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7:30 AM Fri, Nov. 16th

Physical therapy, medication are best treatments for arthritis

Matt Hinshaw/The Daily Courier<br>Dr. Daniel Burchfield, an orthopedic surgeon, talks about arthritis in the shoulder during the Arthritis Foundation’s “Living Well with Arthritis Expo” Friday afternoon at the Hassayampa Inn in Prescott.

Matt Hinshaw/The Daily Courier<br>Dr. Daniel Burchfield, an orthopedic surgeon, talks about arthritis in the shoulder during the Arthritis Foundation’s “Living Well with Arthritis Expo” Friday afternoon at the Hassayampa Inn in Prescott.

PRESCOTT - With the help of physical therapy and the proper doses of over-the-counter medication, many arthritis sufferers can live comfortably with the chronic disease.

During an Arthritis Expo conducted by the Arthritis Foundation Friday afternoon at the Hassayampa Inn, a Prescott-based rheumatologist and an orthopedic surgeon discussed treatments with about 80 event participants.

The foundation reports that 20 percent of our population is afflicted with arthritis, which inflames and degrades the body's joints, but that the severity of the disease in people varies broadly across the spectrum.

And the cost of arthritis to society is astounding, as billions of dollars are spent each year treating an affliction that represents the No. 1 reason for disability claims in the workforce. The foundation finds that early intervention and more services would decrease the impact since a cure remains elusive. Among other things, those who exercise regularly find themselves much better off, whether they walk, hike, bike or swim.

Dr. Kenneth Lawlor, a rheumatologist, said there are more than 100 different types of arthritis. Strikingly, the disease is not confined to the senior population, as more than 300,000 children in the U.S. have been diagnosed with it.

Essentially, arthritis affects our joints, muscles, tendons, ligaments and internal organs, which causes pain and difficulty moving.

Osteoarthritis, the most common form, is degenerative and can develop in the spine, hips, hands, knees and feet.

For example, in an arthritic knee, the cartilage, which lubricates joints so they move smoothly and painlessly, wears away to the point where bone grates on bone. When the knee is grinding constantly, it could lead to a knee replacement. Currently, there is no remedy for replacing cartilage, although one can receive injections for "cushioning."

With osteoarthritis, Tylenol, Tylenol Arthritis or generic acetaminophen, Aleve (naproxen) and other anti-inflammatory drugs are helpful, as is capsaicin cream - which has chili peppers as an active ingredient that block the body's pain signal.

"With enough of the right medications, sufferers can feel better, depending on the severity of one's condition," Lawlor said. "You can get this arthritis under fairly good control (with these meds). Some are afraid to take medicine, but Tylenol is fantastic. As long as you follow the directions on the box, you won't overdose."

Steroid injections, which are non-invasive and performed in a clinic, can provide one to six months of relief. But physical therapy remains one of the best treatments because a sufferer is rehabilitating the muscles around the joints to alleviate the pain, which takes pressure off the joints.

Physical therapists offer exercise regimens catered to a patient's specific needs and capabilities.

"There are lots of forms of therapy - you can dance at home, ride a bike, go for a walk, or bike to feel better," Lawlor said. "Joints are finicky. You must use them, so it's important to stay active."

About 21 million people in the U.S. have osteoarthritis, which represents about a quarter of all primary care physician visits, Lawlor said.

Lawlor added that based on one's symptoms, detected through a routine exam, a rheumatologist should be able to prescribe the proper treatment.

"It's most common in elderly individuals by the age of 65," he said of osteoarthritis. "You may or may not have pain, which can be off and on or constant."

Unlike osteoarthritis, rheumatoid arthritis occurs when the immune system attacks the joints. It can affect adults and children.

Severe rheumatoid arthritis has the capability to hinder all joints, although it primarily harms the hands, wrists, feet and ankles on both sides of the body.

Lawlor said this type of arthritis affects women two to three times more than men, although it can happen at any age. He added that the disease is worse in smokers.

"Something goes haywire in the genes, but the environment (smoking, air pollution) can bring it on," he said.

Methotrexate and other biologic injection medicines are "life-saving for rheumatoid arthritis patients now," Lawlor added.

"These new medicines can prevent joint damage and put this type of arthritis in remission, while causing minimal pain and swelling," he said. "These meds can carry a risk for developing blood cell cancers, but typically those cancers are brought on by longtime rheumatoid arthritis and not necessarily the meds."

While arthritis is crippling for knees and hips, Dr. Dan Burchfield, an orthopedic surgeon, said that shoulder pain is also a common problem that's a bit more complicated.

He added that rotator cuff tears in shoulders happen far more often than shoulder arthritis, where patients can feel a "crunch in the shoulder with bone on bone" because the cartilage has worn out.

Ironically, with rotator cuff tears, Burchfield said, it's the smaller ones that cause the most pain. He said that those with tears might not need surgery if the shoulder gets better after therapy. But it depends on the severity of the pain - such as whether one can't sleep through the night because of it, which often requires going under the knife.

"If physical therapy doesn't work after six weeks, we will put dye in the shoulder and look for a leak," Burchfield said. "If there's a hole in it, the dye will leak out."

With rotator cuff disease, Burchfield said physical therapy and anti-inflammatory drugs, such as cortisone, help clean up the problem.

He added that if patients simply do their shoulder exercises on a routine basis, it's less likely that they will have a recurring problem.

"If you strengthen the rotator cuff muscles, you can keep it (disease) from coming back," he said.

Burchfield said shoulder problems are complicated because sometimes people think it's their shoulder that's hurting them when it's actually the nerves in their neck or the muscles around the shoulder causing the trouble.

For more information about arthritis and how to combat the disease, log on to www.arthritis.org.