Disability and Progress-February 13, 2025-Arthritis

[00:00:00] Speaker A: KPI.org. [00:01:00] Speaker B: Greetings and thank you for joining Disability and Progress, where we bring you insights into ideas about and discussions on disability topics. My name is Sam. I'm the host of this show. Thanks for joining in. Charlene Dahl is my research PR person. Hello, Charlene. [00:01:15] Speaker A: Good. [00:01:16] Speaker B: Good evening, everybody, whatever it is. And Erin is my podcaster. I have questions for the listeners. I'm just wondering if they ever notice themselves getting stiff in the morning or if they're sitting too long. Maybe they have a lot of aches when the weather changes. And our topic today is arthritis and we are speaking with Dr. Marta Michelska Smith, and I hope I pronounced that right. And she will be talking about. She'll be giving us insights on this topic. So. Hello, Dr. Marta. Is it okay if I call you Dr. Marta? [00:01:57] Speaker A: Of course. Good evening. Thank you so much for having me. [00:01:59] Speaker B: Sam, thank you so much for being on and giving us your time. Can you just give us a brief history about you? [00:02:09] Speaker A: Sure. Yeah. My name is Marta Mihalska Smith, and I am a rheumatologist here at U of M Health Fairview. I work with the University of Minnesota and I did my medicine pediatrics training here at the university and then went to D.C. to do my fellowship in rheumatology. And now I'm back as staff. So I have clinics kind of in two different locations in the cities and then also work in the hospital. [00:02:36] Speaker B: Excellent. All right. Well, let's start out by giving the listeners an explanation of what is arthritis and how does it affect the body? [00:02:51] Speaker A: Great question. Arthritis is a very general term. It just means inflammation in the joint. As anyone with arthritis knows, that can cause some stiffness and pain in that joint. If it's present for a long period of time, it doesn't go away. It can actually cause permanent damage to that joint and a lot of disability. We use our joints to walk and to be able to pick something up and grasp something. So it can really affect our daily function. Then when one joint is affected by arthritis, it puts stress on other joints and different mechanics. And so it can affect a lot of areas of our body. There's also types of arthritis that don't just affect the joints, but are actually considered full body diseases and can even affect other organs like our lungs or our eyes. [00:03:44] Speaker B: How many different types of arthritis are there? When I was doing the a little bit of research on this, it seems like there's a lot. [00:03:52] Speaker A: Yeah, there's a lot more than people realize, I think. You know, when we think of arthritis, we think most of us Think of osteoarthritis, which is the most common type of arthritis and is kind of traditionally thought of as kind of the wear and tear or non inflammatory arthritis, although we now know that those are a little bit misleading terms because there actually is inflammation in the joint and it's not really all about wear and tear. But besides osteoarthritis, there's also these autoimmune arthritides. So that includes things like rheumatoid arthritis and psoriatic arthritis, ankylosing spondylitis, juvenile arthritis. There's a host of these, and these are actually full body diseases that are about the immune system. So our immune system job is to kind of keep bacteria and foreign particles away and fight them. And in these autoimmune arthritides, it kind of gets dysregulated and it turns in on itself and attacks somebody's own body and the proteins in our body, and that causes inflammation. So that's kind of the other big camp. But there's also crystal arthritis, like gout and pseudogout, and then there's septic arthritis and infectious related arthritis. So there's, there's a lot out there. [00:05:04] Speaker B: So the most common ones are there like just kind of two or three most common ones. And what, what would they be? [00:05:11] Speaker A: Yeah, so osteoarthritis is definitely the most common one. And then rheumatoid arthritis and psoriatic arthritis are probably the two that I see the most. And I also see quite a bit of gout. [00:05:22] Speaker B: Gotcha. I do hear about rheumatoid arthritis. I don't ever think I understood what that one exactly was. How is that different from, you know. [00:05:40] Speaker A: The, all the other ones that we mentioned? Yeah, so rheumatoid arthritis is in that same camp that we were talking about with psoriatic arthritis and juvenile arthritis, where it's an autoimmune disease. The big question is, how do you differentiate all these different types of arthritis when someone comes in? Rheumatoid arthritis actually affects slightly different types of joints than psoriatic arthritis, although there is some overlap and we use again, slightly different medications. But in all of those, autoimmune arthritis, our treatments are kind of targeted at the immune system, since that's kind of the problem. [00:06:19] Speaker B: So are there general causes of what the primary causes are of arthritis? [00:06:27] Speaker A: So it depends a lot on which arthritis we're talking about, but in general there is both. There's always a genetic component and an environmental component to all the different types of Arthritis. I think when we're talking about osteoarthritis, there actually is a genetic component to that one, too. So if your mom has, you know, really bad hand osteoarthritis in her 50s, you're a little bit more likely to also have earlier hand osteoarthritis. But there's this interplay of the environment. So for instance, if you had an old football injury to your right knee. [00:07:03] Speaker B: Ah, yes. [00:07:05] Speaker A: Yeah. Then that knee is gonna. Yeah, right. That knee is going to be more likely to get osteoarthritis later in life. And similarly, with all the other types of arthritis, there's a little bit more of a genetic component, we think, with the autoimmune ones like rheumatoid arthritis and psoriatic arthritis. But again, there's an interplay with the environment. So there's usually a trigger that kind of triggers the arthritis. So you might kind of have this genes that set you up for getting rheumatoid arthritis, but then maybe a virus or an illness that you get, or your body goes through some kind of stress that really activates and gets that immune system revved up, and then that'll trigger the rheumatoid arthritis to kind of, you know, bloom in you. And we actually see that, you know, in identical twins. Just because one has rheumatoid arthritis, it doesn't mean the other one will. So it's not just genetics. There's always this kind of interplay between our genetics and then what our bodies go through throughout our lives. [00:08:05] Speaker B: So heredity and arthritis, if you're, you know, we were talking about if your parent had arthritis, that maybe you have a higher chance. Is there a percentage or is it just kind of a hit and miss thing? [00:08:22] Speaker A: Yeah, good question. There's. There's probably a number out there that I just don't know about exactly. You know, if both of your parents have rheumatoid arthritis, what. What are your chances? But it is a little bit of a hit or miss. And there's not, you know, I don't think there's too much that we can do to kind of control what happens with whether or not we get arthritis. But there are definitely things we can do, you know, to help protect our joints and to kind of help our joint health in general. [00:08:56] Speaker B: So I'd like to talk about aging. I always tell everyone, everyone's aging except for me. Well, you know, it's a good thought. So talk about how aging contributes to the development of arthritis. [00:09:13] Speaker A: Yeah. So when we Think about osteoarthritis. That really is a disease of aging. So as we get older, more and more of us are going to get osteoarthritis. [00:09:24] Speaker B: It's of the bones kind of, or. [00:09:28] Speaker A: Yes. So again, it's, you know, so I get the traditional way of thinking about it is you've got this joint and it's. It's kind of. It's seeing stress, repetitive stress over time. And that repetitive stress kind of wears away at the cartilage, which is that tissue that cushions and protects the joint. And so as that wears away, you know, it. It causes inflammation and destruction. But we actually, the more we study osteoarthritis, we. It's actually a little bit more complicated than that. And we know now, yeah, it's like kind of a disease of a WHO joint. And there's a lot of factors that go into kind of who will develop osteoarthritis. Not necessarily those who use their joints more. So I don't like calling it the wear and tear arthritis because I don't want people to not use their joints. Right. And to be like, well, I'm not going to go on my runs every day because that'll make me more likely to get osteoarthritis. And that's not quite true. There are a lot of metabolic factors in, you know, our joints are living tissues, and there are lots of different tissues that go. That support our joints and there's fluid in our joints, and so there's a lot that goes into it. But as we age, just like everything else, you know, things do start to break down sometimes and not work, not function quite the way they're supposed to. And so it does become more common with age. And osteoarthritis does affect joints that kind of do see a little bit more stress more often. So, like our knees or our hips. But with the other forms of arthritis, age is not. It's not really a disease of aging. So rheumatoid arthritis can affect young women in their 20s. There's another peak where it affects kind of more like older women are in the upper middle age. Ankylosing spondylitis is also not a disease of aging. So it usually affects more young men. And of course, our juvenile arthritis affects children. The only other arthritis that has some age component is gout. So it tends to be more common in middle age and later. And in women, we really almost never see it until some. Someone's postmenopausal. Yeah, because our estrogen is really helpful in. In gout and can be protective. So that one's also kind of associated with aging. [00:11:47] Speaker B: So I was going to ask what are some of the early warning signs of arthritis, but it occurs to me that the different ones would probably have different warning signs. So could you take the most common osteoarthritis? What are some of the warning signs that that's happening? [00:12:05] Speaker A: Yeah, great question. So stiffness in the joints and pain that's kind of becomes a little bit more. Not just like, oh, I went out and I did this thing. And then my. My joints hurt for a couple of days, but becomes more of a daily thing where you're getting stiffness and pain in the joints. Those are kind of the first warning signs that you might be developing some arthritis in that area. [00:12:33] Speaker B: So I have an interesting. I have some sports injury and also, like, I was in an accident, and when I found out I was developing some arthritis in my knees. And I was so sad because I am very active. And I was told by, you know, physical therapists that don't, like, don't wreak havoc on your joints, obviously, but don't slow down, don't sit, don't be sedentary. If you sit more, you actually cause it to go faster or to develop more. You need to move, move, move, move. And that's what lubricates and keeps it going, keeps it at least less active or not as likely to progress as fast. Is this true? [00:13:34] Speaker A: Yeah. Yes, it is. Exactly. So, you know, I like to say if you don't use it, you lose it. Right. So movement really is key. Now, if you're. If your joint is hot, warm, and swollen and really inflamed, then that's not a good time to put a lot of pressure on that joint, and you'll just increase inflammation. But besides, beyond that kind of situation, that kind of scenario, we really do a great disservice to our joints if we don't use them. So using them not only helps like, like your physical therapist was saying, kind of increase blood flow and lubricate the joint and keep everything moving, but also strengthening the, you know, the tissues around the joint, the muscles that support the joint. These are really important to our joint health and our bone health. And you mentioned an accident, you mentioned these injuries in the past, and that's something we see a lot, that when people have injuries and accidents, they might have some more problems with those joints. But it's really important to sign up for that physical therapy, learn how to use, how to move those joints safely. And how to build up the strength around those joints and keep active. [00:14:48] Speaker B: But I presume the same thing happens as you age. Don't sit for long periods of time. Get up and move. Do something more active on a consistent basis. [00:15:01] Speaker A: Exactly. And a lot of people tell me, like, oh, when I first get up in the morning, or when I stand up after sitting for a long period of time, I'm really stiff, and that is very normal. And to kind of have that. That stiffness when we've been sitting for a while and need to kind of move our joints. But that's actually one of the ways that I help. That helps me kind of differentiate between more of that osteoarthritis and that autoimmune arthritis is how that stiffness lasts before it gets better. So definitely move those joints. That's kind of the core message. [00:15:37] Speaker B: And if you're one of those people that sits for long periods of time and don't have to do that, stop doing that. But if you get up in the morning and you're stiff, is this a time that would be good for, like, why don't you start doing, like, a stretching routine where you start stretching and kind of working yourself slowly into, you know, that kind of thing? Is that a good thing to do, like, in the mornings when you're first getting up so you can kind of just warm up your body? Or. No. [00:16:12] Speaker A: Yeah, no, that's really a great. A great time. So, of course, you don't want to do anything that causes a lot of pain. Pain is our body's way of telling us to stop or slow down and that we're causing injury. But we want to. When you're waking up in the morning, that's a great time to do some stretches, to do some movement to bring that blood flow into the area, and that can really help prevent any injury from suddenly moving. I also really like tai chi and yoga for people with arthritis because it really helps with this biofeedback and knowing where our body is and our joints are and working on balance and strengthening. There's actually a lot of. There's evidence that especially tai chi can be really helpful with people with arthritis. [00:17:01] Speaker B: I want to talk about the different diagnostic approaches to different types of arthritis. How do you diagnose arthritis? [00:17:10] Speaker A: Yeah, so that's kind of the crux of what I do. And there's not one perfect test. And rather, it's a combination of things that I take into consideration. And the really, the most important thing for me is the patient's story and my exam so if. If I'm listening to someone in my exam room, they can really tell me what type of arthritis they have and whether or not they have arthritis with their story. So, for instance, a big part of what I do is try and differentiate between osteoarthritis and the inflammatory arthritis and the different types, and how much morning stiffness someone has, whether there's swelling or redness or warmth, and what kind of. What joints are involved are all really important pieces of the puzzle. And then, of course, my exam. So there are actually changes that happen to your bones based on the type of arthritis you have. So I don't know if you. You might know some people who have, you know, or maybe you suffered some knobbiness into their fingers, like kind of bony growth at the ends of our fingers and those nodes, bony kind of nodes are actually very common in osteoarthritis. Whereas you'll see different changes to the hands with rheumatoid arthritis, where you might see kind of the fingers moving out to the side. So our exam is really an important piece of the puzzle. And there are blood tests for some of these. Rheumatoid arthritis, one of the most common types of autoimmune arthritides, does have some blood work that has. That we can get on people that shows that they have these antibodies, but those are imperfect tests as well. You can have arthritis without those with gout. Of course, there's also a blood test that. To see if there's a lot of uric acid or this is waste product in our body that can predispose people to getting gout. And then the other kind of piece is imaging. So when you take an X ray of a joint, there are sometimes different patterns of wear and tear or destruction of that joint that we see more typically in osteoarthritis, versus a different pattern that you would see in psoriatic arthritis or rheumatoid arthritis. So you take kind of all those pieces together, kind of, again, with a lot of emphasis on what the patient or the person is telling me their symptoms are. And together you can kind of come up with a diagnosis for if they have arthritis and what kind. [00:19:36] Speaker B: So when you're talking about that, I was, like, looking at my fingers and like, okay, do I have these symptoms? I'm sure everyone out there is doing that as they're listening. Can you talk a little bit about psoriatic arthritis? How is it different than. Or how does it relate to psoriasis? And what is psoriasis exactly? Because I do hear the term, but I don't know if I know exactly what that is. [00:20:01] Speaker A: Yeah, so psoriasis is a type of autoimmune skin rash. So usually it kind of comes up as like pink and kind of scaly rash. And it can be oftentimes mistaken with eczema. So I tell people to really make sure, you know, they see a dermatologist and kind of get an accurate diagnosis because it does have different kind of, you know, we think about different things for someone who has eczema versus someone who has psoriasis and not, you know, and if you do have psoriasis, you are more likely to get psoriatic arthritis, but again, not perfect. So you can have psoriasis without psoriatic arthritis and you can have psoriatic arthritis without psoriasis. So it can be a little confusing. But both of these diseases are really full body diseases. So they might show up in the skin and they might show up in the joints, but you really need to be under the care of a doctor that can help monitor and make sure that it's not showing up in other places. So in that family of psoriatic arthritis and psoriasis, you can also get arthritis or inflammation in the eye, and sometimes it can be also associated with inflammation in the gut, like in inflammatory bowel disease. So again, it's a full body autoimmune. [00:21:19] Speaker B: Wow. So many different things and hard to know. I'm sure what you would have would, you know, you think of osteoarthritis where it's obvious you are stiff and I mean, you probably feel that with this arthritis, you know, psoriatic. Do you notice it? [00:21:45] Speaker A: Yeah, exactly. You would. It would be very similar. Kind of the first kind of presentation is stiffness and pain in the joints. Okay. And it really differs more about where, you know, which joints are affected and a couple of other kind of details of how long that stiffness lasts. And, you know, we had talked about how there is inflammation in osteoarthritis, but these autoimmune arthritides tend to be more inflammatory, so you might get more swelling or warmth or redness. And in psoriasis or psoriatic arthritis, you can get something called a sausage digit. So where your whole finger, your whole toe kind of swells up like a sausage. So it can be, it's, it's not subtle. Usually people, you know, with psoriasis don't. They don't need to worry about it if they're not having symptoms. If they're having symptoms that's when they usually get sent to the rheumatologist to. To check and see if there's some psoriatic arthritis going on. [00:22:41] Speaker B: I know you talked a little bit about this, but can you touch on a little more about what gout is and how that interplays with arthritis so that people understand? Because I hear the term gout, but I don't think of, like, what the symptoms might be, what causes that, things like that. [00:23:01] Speaker A: Yeah, so gout, we, you know, it used to be considered this disease of rich, noble tea. The kings would get gout. And that is because some of the foods that can flare gout or foods that only the wealthy could afford in the past. But what gout is, it's really interesting. We all make this waste product called uric acid. That's a byproduct of the foods we eat. Humans and apes are actually the only mammals that. That don't have a special protein that can break down uric acid into a form that we can pee out. So a little fun trivia for you today. But as this uric acid builds up, there are some people, for whatever reason, again, genetic, usually, that they're not getting rid of their uric acid well enough, or they're making more of it and building it up. And if we have enough of that uric acid in our bodies, then it forms little crystals. And those crystals, they kind of get put in our joints, deposited in our joints, and they are very inflammatory. So it means they are really good at making our immune system angry. And so when that crystal kind of gets put in the joint, our immune system blows up and you get this really painful, really hot, red, swollen joint. If you know anyone who's had a gout flare, they will tell you it is very painful. And there's a great kind of art piece of what gout looks like in this little devil on someone's toe. So the toe is a very common spot for gout to form. [00:24:41] Speaker B: Dr. Marta, I'd like to talk a little bit about juvenile arthritis, which is not really necessarily affiliated with adults. Children get this. How is this different and what causes it? [00:24:55] Speaker A: It. Yeah, so juvenile arthritis is also an autoimmune arthritis. So it's also kind of a problem with the immune system becoming dysregulated and attacking the, you know, your body. And, you know, toddlers can get this. And children. And children are special because their. Their joints and their bones are still growing. [00:25:19] Speaker B: Right. [00:25:20] Speaker A: And so when you have inflammation in this setting, it's. It's even more important to. To Control it. Because if those. Sometimes that inflammation can cause those growth plates to close prematurely or in the beginning stages can actually make them grow too fast. And so that can lead. When they close too early, they can lead to, of course, shorter bones and more permanent kind of changes. Juvenile arthritis also is a little bit more likely to have other, what we call systemic manifestations, so inflammation in the eye or fevers. And so this is a whole. We have amazing pediatric rheumatologists at the University of Minnesota that deal with juvenile arthritis and take great care of these kids. Some of them will carry this diagnosis into adulthood. So they'll end up still having arthritis as an adult that needs to be treated. But some, it can be pretty quiet once we gain control of the disease. We have such great therapies nowadays for juvenile arthritis that these kids are doing, you know, are by and large doing very, very well. [00:26:33] Speaker B: So how early can this be diagnosed in kids and, you know, when do they usually start showing symptoms? [00:26:44] Speaker A: Yeah, so it can be kind of any stage of childhood. The, you know, as a. When you have a toddler who will develop swelling or pain in a joint, the tendency, what we usually kind of. How it usually comes to the notification of the parents or the doctor is that maybe a kid will be refusing to walk on a leg because they're having pain there. And it tends to be kind of like a knee that's affected. When you have older kids, of course, they can just tell you that their joints are hurting or that they're unable to do the activities that they used to be able to do because they're having pain in their joints or, or visible swelling in the joint. That's usually the first sign. Again, it can also be fevers that, you know, with the swelling. So all good reasons if, if a kid is having that to, to go get seen. There is also, I should mention though, a reactive. So reactive arthritis is a thing. So that means if you get an infection, you can kind of get an arthritis after the infection. And that doesn't always mean that that person's going to have our, you know, a diagnosis of kind of ongoing arthri, kind of just be a reaction to the illness and it can go away and not cause major problems. [00:27:59] Speaker B: So you talk about that once you get this under control for the child that oftentimes it's quiet as an adult, but they don't grow out of it. It's still there. Right. [00:28:14] Speaker A: It's always something that we want to think about and that we want, want someone to be monitored for, because it can come back. You know, people can. We can put this disease, what we call into remission, where it'll just be quiet and maybe stay quiet for, you know, very long periods of time, but it can flare again, you know, a decade later. And so you want to monitor for it and react, respond if it does, you know, come back or have another flare. But again, it's. Our goal is to keep it, keep it down. [00:28:46] Speaker B: So what are some of the most common treatments for arthritis? I realize it's possible, depending on the type of arthritis, the treatment will change. [00:28:57] Speaker A: Yeah, so we'll start with osteoarthritis. Right. Because that's probably the one we're all kind of familiar with and probably what they want to know what to do there. So with osteoarthritis, the treatment really centers around physical therapy and pain control. So we want to just kind of, like we mentioned earlier, we want to strengthen the muscles and tendons and the ligaments that support the joint. So physical therapy is the first line treatment. And using medications for pain like acetaminophen or ibuprofen can be helpful. Steroid injections into the joint can be helpful. And eventually, you know, if we're not getting to where we need to go with those interventions, the only kind of cure for osteoarthritis is a joint replacement. And so some people will need eventually to get a joint replacement for their osteoarthritis. Now for the autoimmune ones, like the rheumatoid arthritis, psoriatic arthritis, juvenile arthritis, because these are diseases of the immune system, we use medications that target the immune system. And there are a multitude of these medications. They can be pills, they can be shots, they can be IV infections, infusions that people go into an IV center to get. These medications suppress the immune system and target different parts of the immune system to calm down that immune response. Those two approaches. Then lastly, we mentioned gout gas come up a couple times actually. In Minnesota, we see a lot of gout because we have a very large monk population, and our Hmong Minnesotans have a genetic predisposition to get gout a little bit earlier and more aggressive than. Than other folks. And so. [00:30:43] Speaker B: Oh, wow, it's. [00:30:45] Speaker A: So yeah, if you, if you're among. And you're. And you're struggling with gout, that's a really important time to kind of get plugged in with a doctor because it can be a little bit more aggressive based on genetics. But in, in gout, the treatment really is twofold. So you want to treat we talked about that kind of really, really angry, inflammatory response. Those crystals form. So you want to put water on that fire. You want to get that inflammation down. And so we use certain medications like prednisone, non steroidal anti inflammatories for that part of it. But to prevent further flares, we really have to focus on getting that uric acid level down. And that is usually done with different types of medication and avoiding foods that are high in uric acid. [00:31:28] Speaker B: Yes. I was going to say this might be a case of a diet switch. [00:31:32] Speaker A: Yeah, yeah. So diet is helpful here. So foods that are high in uric acid are. Are things like shellfish and red meat or they're high in. They're not high in uric acid. They're high in something called purines that then kind of converts to uric acid in our bodies. But red meat and shellfish and beer and other forms of alcohol sodas, like things of high fructose corn syrup. So diet changes are important. They can flare gout. But most people can't control their gout with diet alone. They really will need a little bit extra help from a medication to lower that uric acid level. [00:32:08] Speaker B: I want to just touch on. You talk about joint replacement. If the joint gets too unusable or whatever the term is you'd like to use. Are they cadaver joints or are they, you know, manufactured joints? [00:32:29] Speaker A: Yeah, so most are manufactured. And we really rely on our orthopedic surgeons to stay abreast. There are, there are. You can get cadaver, for instance, cartilage transplants and things like that. But for most people, when they, when they, when you're getting a joint replacement, full joint replacement, it's going to be mechanical. So they have, you know, titanium. They have different materials that they use for. For those, those joint replacements. [00:33:01] Speaker B: All right, so we talk about physical therapy. And actually I want to invite Charlene, who is my research person. Charlene, I want to ask you if there's any questions you have, and I'm wondering if you have experienced any of the arthritis joys of life yet, and maybe ask the doctor, like, how easy is it for somebody who is just getting some aches and pains to be able to get into physical therapy just for some ideas on how to manage things. But did you have any questions, Charlene, before she answers? Really, not only thing I have is my little finger that I broke when I tripped one time. But my knees and stuff are pretty good. One thing I did is I started eating better and lose some weight. Dr. Marley, do you want to comment on that? [00:34:05] Speaker A: Yes. No, Charlene, I'm glad you mentioned weight. I mean that is an important factor here too. So, you know, the more weight we carry, the more pressure we put on our joints. And so if you think about, if you go up in a flight of stairs, your knees see about three times your body weight in pressure. So losing weight can definitely help decrease the stress on our joints. But also fat is actually pro inflammatory, so it can kind of amplify inflammation. So that's another reason that weight loss can be helpful in all kinds of arthritis, especially in psoriatic arthritis and osteoarthritis. We see that in gout weight also plays a role in obesity. And so eating healthy is good for all of us. And there's, there's a lot out there right now about these, you might have heard like the low inflammatory diets or anti inflammatory diets. And my patients ask me about that a lot. [00:35:01] Speaker B: Right. [00:35:01] Speaker A: And we don't have, you know, we don't have controlled trials about. Diet's really hard to study because it's really hard to kind of control what people eat all the time. And so I don't have great, you know, I can't say 100% for sure that this diet's helpful and this one's not. But in general we do know that eating, you know, whole foods, non processed foods, you know, eating things that come from the ground or from the farm are better for our overall, our overall health and definitely also better for arthritis. And so eating a healthy, well balanced diet, moving, you know, all the stuff that we all know is probably good for us for all kinds of other reasons too, is also good for us in arthritis. [00:35:42] Speaker B: Can you talk a little bit about is there anything new you see coming up that is starting to be developed or promising that might change anything with arthritis? [00:35:56] Speaker A: Oh yes, definitely. There's so much, and this is one of the reasons I picked rheumatology as a specialty is there are so many exciting things on the horizon for treatment and prevention when it comes to the more autoimmune arthritis. We used to just have a couple agents that we would use and they were very, you can think of them as these blanket agents just going to throw them at someone and hope they work. But now we're really developing more targeted therapies in the future. I think of arthritis treatment is really understanding everyone's very specific disease and which therapies will getting a blueprint for their particular disease and which therapies will work for them because we have so Many to choose from now that target very specific parts of the immune system, and not all of them work for everybody. And so currently we kind of try one and we see if it works. If it doesn't, we move on to another one. But in the future, I think we're going to have a lot more information, probably a test up front that we could run that really says, here, this is your disease and this is what's going to work well for you. And with osteoarthritis, we mentioned how much has changed over time, our understanding of osteoarthritis, where we used to just think of it as the simple wear and tear, and now we realize it's a little bit much more complicated than that. There are lots of researchers who are continuing that work to see are there really things we can do to really help prevent arthritis from forming or at least delay it, and to help delay or prevent when we need to get those joint replacements. And probably for me, the most exciting new treatment. Again, more now going back to the autoimmune arthritis is something called CAR T cell therapy. That stands for chimeric antigen receptor therapy. And we actually have a couple clinical trials at the University of Minnesota for CAR T cell therapy in lupus and in rheumatoid arthritis right now. And this is a therapy where we take someone's immune cells out of their body, then we genetically engineer them so that they target problematic immune cells, and then we put them back into their body and they go and they find those problematic immune cells and they. They attack them. And so far, the results of CAR T cell therapy have been extraordinary. Some are even calling it like a cure for arthritis because people who've had in for lupus, which is another autoimmune disease, but people who failed lots and lots of treatment on options and are just not able to get control or being able to kind of, for the first time, go into remission with CAR T cell therapy. So if you or someone you know, you know, are dealing with arthritis, it's really difficult to treat and not responding well to therapy, then they should ask their doctor about maybe getting involved in one of the CAR T cell therapy trials at the university. [00:38:50] Speaker B: So would the CAR T cell be similar to immunotherapy? [00:38:56] Speaker A: Yeah, immunotherapy is kind of a broad term that encompasses a lot of different types of therapy. So this is. This is one type. [00:39:03] Speaker B: Yes, Gotcha. So it is targeting those cells. And I do want to touch a little bit on the. Because you talked about, you know, that kind of thing. I presume you have to exhaust your other measures of. Because some people who hear this say, I don't want to have to deal with all the other medications. I just want to go and try this. Are there downsides to doing that or could they not just jump to trying this to see if it works? [00:39:40] Speaker A: Yeah. So right now, because this is still an experimental treatment, in order to get into a trial, you need to have failed, you know, at least two or three other, usually three other treatment options that are already are, you know, approved, FDA approved, and have gone through all the measures. So we're still, you know, we're still in the, this, this experimental phase of this treatment. So if it becomes, which I think it will, you know, approved and goes through all the safety checks, then it might, you know, be. Be available to people a little bit earlier. But it's, you know, probably expense is going to be the, the tricky part here, how to get this therapy to be actually affordable for people. Right now, the insurance. Insurance companies won't cover expensive therapies unless you've first failed some of the less expensive ones first. As for kind of risks, that's again, still being parsed out. But there is an inflammatory. Anytime you're dealing with the immune system and you're kind of trying to alter it, you risk kind of stimulating the immune system in other ways that you weren't wanting to. And so you can get kind of a different inflammatory response from this therapy and from some of the other ones that we use as well. [00:40:59] Speaker B: So I presume some of the new tests and things that you're talking about, that talk about discovering your kind of blueprint, so to speak, of arthritis would be like a blood test that you'd get. [00:41:15] Speaker A: That's the goal. Right. It's got to be something that's easy to get done, that's relatively inexpensive to run, and that can help us predict what you're going to respond to and which combination of medications you'll respond to. That's kind of what I see as hopefully in the future of arthritis care. [00:41:39] Speaker B: So now that we've talked about, like, a lot of this stuff, and people are probably thinking, well, I already have arthritis and what do I do now besides get on a good regiment and follow a good doctor's orders on what to do for yourself? Can we talk about preventative or things that will help slow the process? What can people do to either prevent arthritis or slow it from progressing? [00:42:11] Speaker A: Yeah, so I think with this one, we'll talk more about osteoarthritis. Right. Because Again, different types of arthritis. We're going to kind of approach those in different ways with osteoarthritis. We mentioned a healthy weight can be helpful. Continuing to move our joints and strengthening the muscles that support our joints are both very important parts of keeping our joints healthy and preventing them arthritis from forming. But we're still doing a lot of research into how exactly can we prevent osteoarthritis. Because right now I can't say there's a silver bullet of do this one thing or follow this regimen and you won't get osteoarthritis. We mentioned there's a genetic component too. Right. And there's also a component of what happened to your joints throughout your life. [00:43:09] Speaker B: Right. [00:43:10] Speaker A: So it's really, you know, as simple as it sounds, it's actually a lot of work. Right. To maintain a healthy lifestyle and to keep moving our joints. But that is really the key to good joint health. [00:43:24] Speaker B: So exercise. Movement. Exercise. Movement, yeah. [00:43:29] Speaker A: And I love, I like using movement over exercise because I think exercise can be overwhelming word for some people and they think of like high intensive, you know, therapy, but it's really, it's not. [00:43:40] Speaker B: Necessarily that at all. [00:43:41] Speaker A: Yeah, you just gotta move and do something that you enjoy. And you know, I like to tell people to try to add it with something social too, if that's just to make it a part of, you know, part of their routine where they can also get some social health, health from it. Movement, community, all those good things. [00:44:03] Speaker B: So I'm going to ask you this. You hear about all types of supplements and I think physicians often don't they cringe a little bit when you talk about supplements because there's, I suspect there's not really good studies out there. But do you know or do you recognize, is there any benefit to taking joint supplements or, you know, my vet says sometimes giving your dog a joint supplement can, you know, pre arthritis can help things. Is there any studies that you've seen in regards to people taking joint supplements ahead of time or during when they have arthritis? [00:44:49] Speaker A: Yeah, I do get this question a lot and we have actually studied this and unfortunately there's not a lot of good evidence that taking these supplements can help prevent arthritis or help help when you get it. There's some mixed data out there though, and it's definitely not like a, you know, for sure thing and something that I, that I counsel or encourage people to do. But if someone's taking, you know, glucosamine or they're taking turmeric and they feel like it's helping them. I have nothing against it. It's not going to hurt. It might just hurt their pocketbook a little bit if, depending on they're getting. [00:45:25] Speaker B: It, but swear by it. [00:45:28] Speaker A: Yeah. And if, and if, you know, I'm all for that if it's helping you and you know, there's enough that we don't understand with the body that I'm, I, I, you know, I'm. Same thing with diet. Right. If somebody tells me that they, they did something with their diet and it's really helped them, I'm 100% supportive of them continuing those efforts because we don't just, we just don't know how every particular person might, might respond to those things. But there are any, any big data to support most supplement use. The caveat there for bone health is vitamin D and calcium we do know are important for good bone health. And in Minnesota especially, most of us don't get enough vitamin D or in the sun. And so I do recommend, if people have low vitamin D, to take a vitamin D supplement and to focus on eating foods high in vitamin D and calcium. [00:46:18] Speaker B: And of course there is that thought that, that sometimes psychological thing is everything that if people believe that it's helping them when they're taking a supplement and it's not a harmful thing, that that whole psychological part can sometimes just be helpful. [00:46:40] Speaker A: Yeah. Our brains are so powerful and I'm constantly humbled by what our brains can do with our bodies, how they can actually change the physiology of our bodies. And so, so I say harness that if we're doing something that activates parts of our brain and make us feel less pain, make us feel like we can get up and move more. That's beautiful. We should keep doing that. [00:47:03] Speaker B: So what is your advice to somebody who just got diagnosed with some type of arthritis? [00:47:10] Speaker A: Yeah, so I say talk to your healthcare provider. Is the first step about best next steps for you? Because so much of it will depend again, what type of arthritis and also where you are in that stage early, you know, or kind of late arthritis. And so getting, getting plugged in with, with a doctor. And so you start, you'll start with your primary doctor and they can help kind of guide whether you need a rheumatologist or not. Rheumatologists tend to treat more of the autoimmune arthritis and the gout. But not everybody with gout needs a rheumatologist and not everybody with osteoarthritis needs a rheumatologist. So that's really helpful to Kind of start there and then everybody, no matter what kind of arthritis they have, you know, should be doing some physical therapy and some movement and that is kind of the, the other first next step. [00:48:02] Speaker B: And it sounds like getting advice or a plan on what path to take and what you should do earlier is better than waiting. [00:48:13] Speaker A: Yeah, definitely. You know, just getting on top of it earlier with our autoimmune arthritis, you know, controlling the disease is easier if we're doing it before it gets, you know, too active and out of control. And so good follow up, good access to care. It can be really hard to get in to see a rheumatologist. So, you know, there's, there's a shortage of us and a lot of people who need to be seen. So getting kind of activated early can help. [00:48:45] Speaker B: Dr. Marta, I want to know if you can talk a little bit about briefly about. Are there studies going on that somebody can apply to in regards to arthritis and if so, how do they find them? [00:49:00] Speaker A: Great question. So, yes, there's lots of studies going on and specifically at the University of Minnesota, we, we mentioned the Car T cell ones, but there's actually, if you go, if you ask your physician, they can usually send you to a website or if you just kind of Google the disease that you have and research registries or ongoing trials. ClinicalTrials.gov is a website that kind of has all of the clinical trials going on right now that people can be a part of and, and the contact information for how to get involved in those trials. So ClinicalTrials.gov is really a good starting point for that. [00:49:46] Speaker B: And I have not been on that website lately, but hopefully there's hopefully stuff going on. So I'm hoping that it's still, that's still going because that's such an important thing to be able to do. [00:50:02] Speaker A: Yes. And we, you know, I, I think that that's another really important thing is that a lot of our trials are funded by pharmaceutical companies. And it's really important to also have those federally funded trials that aren't funded by pharmaceutical companies as well, because obviously there's going to be different pressures there from different motives. I'm a huge supporter of having federal funding for our research in arthritis, especially in juvenile arthritis and rheumatoid arthritis, all these different ones that we treat. [00:50:39] Speaker B: Dr. Marta, is there any final things you'd like to leave us with? I do want to thank you very much for your time. [00:50:46] Speaker A: I'm just. Thank you for having me. It's always a topic I feel passionate about and I know people can do so well with arthritis with the right tools. And so I hope everyone stays warm, keeps their joints nice and warm this winter and keeps them at war. [00:51:03] Speaker B: Thank you so much. This is KFAI 90.3 FM, Minneapolis and kfai.org Dr. Marta, thank you again for coming on. I really appreciate your time and I hope to have you back at another time at some point when some of the new things are coming to fruition that you can talk about. And so please stay in touch and we'd love to have you back on. This is a global show and we always depend on user comments and whatnot. So this show goes out all over the world and hopefully people are listening and taking your great advice. So thank you very much. [00:51:43] Speaker A: Thank you for having me. [00:51:44] Speaker B: This is Disability and Progress. The views expressed on this show are not necessarily those of KFAI or its Board of Directors. My name is Sam. I'm the host of this show. Charlene Dahl is my research PR person. Erin is my podcaster. This week it has been all about arthritis. We have been speaking with Dr. Marta Mihalska Smith and she is from the University of Minnesota and she was talking about all the stuff that is entailed in regards to arthritis. If you have a comment or a topic you would like discussed here, you can email us at disabilityandprogressamjasmon.com that's disability and progress all written out at Samjasmin S A M J-A S M I N E.com thanks so much for your listenership and your support.