Nevada County Picayune and Gurdon Times Newspaper Archive

New treatment for arthritis

Arthritis in any form hurts, make no mistake about it.

However, there is good and bad news concerning this disease. The bad news is it remains incurable. The good news is there are treatments available which can alleviate the worst of the pain, especially in the knees.

Approximately 369,000 Arkansans suffer with arthritis, as do 37 million Americans. Arkansas, though, ranks fourth in the nation with people with arthritis.

Dr. Bud Dickson, arthroscopic surgeon at Medical Park Hospital in Hope, hosted a seminar at the Hamilton-Blakely Senior Adult Center in Prescott Thursday, Feb. 7, on the different treatments available for arthritis.

Dickson said there is a "drugless" drug available to treat arthritis with, called Synvisc. It is made from the same compound found in the cartilage of the knee, sodium hyaluronic acid, and is used to help repair damage caused by arthritis, and only in the knee.

However, before this treatment can be attempted, he said, the patient must meet certain criteria, including having been diagnosed with osteoarthritis and undergone other treatment programs. There must also be cartilage left in the knee for the drug can interact with. The patient, he said, must also be undergoing physical therapy at the time.

It's also an expensive treatment, Dickson said, with the shots costing the doctor almost $700 each, and three such shots are required over a 15-day period. The injections are given directly into the knee.

According to data, this treatment is about 80 percent effective in relieving knee pain caused by arthritis. However, the duration of its effectiveness depends on the patient's lifestyle.

However, he said, there are a number of other factors also involved in the treatment's effectiveness. These include: age, race, heredity, gender, injury, repeated overuse and obesity.

"We don't know what causes arthritis," he said, "but we do know overuse and obesity aggravate it."

The cartilage is nourished by fluid in the joint. When the joint is injured or damaged, it swells and cartilage is destroyed, thereby releasing acids into the affected area.

Taking aspirin and steroids, he said, does help by strengthening the cartilage cells and preventing them from rupturing.

Dickson said other treatments include surgical management, such as knee replacement and arthroscopic surgery.

Again, the treatment depends on the type and stage of arthritis.

Surgery, he said, should only be considered when other treatments haven't worked and the pain interrupts the person's ability to function. The goal of surgery is to alleviate pain and correct deformities, while increasing function and mobility.

Arthroscopy can help alleviate mechanical symptoms of arthritis, Dickson said.

Patients should be concerned about the infection rate of surgeries, and question their doctors about them, he said. At MPH, the infection rate is less than one-half of 1 percent.

In doing arthroscopic surgery, three punctures are made in the patient's knee, all being less than a quarter of an inch long. A camera, which weighs 1.5 ounces, is inserted into one, with a probe placed in a second and the surgical instruments in the third. The "operation" is done on an outpatient basis and is videotaped for the patient.

Medical Park, Dickson said, has state-of-the-art equipment for such surgery, which is called "band aid" surgery because no stitches are involved when it's done. Bandages are taped over the wounds, with the knee then wrapped in an ace bandage.

The patient doesn't even need crutches after being "scoped", with the average time missed from work being around two weeks. Patients, he said, should expect some soreness after the surgery.

This form of surgery is usually done on the long bone if it has cartilage.

But, when the cartilage is gone and its down to bone on bone, the problem, he said, is too far gone for many types of treatment, especially if the patient has pain while at rest.

This is when operative procedures are considered, Dickson said, where part or all of the knee is replaced.

In some cases, part of the leg bone an be cut to straighten the leg and buy the patient some time.

When it reaches the point where total knee replacement must be done, he said, the surgery is bloodless, as tourniquets are used to stop the flow of blood around the knee area.

Dickson said the surgery is usually done from the side of the joint to prevent damaging the muscle. Damage to the muscle would reduce the patient's mobility.

When this surgery was first developed, he said, the patient was fitted to the prosthesis. Now, though, the prosthesis is fitted to the patient.

It was first thought the device would wear one millimeter per year, he said, but the wear has been found to be less than a millimeter every five years. Because of this, Dickson tells his older patients the knee will be the last one they need.

This, though, can't be said for younger patients, as younger people are rougher on their joints. In many cases, the younger patients have to have multiple knee replacements because of wear to the prosthesis.

"These are safe operations," Dickson said, "but any surgery that can be avoided should be avoided."