Oct. 2, 2024
When Uncle “Arthritis” makes a visit
Do you wake up with achy joints or is your body stiff and sore? Tamika Perry, DO from WellMed at Redbird Square explains what happens when your “Uncle Arthritis” makes a visit.
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Show transcript
Podcast transcript
INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts, Dr. Tamika Perry, and award winning veteran broadcaster Ron Aaron, will share information to improve your health and wellbeing. And now here are Ron Aaron and Dr. Tamika Perry.
RON AARON
Thank you so much for joining us today on the award winning Docs in a Pod. I'm Ron Aaron. Our podcast is available wherever you get your podcast. Docs in a Pod is also available on several radio stations in Texas and Florida as well. We've got a special treat today. Our co-host is also our expert. Dr. Tamika Perry is with us. Dr. Perry, as many of you know, is an associate medical director at WellMed. She oversees several large clinics in the Optum Care North Texas Region. As associate medical director, Dr. Perry's goal is to support the providers at these clinics. She also serves as a primary care physician for WellMed up near Dallas. Dr. Perry earned her undergraduate degree from Prairie View A& M. She then went on to graduate from Philadelphia College of Osteopathic Medicine for where she was National Health Service Corps Scholar. Dr. Perry, when she's not playing doctor, loves to travel and has been to six of the seven continents. Antarctica is on her list.
DR. TAMIKA PERRY
Antarctica is on my list. Most recently, I was in Thailand. Unfortunately, while I was in Thailand, I got an infection from food there. But I love Thailand, so let me just put that out there. I segued that into that the infection actually caused my joints to hurt. There is more than one reason why your joints may hurt.
RON AARON
Which brings us to the question of arthritis. I know you were telling me off the air and I'm as guilty as anybody else, I wake up in the morning and this hurts, that hurts, this hurts. I figure it's arthritis.
DR. TAMIKA PERRY
And you're right. So, your uncle Arthur, that's what I like to call him, will move into your joints. Hell being his wife, he'll bring his side girlfriend, all his kids, and he will wreak havoc in your joints, and it is difficult to evict him. But you got to figure out first where Arthur is coming from. So, arthur literally means joint. Itis means inflammation of the joint. Why is there an inflammation of the joint? Ron, most commonly is osteoarthritis, which is just wear and tear arthritis. Unless you sit on a log as an entitled princess your whole life, you are going to get osteoarthritis because as long as you move your joints, at some point they start to wear out. Think of them like parts of a car. At some point you have to change your brake pads because they just go out. Your joints you use from the time that you exit your mother's womb. You're moving your arms, your legs, your knees and most commonly osteoarthritis is in the large joints like the hips, the knees, the shoulders because those are the ones that we use most often.
RON AARON
Now I ended up with a left knee total replacement, ultimately because the pain was too much for me to bear. Bone on bone, nothing in there to protect me. Arthritis is clearly a trigger for that. I went for a period of time getting shots, trying physical therapy, but in the end, nothing worked.
DR. TAMIKA PERRY
Ultimately, they had to change that joint for you. Now, when you were in high school or college, were you an athlete?
RON AARON
I don't know if I'd call myself an athlete, but I was a swimmer. I swam on the swim team, and I wrestled intramurally. So, I guess I could be called an athlete.
DR. TAMIKA PERRY
Those joints were used more than the average bear would use those joints, your knees and your hips and wrestling and swimming to a degree. Actually, swimming is good for osteoarthritis because you get the benefit of the exercise, but the normal pounding from the exercise that you would get is absorbed by the water.
RON AARON
Yeah, the water takes the weight off your joints.
DR. TAMIKA PERRY
Yep. So, it's actually really good. But if you think of people like Troy Aikman and Michael Jordan, you know, these professional athletes, by the time they're in their late thirties, mid-forties, they have osteoarthritis because they use their joints for living very aggressively over and over. They may have great blood pressure, they're going to have great vasculature, but that's why when Shaq retired, his first commercial was a Bengay commercial. Joint aches and pains everywhere. That's just from overuse. It's from wear and tear.
RON AARON
One of the saddest things to see is a retired professional athlete, many of whom look like they can barely walk.
DR. TAMIKA PERRY
That's because they've used their joints for a living. That was their job. Think about working out very rigorously all day, every day. The joints after a while go, enough is enough. We're tired.
RON AARON
I will tell you though that having had that knee replacement, it was the best thing I ever did. From the moment I woke up after surgery, all the pain was gone.
DR. TAMIKA PERRY
When did you have your knee replacement?
RON AARON
About 2000. A lot of years ago.
DR. TAMIKA PERRY
About twenty-five years ago. The typical person who's around 60, 65, 70, when they had that knee replacement, you got to remember, they've been using that knee for 70 years. When you come out of your mother's womb, even if you're not crawling yet, you're still extending that knee. Then you start to crawl. Then you start to walk, then you start to run. So, you're using that knee over and over again, using those hips over and over again, using those shoulders over and over and over again.
RON AARON
I remember saying to my orthopedic surgeon, Dr. Pontius, who is now retired, I was his last knee surgery. He said, it doesn't get any better than this. I'm done. I remember asking him, Dr. Perry, and this is the naivete of not knowing. I said, okay, so you're going to put a new joint in there. How will it know how to move?
DR. TAMIKA PERRY
Well, it's attached to everything that makes it know how to move. Your muscles know how to make that joint move, your bones know how to make that joint move and they're all connected to your brain in essence.
RON AARON
And it did. It learned to move.
DR. TAMIKA PERRY
Yep. It learned to move. Ron, it's just not wear and tear arthritis. There are different types of arthritis besides just osteoarthritis. So, you could have something called rheumatoid arthritis.
RON AARON
Now hold that thought. Let me let folks know who may have just joined us. You're listening to the award winning Docs in a Pod, our podcast is available wherever you get your podcast. We're on the radio as well in several markets in Texas and Florida. Our special co-host and guest today is Dr. Tamika Perry and I'm Ron Aaron. We're talking about the various forms of arthritis. Walk us through the litany arthritis A, B and C.
DR. TAMIKA PERRY
Absolutely. We talked about wear and tear arthritis, which is osteoarthritis. Now if we look at rheumatoid arthritis. Rheumatoid arthritis is a type of arthritis where your immune system attacks your joints. I always tell patients think of the immune system as the military of your body. You have lymph nodes and strategically placed in these lymph nodes are where white blood cells gathering and they talk about it's like the soldiers talk about how are we going to attack whatever is coming into our bodies that's foreign? When you have an autoimmune disorder, your immune system recognizes parts of you as foreign and it attacks parts of you. So, with rheumatoid arthritis, your immune system attacks your joints, and it usually starts in small joints like the distal joints, the end joints of your hand, the wrist. Now, we talked about before osteoarthritis where it's wear and tear of the big joints. Even though you may use your hands a lot, that very end joint, we hardly ever bend those, even when you're typing. So, those end joints start to swell up and become problematic. Usually rheumatoid arthritis is bilateral, meaning that it affects both sides of your body, so both hands. If you have morning stiffness that last greater than an hour. It has a greater preponderance in women than men. In fact, it's a four to one ratio. If you have a family history of it, this may lead us to say, this is osteoarthritis. We can tell that by x rays of the joints and by blood tests.
RON AARON
Oh, really? A blood test?
DR. TAMIKA PERRY
There are antibody markers for osteoarthritis because remember, this is an autoimmune disorder. Your body makes antibodies or proteins that attacks those joints. When we look at that destruction, it looks a little different than the osteoarthritis which is what we would see on an x ray. The reason it's important to see your doctors is because you want to know which one you have, because the treatments vary a little and the end result varies. The end result of rheumatoid arthritis would be loss of function of those small joints, particularly your hands, and it can cause loss of function and deformity.
RON AARON
The one thing you haven't mentioned, because I've got a few friends who have rheumatoid arthritis, is that it can be very painful.
DR. TAMIKA PERRY
Extremely painful. Painful loss of function and deformity of the joints. I don't want the audience just to go, Oh, my hand hurts. It's Arthur. Let me just take some Tylenol arthritis or rub some gel on it. I want you to let your physician know because they're going to tease out and differentiate to make sure you don't have that special rheumatoid arthritis. The earlier we know, the better, because the better your outcomes will be so we can get you the appropriate treatment for it.
RON AARON
The other thing I've learned, because I've got a friend whose daughter has rheumatoid arthritis that started when she was very young, it is non-discriminatory when it comes to age or gender. Young people can get rheumatoid arthritis.
DR. TAMIKA PERRY
It can. It happens more in women, but it most certainly happens in men and when it happens in men, it's actually worse. You can have something called Juvenile RA, which is very important. If you're a person younger than myself, you definitely want to see your physician. The thing about juvenile rheumatoid arthritis is it'll have some of the same components as RA and you may be what's called seronegative, meaning your blood result will not quite show those antibodies yet, but you have all the components of rheumatoid arthritis. Once again, it is important to realize what it is so you can preserve the function of that joint, not be in pain and not have the deformities.
RON AARON
How is it treated? I know in the case of my friend's daughter, they have struggled finding a physician who can treat her effectively, and they finally found someone who specializes in treating rheumatoid arthritis. What are the treatments, Dr. Perry?
DR. TAMIKA PERRY
Those specialists are called rheumatologists. The treatments for osteoarthritis, if we go back to that one for a second, is what causes wear and tear for the inflammation? So, rest during active periods. Anti-inflammatories like Naprosyn, Motrin, Aleve, if that's indicated for you, because it's not indicated for every person. Steroids, intra-articular injections, joint replacements, physical therapy, like you mentioned before, Ron. With rheumatoid arthritis, those same conventional methods can treat the symptoms, but you want to treat the cause also. Remember, the cause is not wear and tear, it's your immune system going a little cuckoo. So, we can give you medicines to target that immune system to help calm it down. Those medicines are what we call DMARS, disease-modifying anti-rheumatic drugs. Also, there are newer biologic agents like Humira that we may give to calm that immune system down.
RON AARON
Does that reverse it? Or is it simply masking the symptoms?
DR. TAMIKA PERRY
It does take away the symptoms, but it's kind of like we talked about in previous shows about other entities. Sometimes the damage is done, and you can't get back what you've lost, but you can prevent the progression from going any further. That's what we want to do. Let's just say you were that person who came in and the distal or the end parts of your fingers were swollen, and we found that you had RA. Well, we don't want any more joint destruction. We want to calm down that inflammation there and prevent any more joint destruction or very specific types of deformities called swan neck boutonniere deformities that can come with this disease entity. The disease entity is still there but we're preventing negative sequela.
RON AARON
You used a term I'm not familiar with when it comes to deformities. Boutonniere, I thought you wear that in your tuxedo, a little boutonniere.
DR. TAMIKA PERRY
You know what you do, and we call it boutonniere deformity because it kind of looks like that area of the tuxedo, and we call it a swan neck deformity because your finger will start to look like a swan's neck.
RON AARON
Is that then reversible as well or are you stuck with it?
DR. TAMIKA PERRY
It depends on how long you've had it and how bad it is. It can get better but unfortunately, you may be stuck with it.
RON AARON
Wow.
DR. TAMIKA PERRY
Yeah, so that's why you really want to let your doctor know if you are having aches and pains that are uncharacteristic of you. Now, unfortunately, a lot of people kind of just go through life with RA and they don't realize that they've had RA. I've had plenty of ladies and a few gentlemen in my practice and they come in with the end stage of the deformities and I'm like, you never told anybody. Once we diagnose it, we can treat it and make it better.
RON AARON
We're going to come right back to you. I'm Ron Aaron, along with our co-host and guest today, Dr. Tamika Perry. We're talking about the various forms of arthritis, the ways in which they can be treated and maybe some of the newer miracle drugs that are coming along. You're listening to the award winning Docs in a Pod.
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RON AARON
Thank you so much for staying with us right here on the award winning Docs in a Pod. I'm Ron Aaron, along with our co-host and guest today, Dr. Tamika Perry. We're talking about arthritis. We've talked about osteoarthritis, bone and joint problems and we've talked about rheumatoid arthritis. Before we shift gears into other forms of arthritis, Dr. Perry, with rheumatoid arthritis, can you develop that as an older person or does it develop over years?
DR. TAMIKA PERRY
It develops over years, but because the beginning symptoms may be insidious, like with the morning stiffness or the hand or wrist pain, they may just attribute it to, I've been a carpenter my entire life, and an electrician. This is what that's from. But it starts at the beginning, usually 30 or 40 years of age and it kind of progresses from there.
RON AARON
The patients who come to you later, never having complained about or having been diagnosed with RA, when you make that diagnosis, does the light go on for them?
DR. TAMIKA PERRY
Yes, because they've gotten used to the joint deformities. They think, well, my mother had a big wrist as she got older, or my mothers index fingers were shaped like that, but your mom probably had already to that was undiagnosed. What we want to do is get to the point where you don't get that deformity, you are diagnosed early, you don't lose the functions of those joints.
RON AARON
What are the treatments for the older newly diagnosed patient?
DR. TAMIKA PERRY
Some of the same treatments as you would in the beginning. You want to do things to calm down the immune system but most certainly address the pain and that's most commonly with steroids. Like you mentioned earlier Ron, RA can really hurt. I actually do medical mission trips in Honduras, and when I'm in Honduras, I see a lot of end states of diseases that I don't see in the United States because we have all these fancy treatments. There are plenty of young people who get hip and knee replacements in other countries that necessarily don't have healthcare like us because RA, rheumatoid arthritis, deforms their joints to the point that they need to be replaced really early in life at 30 and 40 years of age.
RON AARON
Wow.
DR. TAMIKA PERRY
Yes.
RON AARON
But you don't do finger joint replacement, do you?
DR. TAMIKA PERRY
No, no. Unfortunately, these individuals just have to live with the deformities of their fingers. And unfortunately, in some of these places, the economy relies on manual labor, so this really puts a big damper on the economy.
RON AARON
You can't work?
DR. TAMIKA PERRY
Nope, cannot work. We talk about health care here and I know this isn't a political show, but we're a lot better off than some people.
RON AARON
Oh, for sure. If you take a look at the availability of treatments, how are we doing on developing newer treatments for rheumatoid arthritis?
DR. TAMIKA PERRY
The biologics, like we mentioned earlier, look really promising. They've been around for a few years, more than just DMARDs for RA. When diagnosed early, your outcome is actually relatively good if you're in a developed nation.
RON AARON
You mentioned RA. That was very helpful in developing vaccines to attack COVID.
DR. TAMIKA PERRY
Yes. RA and osteoarthritis aren't the only types of entities that can cause inflammation of the joint. Ron, like you and I were talking about off-air earlier, gout is extremely common.
RON AARON
I woke up one morning and I figured, my God, I broke my toe. I could barely walk. I happened to be talking to an RN I know, and she said, I'll bet you have got get tested and see whether or not that's the issue. And it was. When they run a blood test, what are they looking for?
DR. TAMIKA PERRY
You can look for uric acid in the blood. It's more diagnostic to actually take the uric acid out of the actual joint, like to extract it from the joint, except for most of the time that patients want to beat you up while you're doing it.
RON AARON
Don't you stick a needle in my joint.
DR. TAMIKA PERRY
Right? It is not the most comfortable. What is gouty arthritis, or gout? That's where your body builds up these uric acid crystals as a result of you not being able to break down proteins appropriately, so the end product gets caught up in your joints and it's usually something that happens later in life, around 50-plus. It can happen to men and women, but the incidence in men is a little bit higher. Gout normally affects a major joint in that big toe and its red, inflamed, angry, and it hurts.
RON AARON
Then I discovered, and I'm not a big druggy, but I want to tell you who ever invented allopurinol, I gather the drug of choice in treating gout, deserves a Nobel Peace Prize. Less than a day after I began treatment, pain was gone, totally gone.
DR. TAMIKA PERRY
Allopurinol helps with the degradation of the uric acid crystals. There are other medicines that help the crystals from getting into the joint space, like a medicine called Ulric. For the acute pain, we can use medicines like colchicine, anti-inflammatories like diclofenac, to help release the inflammation. Remember, these are all arthritis, so we just have to find out where the inflammation is coming from, then we can attack it.
RON AARON
By degradation you mean it goes in there and busts up the uric acid that's collecting in that joint?
DR. TAMIKA PERRY
Yes, it says go away. It fights it like Superman.
RON AARON
Is that something you take in perpetuity, or can you stop it after the pain goes away?
DR. TAMIKA PERRY
It depends on how many gouty flares you have or how often you have them. Some people take it more often than not, some for acute episodes. Now we have to say too, remember we talked about that protein, the byproducts getting caught up in the joints. Where did you get that from? From the foods that you eat. So, you think about, what should I stay away from? Probably all the things that we like.
RON AARON
Shrimp is one. I love shrimp.
DR. TAMIKA PERRY
Yes. Shrimp, red meat, cheese, red wines. Please no one fire me or put me in the corner from saying any of this, but it is what it is.
RON AARON
If you eat those foods, you generally will trigger more uric acid. Is that what happens?
DR. TAMIKA PERRY
Yeah, that's exactly what happens, Ron. For my patients who choose to go down that direction, I always tell them in your car, in your wallet, in your purse, in your pocket book, make sure you have something I've given you on hand to treat the gout.I think it's important to mention on a side note here too, that even if you think it's regular osteoarthritis, you still want to see your doctor. You still want to see your doctor to make sure you are treating the proper arthritis instead of just taking Advil or ibuprofen over and over again. Absolutely, these medicines treat inflammation. However, chronic use of these medicines is not good for your system. It can really drag down your kidney function. It can cause acute kidney failure. It can cause gastric ulcers. So, you want to, instead of just popping over the counter medicines for your various joints, aches and complaints, see your doctor.
RON AARON
I was living on ibuprofen with my knee pain, and I finally went to the doctor. He did the x rays, he told me what I had, and I didn't really want surgery. I said to him, Dr. Pontius, when do you think you're going to have to do this? And he said, the day you crawl into my office on your hands and knees and beg me. Which guess what? I did.
DR. TAMIKA PERRY
It happens. There are other forms of arthritis, less common, but definitely other forms of arthritis. Arthritis is something that's probably going to affect all of us, most commonly osteoarthritis. But the important thing is we need to know which one and how to attack it.
RON AARON
That's the job of a PCP.
DR. TAMIKA PERRY
That is my job.
RON AARON
Thank you, Dr. Perry. Not only are you a great co-host, but you also turn out to be a wonderful expert guest as well. Dr. Tamika Perry, thank you. I'm Ron Aaron. We thank you all for joining us today on the award winning Docs in a Pod.
OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.
DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
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