Osteoarthritis questions for all you lay doctors

[MidwestMom]

I have osteoporosis of my lower spine and osteoarthritis in my knees. I went to a rheumatologist for the osteoporosis diagnosis, but decided to go somewhere closer when my knee kicked up (after I had worked at a job for two weeks in which I had to climb, lift, bend, etc). My knee never bothered me that way before, but it's letting me know it's there now!

I'm wondering if it could be rheumatoid arthritis too because it's bothering me so much. I didn't work out today for the first time in forever. The knee was so sore yesterday that I actually felt physically sick too. Is that part of osteo?

I'm wondering, if this were you, would you go back to the rheumotologist, which is an hour away, or just see the knee guy who saw me for the osteoarthritis. He is in sport's medicine and I think they are Orthopedic surgeons (although no surgery is even being considered). I will probably have another x-ray. I've been going to PT, and I've been working hard, really pushing myself, but that seems to have made it worse. It's to the point where even putting my shoe on causes a little twinge in the back of my knee. And it aches sometimes even when I'm sitting down.

Any insight? I'm new to both osteoporosis and this osteoarthritis. I could use a little help on symptoms, treatments and doctors from anyone. Can the joint aches actually make one feel ill?

Thanks in advance!!!

[Dammit Janet]

You are quite old for RA to show up. It normally rears its head in younger people. Not just juvenile RA but regular RA. My 28 year was just dxd with it this past year.

If you have OA, it is just probably that you kicked it up in your knee. Go see a ortho. He can take xrays and see if maybe you tore the meniscus or just damaged the cartilage more and should consider getting it scoped .

[Hound dog]

If it were me, I'd be seeing the orthopedist for the osteoarthritis as it is in his area of expertise.....and not so much for the other doc, although they are quite knowledgeable as well. Rhuematoid arthritis and osteoarthritis are very different from each other, the treatments are also very different.

Like I said, that's what I would do.

[Lothlorien]

Yep, orthopedist (speaking from one who works for one). They can do bloodwork for rhuematoid. If those levels are elevated, then you can go to the Rheumy. I don't know your age, but I'm assuming, by looking at the ages of your kids that you are about 50? Osteoarthritis is not uncommon. There's not a whole lot that can be done to go back, but there are some preventative measures to reduce the progression and some palliative treatments like Synvisc or Hyalgen (for the knees). Your ortho should send you for a bone scan to determine if you have osteoporosis. There is medication to help prevent bone loss.

One thing that is super highly recommended is taking Calcium with Vitamin D to prevent bone loss. Orthos recommend beginning this very early. I started taking this in my early 30's. The other thing that the doc will recommend is Glucosamine/chondroitin.

[MidwestMom]

Thanks! I'll go back to the Ortho guy...he's ten minutes from me vs. an hour. I'm 56 so...yeah...lol.
I'm taking prescription Vitamin D right now for three months, then I'm going to go on something for osteoporosis because I have that in my spine. I was told not to take Calcium while I'm taking this. This may sound silly, but the Glocosamine gives me bad enough side effects that I won't take it. I'll see if he can come up with something else. Thanks!

[Marguerite]

Don't think that because te pain is really severe, that it's too severe to be "just" osteoarthritis. Osteoarthritis can be agony.

Rheumatoid arthritis is very much an inflammatory disease. That said, osteo can be eased with anti-inflammatory meds. But rheumatoid arthritis is a systemic disease, you get fever, heat and puffiness in the joint, elevated blood levels of various markers. Whereas osteoarthritis is generally caused by long-term wear and tear, in rheumatoid the 'wear and tear' is caused by the body's immune system.

If you have osteoporosis, you need to build up your body's calcium levels including boost your body's ability to absorb and use the calcium. You will benefit form Vitamin D with the calcium. I would get your GP to do some blood tests (one venepuncture should do it). You need to look for rheumatoid factor, for ANA, for ESR and also Vitamin D levels. The doc will probably have some other tests to throw in.

Something else to maybe consider - ask the doc (ortink about it yourself) to look for possible bleeding disorder. The most common one is von Willebrand's disease, which is caused by a defective gene. Von Willebrand's factor is needed in the clotting cascade, to help blood clot properly. It comes further along the line that Factor VIII, which is what haemophiliacs lack. The normal levels of von Willebrand's factor varies considerably, because a lot of people carry one defective gene which means they can at times have levels dropping to half normal. They make their own von Willebrand's factor, but not as much. When the body is stressed, their factor levels drop to half normal. We have recently discovered tat Dh is in this category. He had a cousin who lacked both genes, they didn't discover it until he was having surgery for a hernia repair. If they had known, they could have given him a preventive injection, but they didn't know so he bled out on the table. The message went out to the family - this is hereditary, everyone get checked. We found tat Dh has one defective gene which means his mother does too. We suspect PC2/GFG2 got a defective gene from dad, probably both boys as well. The only way to know for sure is to get checked for the gene, but they won't do that unless the factor level is checked and comes back as abnormal.

Why is this relevant? Because anyone with a bleeding disorder risks at time bleeding into the joints, and this causes long-term inflammatory problems as the blood in the wrong place causes the body to react to it. The joint gets damaged as a result.

Unlike haemophilia, von Willebrand's disease needn't be life-threatening. Knowing about it means that if you're going into surgery, they can give you a top-up of von Willebrand's factor. Of it there is an injury. But having low levels means you try to be careful and take it into account when you have an injury, that your blood will take a bit longer to clot. If you have one normal gene and one defective gene, your blood will a lot of the time take longer to clot but the long-term risk to life is minimal. However, joint damage long-term is far more likely than for the rest of the plebs.

If you know, you can take precautions and use other measures to protect your joints. And you can take tose precautions knowing you're not being a hypochondriac, but instead being responsible and sensible.

DH (and the kids) use a lot of wrist braces, knee braces and ankle braces. When we're travelling, Dh uses a wrist brace to carry the luggage. He puts it on even though his wrist is not hurting, because sure as eggs, if he doesn't use the brace he will get pain because the unsupported wrist will tear something and bleed internally. Not much, just enough to cause more problems. Plus he has hypermobile joints (which seems to go hand-in-hand with the form of Aspergers/autism we have galloping in our family).

Look after yourself. If you can't take calcium, at least find out if you can take Vitamin D. With the insistence on wearing so much sun protection (plus you've just come through a long winter) it is very easy to be low in Vitamin D. From what I recall, you have darker skin than average, don't you? Pale skins need a lot less sunlight to make the amount of Vitamin D they need. If you have olive skin or darker, you need a lot more sunlight. I have olive skin (currently tanned to coffee colour) and I can lie in the Aussie summer sun in the hottest part of the day for an hour, and not burn. But according to my blood tests I am still deficient in Vitamin D and have to take supplements.

Marg

[MidwestMom]

Hi, Marg. Thanks for the feedback. I'm going to ask my doctor about that disorder. I had low stores in my blood once and they were looking to see if it was significant, but couldn't find anything.

We don't get that much sun in Wisconsin. Although I have dark hair and eyes, I'm VERY fair skinned, so much so that I get skin poisoning...yuk. I even get it in Chicago and I don't burn or tan. The sun is pretty toxic for me so I sit in the shade. I will ask about Vitamin D, but I'm taking it in a prescription form.

I'm getting blood tests done on Tuesday, so I"ll know more then. I think this is osteoarthritis because I'm 56 and, although it is a pain in the knee (har har), my knee isn't swollen.

I appreciate all the feedback. Seems like there is always somebody who knows about medical stuff. Thanks again

[everywoman]

I have Von Willebrands. It was discovered after I bleed to death (literally brought back to life) after my hysterectomy. It is not always active, like Marge said, but if my body is stressed, it flairs. I always know when I started bruising badly. For instance, I can scratch an itch and bleed internally. Jana has it too, as does several members of my dad's family. What I didn't connect was the joint issue. My joints are all in bad shape. For instance, I have had 8 surgeries (2 on each knee, surgery on my right index finger, surgery on my right wrist) for joint issues. Right now I've got an inflamed tendon in my left ring finger. So far it is not triggering, but it is painful. There are very few days when I don't have significant joint pain. I take an anti-inflammatory every day. It helps take the edge off most days.

[crazymama30]

My dh has osteoarthritis, and his pain can be excruciating. I have a friend who has RA, she is in her 80's and has had it since her 20's. She is extremely disfigured, very severe case. She told me she thought osteo was more painful thann RA!

[Dammit Janet]

The thing about RA is there are treatments that can work to help. OA, you are SOL. You might be able to take an anti-inflammatory med such like motrin or even aleive or even a cox2 inhibitor like (sheesh, what is the only one left? Vioxx was one but they took it off the market.)? I cant take the cox2's because they dont work for me. Not worth the stroke chance since I get no relief. Motrin or other NSAIDs work a tiny bit. Ketoprofin works the best but they wont allow me to be on it for more than a month at time every 4 months because of stomach worries. But even the keto only gives minor relief.

There is nothing that stops the degeneration or reverses it except joint replacement. Thats the point I am at. We are on hold waiting for me to get to the point I cant take it one moment longer and hoping that will be over 50 because knees dont last but for so long and at 50 I would be looking at replacing them at least twice if not three times. Lovely.

[crazymama30]

The other cox 2 is Celebrex Dj--dh takes it.

[Dammit Janet]

LOL...yep CM...my mind is like swiss cheese half the time. I swear words escape me when I need them most. I normally can just walk away from the computer until I remember the word unless I really want to post fast. Then I just give you all my "whatchamacallit" random verbiage.

[Shari]

I have OA, as well, and have had the RA testing come back significant, tho with monitoring, the RA factor has decreased...so not sure what's up there.

I know that once my joints are irritated, tho, it takes months if not years for them to calm down.

I take maintenance ibuprofen, and most generally have joint pain every day...but I've had this since I was 28. I'm not replacing my knees yet! I also learned recently that sugar for a person like me is an inflammatory. For the past year or so, I've tried to follow closer to 130g carbs/day and have seen significant improvement in my joitn pain as a result.

My dad had OA as well, and an injection into his knees, Synvisc, helped him tremendously until he had his knees replaced.

[Dammit Janet]

Shari...I have had a cousin to that...cant remember the name of it but instead of only one shot like Synvisc, mine is a 5 shot series. I have done it three times in my left knee and twice in the right.

This last time...well lets just say it was a failure.

[Shari]

It got to where it wouldn't work for dad anymore, either, but it did buy him a few years.