Hopefully medical research will bring us to the point where ankle replacements are more successful but right now we just don't have enough success with them.

MEMBER QUESTION:
My husband has gout. What are the best methods to reduce this?

SMITH:
In addition to medication, diet can play a role. A diet rich in meats and high-fat foods can increase gout attacks. We recently discovered that being overweight may be the most important cause of gout attacks; there is something about being overweight that seems to trigger gout attacks. So in addition to medications I would recommend a healthy diet as well as losing any excess weight if necessary.

MEMBER QUESTION:
Have you heard of surgeons not performing a hip replacement because the hip arthritis was just too advanced? I have my first appointment with an orthopaedic surgeon next week.

SMITH:
Severe arthritis would not be a cause of not performing the surgery. However, if the area around the joint is so deformed, for whatever reason, it can make joint replacement impossible. I doubt this is the case with you.

Reasons for not doing surgery can be age as well as overall medical condition. If someone is too young they hesitate to do the joint replacement because they typically only last 15-20 years at the most. And redoing the surgery is quite complicated.

MEMBER QUESTION:
Can osteoarthritis affect multiple joints in the same person? And, if so, what are some possible causes (besides obesity)?

SMITH:
Osteoarthritis can definitely affect multiple joints in the same person.

We don't really know much about the causes of osteoarthritis other than obesity. There is some genetic tendency and we're still learning more about this. We've identified some genes that seem to increase the risk of osteoarthritis, but right now there really is no way to test for these genes.

We just really don't know what causes osteoarthritis in multiple joints in most people. Previous injuries are another possibility.

"Many people with arthritis are afraid of exercise but when done appropriately it can actually be one of the best treatments."

MEMBER QUESTION:
What are effective treatments for osteoarthritis in feet and ankles?

SMITH:
Treatments would be similar to osteoarthritis in other areas of the body. In addition to arthritis drugs, the doctor can consider physical therapy, but this would depend on the symptoms. Physical therapy is best for increasing range of motion and flexibility in the joint.

Exercise is also helpful. Many people with arthritis are afraid of exercise but when done appropriately it can actually be one of the best treatments.

If the arthritis is very severe, ankle fusion is a possibility. But this is done as a last resort because it will eliminate any range of motion in the joint. It does take care of the pain though.

MODERATOR:
Dr. Smith, we are almost out of time. Before we wrap things up for today, do you have any final words for us?

SMITH:
I think the recent developments with the anti-inflammatory drugs have left many people concerned. I want to reiterate that these drugs are very helpful. And while they do carry some risk the benefits for most people will far outweigh the risks. The best thing we can do is to help our hearts by living a healthy lifestyle with diet and exercise. Those of us who need these drugs, myself included since I have ankylosing spondylitis, need to rest assured that medical research is still looking into this.

Do what you can to stay healthy, take your medication as prescribed, but don't worry excessively about this risk. Just be sure to communicate with your doctor.

MODERATOR:
Our thanks to Michael W. Smith, MD, for joining us today.



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