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Dr. Paul Waytz

Appearances

Health Chatter

Arthritis and Rheumatology

1010.726

not just remove inflammation like you would get with ibuprofen and naproxen and drugs like that. So it does more than just remove the inflammation. It tries to prevent the inflammation getting to the joint. Because that was an aha moment. And one of the first medications was elemental gold. You must remember using gold for rheumatoid arthritis.

Health Chatter

Arthritis and Rheumatology

1038.188

And the great story there is that people thought that TB caused rheumatoid arthritis. And they knew that gold treated the tubercle bacteria. So they said, so we'll give that. Well, in fact, it does treat the tubercle bacillus. But it also reduces inflammation or prevents a certain amount of inflammation from getting there.

Health Chatter

Arthritis and Rheumatology

1065.423

People thought the same thing with hydroxychloroquine or Plaquenil, which is a drug that's used to treat malaria because people said, well, you know, TB is kind of like malaria. And in fact, Plaquenil is still a great drug for rheumatoid arthritis. And then people realized that there were a lot of side effects with gold and a lot of people were escaping, even if they benefited from it.

Health Chatter

Arthritis and Rheumatology

1087.716

And people said, well, one way to really treat inflammation is to give them a cancer drug. which is when the drug methotrexate began being used for rheumatoid arthritis, which, you know, once again, like many medicines, changed our lives because low doses of methotrexate, as opposed to cancer treating dosages, reduce inflammation. It works in a different way than treating cancers.

Health Chatter

Arthritis and Rheumatology

1115.729

And then all of a sudden, after a couple of decades of methotrexate, people were again escaping. And that's when the development of all the MAB drugs, infliximab and adalimumab and all these drugs that end in MAB, the monoclonal drugs that you see advertised. And they

Health Chatter

Arthritis and Rheumatology

1137.795

are once again changing how we look at things because they do a really, really good job of preventing inflammation from getting to the joint and other areas. So I don't know if that's kind of the long answer to the question, but we've evolved and we've continued to evolve so that when I retired 10 years ago, I think there were four biologics, which is the big group named

Health Chatter

Arthritis and Rheumatology

1167.628

And now there's probably 10 and more in the pipeline that work on different aspects of inflammation that produce the cells, the angry cells that chew up the joint.

Health Chatter

Arthritis and Rheumatology

1203.311

You know, I will send you a check in the mail for answering that question because gout is caused by an excess of uric acid. And we all make uric acid. Some people make more uric acid than others. And some of that's genetic or familial. Some it's because they eat too much of the wrong food, especially fatty foods, which helps the buildup of uric acid.

Health Chatter

Arthritis and Rheumatology

1231.277

Alcohol can increase the production of uric acid and slow down the ability for kidneys to get rid of uric acid such that uric acid will build up in a joint and uric acid becomes a needle-like crystal in the joint. And at some point, those needles, those crystals incite an inflammatory response. It's a different kind of inflammation than with rheumatoid arthritis, but it's very...

Health Chatter

Arthritis and Rheumatology

1266.705

It's a terrible situation where people have severe pain, redness, warmth, and swelling. Now you can treat that, or it will go away on its own after two weeks. But the uric acid stays there. And with time, the uric acid, if it left untreated, will affect multiple joints and can cause as much damage as rheumatoid arthritis. And nodules, just like some people get with rheumatoid arthritis.

Health Chatter

Arthritis and Rheumatology

1300.746

So it basically starts with uric acid. And the reason I thank you for asking that is gout is a treatable condition. We have wonderful medications, low risk, low side effect profile, that will lower the uric acid. And if you can get to people, again, before the damage, you can prevent problems with gout. Now, I'll tell you a story. You have to take those medications lifelong.

Health Chatter

Arthritis and Rheumatology

1331.364

There was a lineman for the Vikings who I saw as a patient who had gout. And he had it in a couple of joints. We made the diagnosis. I put him on the medication. He took it. He felt great, you know, and this was a tough guy, really tough guy. He felt so great. Like many people do. He said, I don't need this medication.

Health Chatter

Arthritis and Rheumatology

1355.003

He stopped the medication and within a month had an attack that brought this guy to tears. I mean, this was a professional football player who's, you know, been beat up and strung up and all this kind of stuff. He was in tears because he was in so much pain. So if there's gout and it's a treatable condition and in 2024 people, we shouldn't be seeing the amount of gout that we do.

Health Chatter

Arthritis and Rheumatology

1394.386

Yeah. So the typical symptoms is very abrupt onset, pain, severe pain, redness, warmth, and swelling, usually in the big toe. However, and so people say, oh, it's in the big toe. 30% of initial attacks of gout are more than one joint. which throws some people off because they say, well, you've got three joints, it can't be gout. Or it's not the toe, it's the ankle and the knee.

Health Chatter

Arthritis and Rheumatology

1424.327

The way to prove that, and this sounds barbaric, is you put a needle in a joint and you take a little fluid out. And you look at it under the microscope. And with very easy techniques, you can identify those crystals. And then you say, aha, I've made the diagnosis. I'm going to reduce the inflammation with one drug.

Health Chatter

Arthritis and Rheumatology

1446.306

And then I'm going to put you on another drug that doesn't fight inflammation, but lowers the uric acid in your system. The interesting thing, Clarence, is that say somebody comes in with an attack of gout. in their knee and you prove the diagnosis.

Health Chatter

Arthritis and Rheumatology

1462.279

I can guarantee you, almost guarantee you, that if I put a needle in a wrist that's not even symptomatic, I would find some uric acid crystals because that process has been going on for years. Wow.

Health Chatter

Arthritis and Rheumatology

1499.94

Yeah, it's because we're making uric acid on a daily basis. Okay. And you can lower it, but once you stop the drug, the processes that created that the elevation of the uric acid will just go right back to where they were. And again, we talk about diet and this and that and the other thing. A lot of it's genetic. The most part is genetic. So you're going to have it.

Health Chatter

Arthritis and Rheumatology

1525.151

And so here's another interesting story. The ancient Greek physicians recognized that gout would occur. And you can find gout in mummies, you know, so it's been going on. And the treatment at the time was to go chew on willow bark. Willow bark has acetylsalicylic acid in it, which is the basis of aspirin.

Health Chatter

Arthritis and Rheumatology

1551.057

And if you take enough aspirin or if, I mean, usually low doses of aspirin can aggravate gout, but if you take a lot of it, that will reduce the inflammation. So we, that was recognized, you know, many centuries ago.

Health Chatter

Arthritis and Rheumatology

1598.998

And that was the 1860s. I think Napoleon had gout. I think some of the czars had gout. And there's talk about wars that were either won or lost because somebody had gout or, you know, and they couldn't show up.

Health Chatter

Arthritis and Rheumatology

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Okay. So lupus is an autoimmune disease that generally affects women 10 times more than men. So you're correct there. And like with rheumatoid arthritis that primarily involves the joints, you can get joint involvement with lupus, but generally speaking, you have other organ systems involved, such as the skin. The lining of the lungs, the lining of the heart. So you have multiple symptoms.

Health Chatter

Arthritis and Rheumatology

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You have joint pain. You have chest pain. You have shortness of breath. The bad thing with lupus, the really bad thing, is I think the statistics are, let's just say, a good proportion, over 50%, will have kidney problems. That the inflammation attacks the kidney, which causes kidney failure.

Health Chatter

Arthritis and Rheumatology

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And there are several different kinds of kidney failure such that you really need to recognize what's going on. So part of a lupus evaluation includes looking at a urine specimen and doing blood tests that look at kidney function. Lupus can affect the brain. It can affect not only the lining of the heart, but the heart itself. It can affect other blood vessels.

Health Chatter

Arthritis and Rheumatology

1722.765

So it is potentially a life-threatening disease. Whereas rheumatoid arthritis tends to not be life-threatening, but chronic in pain, you can have life-threatening issues. And just like rheumatoid arthritis, it's a disease of young people, especially young women, women between the ages of 20 and 40. Wow. Wow. Wow. So, all right.

Health Chatter

Arthritis and Rheumatology

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Yeah, yeah. The yes, overuse can certainly lead to more wear and tear arthritis. And again, it's about the idea of pounding that cartilage in the knee or hips or shoulders with people, whatever they're doing, torquing or lifting weights and this type of thing that you're putting an unusual amount of force into. Cartilage is made to absorb a certain amount of force.

Health Chatter

Arthritis and Rheumatology

1826.42

If you overdo it for too long, then that's going to create some problem there. So that nice cushioning of the cart that the cartilage provides falters. And then it sets off, you know, a process that then includes inflammation that just aggravates the process. Now people said, well, does running or does running cause or not cause arthritis of the knees?

Health Chatter

Arthritis and Rheumatology

1855.455

And there have been studies that looked at marathon runners over years. And early studies suggested that it doesn't, that running doesn't, you know, marathon running. Now, you have to factor in a couple of things. You have to really look at more than a few years after as time goes on, so maybe 10, 15, 20 years. And that data still doesn't exist in clear fashion yet.

Health Chatter

Arthritis and Rheumatology

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The other thing is marathon runners tend to be very athletic, so they're not overweight and they're taking good care of themselves and they're eating properly, this type of thing. So it can be multifactorial. The other thing is that a prior injury someplace, so say you, I don't know, fell down some stairs when you were a kid and you had a bad knee, that is a precursor

Health Chatter

Arthritis and Rheumatology

1912.386

to running, aggravating the knee problem. So if there's something underlying going on, then you're gonna have issues. So overuse can certainly lead to wear and tear arthritis, but we're talking decades down the line, we're talking decades. Now, let me just, you know, I love stories. There were autopsy studies of Korean War casualties.

Health Chatter

Arthritis and Rheumatology

1942.502

And so young men in their 20s and 30s, and I think the original data suggests that 30% of Korean War casualties had wear and tear arthritis in their neck, already noted. So the process may start early. Now, you may not have symptoms for a long time. But we know something may well be going on, which then goes back to say, well, maybe there is a genetic issue with wear and tear arthritis.

Health Chatter

Arthritis and Rheumatology

1975.867

Maybe there is a disturbance of the autoimmune system that leads to this as well. So it was a fascinating study.

Health Chatter

Arthritis and Rheumatology

2025.26

Before Barry, so, and then you have to rehab that other side too.

Health Chatter

Arthritis and Rheumatology

2031.862

So it's like you can't win. Yeah, yeah. Go ahead.

Health Chatter

Arthritis and Rheumatology

2113.15

Sure. Yeah. And starting right there with working on a computer is... as I was winding up my career, we were seeing a lot more neck problems because of the position you need to get into to work on, um, uh, a computer. So, you know, we talk about, you know, raising the screen so that it's at eye level, not that you're bending over it.

Health Chatter

Arthritis and Rheumatology

2138.566

We see a lot of overuse issues with the hands, not only carpal tunnel syndrome because of the hand use on keyboards and things like this, but tendonitis and, you know, potentially even some wear and tear in small joints. and things like that because of overuse.

Health Chatter

Arthritis and Rheumatology

2158.278

So again, an overuse of small joints, you have the kind of the sedentary issue of, you know, sitting at a desk for six, seven, eight hours. So all of that contributes. So that's, Part of the answer. So I think we're seeing a new phase of the last two decades of people with wear and tear problems. and the shoulders as well. Yeah, lifestyle changes, weight loss is obvious.

Health Chatter

Arthritis and Rheumatology

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That's something that we always talk about and people think about, but I think the right amount of exercise that you put joints through your ranges of motion and things like that, that you strengthen, you mobilize. We think about certain physical activities such as swimming, which is not weight bearing.

Health Chatter

Arthritis and Rheumatology

2219.542

a non-weight-bearing exercise, so you don't have the pounding on the lower body and the lower back that you would get from walking, from running, and maybe even walking, depending on how much arthritis you have. problem with swimming, it's a terrible exercise for osteoporosis, which is the loss of bone mass, which can lead to fractures, which is not a fun thing as we age.

Health Chatter

Arthritis and Rheumatology

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Thanks for having me. It's a pleasure to be here.

Health Chatter

Arthritis and Rheumatology

2247.644

So, you know, I don't run anymore. I used to run and I walk and I always say that if I knew about cross training, you know, 50 years ago, I'd still be running because I would have added biking, I would have added swimming and this type of thing. So I think, you know, I think it's,

Health Chatter

Arthritis and Rheumatology

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I think our health in general depends on how we treat ourselves, what we put into our systems, and how we take care of ourselves.

Health Chatter

Arthritis and Rheumatology

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Right, right. Well, in general, as we're, when we're younger, our joints and our soft tissue, when I say soft tissue, we're talking about ligaments, tendons, they're Flexibility is maintained by their ability to stretch and move. And some of that or a lot of that relates to fluid. I mean, there's little bits of fluid in our tissues that if you did a biopsy, you might not see it, but it's there.

Health Chatter

Arthritis and Rheumatology

2367.617

We recognize that, that the chemicals that help us be flexible, the muscles, the tendons. and, uh, uh, and the ligaments as we age, we kind of lose that fluidity and some people lose it at a different age. Um, some people lose it when they're in their forties and fifties, some people not to their sixties or seventies.

Health Chatter

Arthritis and Rheumatology

2386.837

So what happens is that you lose the flexibility or the ability of the muscle or the tendon and ligament to stretch as freely and as painlessly. And so, um, um, So things are tighter.

Health Chatter

Arthritis and Rheumatology

2401.792

It's like if you had a very, a brand new rubber band that doesn't have the fluid, but as you stretch it more, you know, that it's the opposite issue there, but it's just, it's sadly a natural phenomenon that, that you. You get stiff. So as an aside, you know, Minnesota is home to so many Somali people, Somali people, the Somali language doesn't have a word for stiffness, right? Interesting.

Health Chatter

Arthritis and Rheumatology

2432.41

And we would see a lot of Somali patients and I had an interest in taking care of them. And most kinds of arthritis, people feel stiff, especially rheumatoid arthritis and osteo. So they use a descriptive term like it's as if I have metal in my body, which is, you know, if you think about it, it's as if you have metal.

Health Chatter

Arthritis and Rheumatology

2472.35

Yeah. And that's a multifactorial thing. With lupus, people die of kidney disease or they can die of brain disease. With... There are other kinds of inflammation. And again, people who don't even have joint problems, they have inflammation of blood vessels such that the blood flow is reduced maybe to the brain or to the heart.

Health Chatter

Arthritis and Rheumatology

2496.21

And it's almost as if there's a clot there and they have strokes or they could die or they could have heart attacks. The other thing, and especially with rheumatoid arthritis is that people, With these new medications, that's changed, Clarence, but people would be very sick. They would be bedridden. They couldn't exercise. They couldn't move well. They would get pneumonia easier.

Health Chatter

Arthritis and Rheumatology

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They would just be... chronically ill to the point that they couldn't participate in daily activities. And those people were just sicker in general, and they had earlier heart attacks than the general population. They would get pneumonia, and that would cause death. So that's changed a lot with our newer medications. And With rheumatoid arthritis in particular, there's two issues.

Health Chatter

Arthritis and Rheumatology

2553.232

People with rheumatoid arthritis, their cholesterol levels and their lipid levels will go up. So that adds to the cardiac issue. The other issue is that inflammation in our systems will raise lipid levels. And

Health Chatter

Arthritis and Rheumatology

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And so that's why if you go to a cardiologist, they may want to do a test called a CRP, which is a marker of inflammation, which might identify at risk people because so it's a secondary effect. Now, again, we're doing a better job, but it's still you got to you got to take care of all these things. And as rheumatologists, we learn to become almost like primary care docs for our patients.

Health Chatter

Arthritis and Rheumatology

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Exactly, exactly. Well, first of all, the term itis means inflammation. So you could have pharyngitis, inflammation of the throat, and all sorts of tendonitis, inflammation of a tendon. So arthritis technically means inflammation of a joint, which is a very generic term.

Health Chatter

Arthritis and Rheumatology

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Yeah. And going back to Clarence's original question about women with lupus, black women with lupus have the highest incidence of mortality. So now, So, you know, we live in Minnesota, which is a pretty white place.

Health Chatter

Arthritis and Rheumatology

2728.892

And so we may be a little we're not maybe not recognizing it. Now, things are changing. Obviously, I trained in Chicago. I did med school in Chicago and a Cook County hospital where it was different. I think there's a number of components here.

Health Chatter

Arthritis and Rheumatology

2745.16

One of which goes back, and again, we're getting into a little DEI stuff, is that people of color and people of various underrepresented groups will do better when they see a physician who looks like themselves. And that's been known. So if I was a black man and I had a white doc,

Health Chatter

Arthritis and Rheumatology

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whether I'm perceived to be complaining or not complaining, there'd be a tendency to not maybe go to him for the aches and pains and to say, I'm just going to put up with my aches and pains. You know, I'm just using that as an example. Yeah.

Health Chatter

Arthritis and Rheumatology

2788.673

Yeah. And you can have better outcomes when you see a doc that looks like you.

Health Chatter

Arthritis and Rheumatology

2794.877

That's been proven over and over again. So is it an incidence issue or is it just, um, is it just, um, you know, um, you know, I hate to say bias issue or, or, uh, that kind of thing. Um, so it's, it's very interesting. Um, I just want to get back to those statistics. When you say all these people go to the doctor or whatever, there's a lot of people who are not going to the doctor, too. Correct.

Health Chatter

Arthritis and Rheumatology

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They haven't. These are just the ones that do. Yeah, so you do a study at one point in time, and that's going to change. The overall statistics for rheumatoid arthritis involves 1% to 2% of the population. And you say, well, 1% to 2% isn't a lot. Hey, 1% to 2% is a lot. Of that 1% to 2%, about 5% are kids under the age of 16. So there's a condition called juvenile.

Health Chatter

Arthritis and Rheumatology

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For rheumatologists and physicians in general and healthcare practitioners, the term rheumatic disease is more encompassing because there are over 100 different kinds of arthritis or 100 different kinds of diseases. rheumatic disease, including some that have nothing to do with the joints. They may be inflammation of blood vessels or muscles or involve other things going on with the body.

Health Chatter

Arthritis and Rheumatology

2856.264

We used to call it juvenile rheumatoid arthritis. Now it's called juvenile inflammatory arthritis. Um, so I can't even remember what the original point was, Stan, but there's a lot of arthritis going on and, and people in underrepresented groups don't, don't necessarily do as well.

Health Chatter

Arthritis and Rheumatology

2872.727

And whether that's genetics, um, or it's because they're not getting to the care that they should be at the right time. It's, it's a complex issue that, you know, it's on my mind. I know it should be.

Health Chatter

Arthritis and Rheumatology

2919.926

Yeah. Well, maybe we should do a show about inflammation. There's many kinds of inflammation. It's expanding. Yeah, the inflammation of gout looks different than the inflammation of rheumatoid arthritis. The other interesting thing along those lines is I saw a number of patients, let's say a half a dozen, so that's, I don't know, it's a number or not a number, who are identical twins.

Health Chatter

Arthritis and Rheumatology

2944.892

And one twin had a rheumatoid arthritis or something, another didn't. And what's that all about? They ate the same food. They had the same cousins. So the takeaway here as we wind up is that there's a lot of arthritis out there.

Health Chatter

Arthritis and Rheumatology

2963.166

The second thing is if you have persistent problems, if you're having certain, you know, that are going on and something doesn't seem right, you should have that evaluated. And I would go to your primary care doc to start that. I mean, primary care docs are great people and they know what's going on. And you can say, well, I think this is osteoarthritis. I think this is rheumatoid.

Health Chatter

Arthritis and Rheumatology

2990.039

I think this is something a little more complicated. And then go see more a specialist after that. And that we do have these windows of opportunity that if you can get in and treat sooner rather than later, you can prevent a lot of problems down the line. Now that's not to say that you can cure, we don't talk about curing arthritis here.

Health Chatter

Arthritis and Rheumatology

3016.427

Although I'd like to think we could cure gout just by taking a pill every day or something like that. But I think early diagnosis and when necessary, early treatment or changes in lifestyle, I think can go a long way in helping people.

Health Chatter

Arthritis and Rheumatology

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Okay. That's great.

Health Chatter

Arthritis and Rheumatology

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There's a lot of jokes. Those are good jokes.

Health Chatter

Arthritis and Rheumatology

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Like I said, arthritis is a very generic term. There's many, many rheumatic diseases, some of which are obscure. We're probably recognizing new rheumatic diseases every few years. So like I say, at a cocktail party, we'll say arthritis between the several of us, we'll say rheumatic disease.

Health Chatter

Arthritis and Rheumatology

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It's been a pleasure. Thanks for having me.

Health Chatter

Arthritis and Rheumatology

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Yeah, it's a great question. So a number of itises, like pharyngitis or carditis, could be caused by an infection like strep. A strep throat is truly an inflammation of the throat. Some viruses can cause inflammation of the heart and this type of thing. However, inflammation is a complicated process and there's many kinds of inflammation. So the root of most rheumatic diseases is inflammation.

Health Chatter

Arthritis and Rheumatology

395.88

And I want to come back to something related to that in a minute. And the itis or the inflammation is often caused by a disturbance of our immune system. So our immune system protects us from foreign agents, external agents, and really does an amazing job in terms of taking care of us.

Health Chatter

Arthritis and Rheumatology

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But sometimes that immune system goes haywire, it goes awry and we start producing inflammatory problems as a basic term against our own organs and tissues.

Health Chatter

Arthritis and Rheumatology

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Um, and my aside here is that the most common type of arthritis is osteoarthritis or wear and tear arthritis, um, which is more of a degenerative process, um, where something is, it goes wrong with the cartilage of our joints, the spacer between the two bony surfaces and, um, There's wear and tear. You lose the normal joint function and joint protection and inflammation can occur.

Health Chatter

Arthritis and Rheumatology

462.027

So we have osteoarthritis, but it's often a secondary process to bone rubbing on bone or a fragment floating around a joint or something like that. So the most common kind of arthritis is kind of and it's becoming clear now that there's probably some immune issues related to it. is more wear and tear and related to other factors like overuse or being overweight and this type of thing.

Health Chatter

Arthritis and Rheumatology

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But the most damaging kinds of arthritis, like rheumatoid, is a problem with autoimmunity.

Health Chatter

Arthritis and Rheumatology

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Yeah, so they truly don't deal so much with the inflammation per se, but the result of the inflammation. Inflammation that has damaged the joint. So once that joint becomes, it's not functioning as well, there's bone on bone or bone near bone, and you get the pain from that because you lose the cartilage spacer. So they're dealing with more of a mechanical issue.

Health Chatter

Arthritis and Rheumatology

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where a mechanical problem, that's a result of the inflammatory process. And, you know, we try, you know, rheumatologists say we like to keep people away from orthopedists as much as possible because that means, oh, well, it's end stage in that joint or something is going on. We need their help to kind of manage the pain by hand. doing a procedure or something like that.

Health Chatter

Arthritis and Rheumatology

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We're trying to, that's, that's the, that's the goal. Although it's amazing. You know, people these days go to, they say, I have pain. I'm going to go see an orthopedist. And when in fact they have something that they should be seeing a rheumatologist first.

Health Chatter

Arthritis and Rheumatology

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Yeah. Yeah. Yeah. Yes.

Health Chatter

Arthritis and Rheumatology

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Well, certainly too much food. I got that one. I saw that one. But basically, it's a great subject. And a lot of people will say, there's no evidence that food affects different kinds of arthritis. And I think that's erroneous because everybody's different.

Health Chatter

Arthritis and Rheumatology

627.077

And if you have some inflammation, I don't think a food problem causes arthritis, but I think food, some people have sensitivities such that if they eat a certain thing, then that might flare their arthritis. And over the years, and there are numerous diets that people propose for, you know, helping arthritis and, and, you know, some of them, have no basis in science.

Health Chatter

Arthritis and Rheumatology

656.152

But if a person thinks that they're eliminating a certain food helps, I would be the last person to say, don't do that. I think there's certainly a placebo effect. And when I say placebo effect, I don't mean to diminish that. But I think that's a very important issue. But it's a very individual thing, Clarence.

Health Chatter

Arthritis and Rheumatology

677.008

And, you know, for some people, if they eat, say, tomatoes, their arthritis flares, and most people, it's not going to be a problem. So again, just like the immune system, it's very individual. Okay, thank you.

Health Chatter

Arthritis and Rheumatology

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Yeah. You know, rheumatologists aren't as sexy as orthopedists. And it's that old surgical adage, a chance to cut is a chance to cure. So they say, well, I got my knee problem. You know, they'll scope me or they'll do a procedure and I'll be fine.

Health Chatter

Arthritis and Rheumatology

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Um, whereas your rheumatologist is, you know, when you say you're a rheumatologist at a party, it's usually a, you know, a showstopper there, you know, people go, okay, fine. Right. Um, but I, I think. Mercifully, I think people are getting more knowledgeable these days and they have friends who have rheumatic problems and they'll say, you know, my knee hurts.

Health Chatter

Arthritis and Rheumatology

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And maybe that friend or somebody with some knowledge, including their primary care doctor will say, do any other joints hurt? And that's the next step. Orthopedists, and I love orthopedists, I have some good friends, you know, you go in with your knee, they're focusing on the knee. And a good orthopedist will say, do you have any other joint problems?

Health Chatter

Arthritis and Rheumatology

792.029

And once they say, yeah, my wrist and my ankle, they said, well, maybe you ought to see a rheumatologist because it might be more than one joint. It's multiple joints that are giving you the problem. But rheumatology is the relatively new field where people were doing orthopedic procedures a century or more ago.

Health Chatter

Arthritis and Rheumatology

822.961

Yeah, you know, I'd like to, I'll just interrupt. It is, but again, with the development of new medications over the last, let's say, 50 years and increasing numbers of new medications, our ability to change the course of people with various kinds of arthritis has improved significantly, especially rheumatoid arthritis, which for years was known as the great crippler.

Health Chatter

Arthritis and Rheumatology

851.61

And it still can be that way, but we've got some amazing medications and amazing insights into how we treat and approach. And I will say this for our listeners, especially, there's a window. There's a window that of a couple of years, that if you can start appropriate treatment within that window, you can do, you know, a light year's worth of work to prevent joint damage.

Health Chatter

Arthritis and Rheumatology

879.437

Once the cartilage is damaged, you can't repair that. You know, it's gone. And it may lead to a process of progressive problems. But if you can get in there before at the very early stages, that changes lives.

Health Chatter

Arthritis and Rheumatology

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Good point.

Health Chatter

Arthritis and Rheumatology

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Sure. That's, again, a great question. Well, when I started out in private practice, say 1980, we, so up until, for a long time, people said, oh, all you can do is remove the inflammation or treat the inflammation that's there and you're treating the pain. And then some bright people said, well, we should try and do more. So they developed, so medications came to be that would reduce