Ask The Doctors: May 2010
What is a physiatrist, and what can he or she do for a person with arthritis?
A physiatrist is a physician who specializes in physical medicine and rehabilitation that involves non-surgical management and treatment of injuries and diseases of the musculoskeletal and neuromuscular systems. Physiatrists treat a wide range of problems, from sore shoulders to spinal cord injuries. After pinpointing the source of an ailment, a physiatrist can design a treatment plan that can be carried out by the patients themselves or with the help of other health professionals, such as neurologists, orthopaedic surgeons, and physical therapists. For patients with arthritis, a physiatrist can help develop a non-operative treatment plan that may include exercise, physical therapy, injections, braces or splints, and the use of assistive devices.
I’ve been diagnosed with knee arthritis, but the pain I’ve been experiencing doesn’t seem to respond well to drugs, and I’m now thinking of surgery. I’ve been told that I shouldn’t wait too long or any chances of improvement may be lost. When do you know the time for surgery has come?
Most patients decide that a total knee replacement is in order when their knee pain significantly affects their quality of life. If you have knee pain that keeps you awake at night, or that limits your activities of daily living—such as getting up from a chair or climbing stairs—or that limits activities that you enjoy—such as traveling, walking, golfing, or shopping—total knee replacement should be considered. Other signs that you may be ready for knee surgery include chronic knee inflammation and swelling that do not respond to rest or medication, deformity of your knee, and knee stiffness that makes it difficult to bend and straighten your knee. More than 90 percent of patients who have a total knee replacement experience a dramatic reduction in pain and a significant improvement in the ability to perform the common activities of daily living. Whether to have total knee replacement surgery should be a cooperative decision made by you, your family, your physician, and an orthopaedic surgeon, with consideration of factors such as age, overall health, degree of bone destruction, and severity of activity limitations.
What is psoriatic arthritis? Is it anything like psoriasis? What are its symptoms, and how is it treated?
Psoriatic arthritis is related to the skin condition psoriasis. Approximately 10 percent of individuals who have psoriasis develop psoriatic arthritis, which is a chronic condition characterized by inflammation of the joints. In about 80 percent of patients with psoriatic arthritis, the skin condition appears first, followed by arthritis. Although psoriatic arthritis can occur at any age, it is seen most often in adults between the ages of 30 and 50. The main symptoms of psoriatic arthritis are joint pain, stiffness, and swelling, but it also can affect the eyes, heart, lungs, and kidneys. Both the skin symptoms and joint symptoms may have periods of improvement or remission, alternating with flare-ups during which symptoms are more severe. There is no cure for psoriatic arthritis, so treatment is aimed at alleviating symptoms. First-line medications for controlling joint inflammation are nonsteroidal anti-inflammatory drugs (NSAIDs). For more severe symptoms, your doctor may recommend corticosteroids, disease-modifying antirheumatic drugs (DMARDs), or other medications. Some of the things you can do to improve symptoms include maintaining a healthy weight and exercising regularly. Using hot and cold packs also can help lessen pain and relax tense muscles. Occasionally, splinting of a joint is used to support and immobilize a painful joint until inflammation subsides.