By conservative estimates, nearly 40 million people in the U.S. are affected by some form of arthritis. Slightly more than half of those cases suffer from osteoarthritis, which is degenerative, and a small percentage suffer from rheumatoid arthritis and psoriatic arthritis, autoimmune disorders that inflame the lining of the joints. Our expert will provide an overview of different types of arthritis, with a focus on symptoms, diagnosis, and new treatment and management strategies.

1. Living with Arthritis
Presented by:
Lauren Kennish, MD
Rheumatologist
October 15, 2019

2. Lecture Outline
• What are the different types of arthritis?
• What are the symptoms and how is it
diagnosed?
• What are the treatment options?
• How to live well with arthritis?
• What is new on the horizon?

3. What is Arthritis?
• Arthritis = pain or inflammation in the
joints
wwww.Arthritis.org

4. Types of Arthritis
• There are over 100 different types of arthritis
• Main types:
 Degenerative or Osteoarthritis (OA)
 Autoimmune
• Rheumatoid Arthritis (RA)
• Psoriatic Arthritis (PsA)
 Crystal-induced
• Gout
• Pseudogout
 Infectious
• Virus
• Lyme

5. Degenerative Arthritis
• Osteoarthritis – wear and tear of
cartilage (cushion) of joints
Copyright ACR, 2013

6. Diagnosis
• History and Physical Exam
• X-rays
• Fluid analysis from joint

7. Medical Treatment
• Pain medications
 Oral - Tylenol, NSAIDs, prescription
 Topical – pain creams, heat
• Injections
• Exercise, Physical Therapy, Weight loss
• Bracing
• Surgery
• Supplements?

8. Autoimmune Arthritis
• Autoimmune disease:
 Immune system incorrectly targets your own tissues
• Type of inflammatory arthritis = pain, swelling
and stiffness in the joints
Antibodies form and attack cells
Inflammation/Swelling
Damage/Disease

9. • Rheumatoid Arthritis
• Psoriatic Arthritis
• Reactive Arthritis
• Ankylosing Spondylitis
• Autoimmune conditions that involve arthritis:
Lupus, Sjogrens, Vasculitis, Polymyalgia Rheumatica
Autoimmune Arthritis
Copyright ACR, 2013

10. Diagnosis
• History and Physical Exam
• Laboratory Data
 Rheumatoid Factor (RF)
 Anti-CCP
 HLAB27
 Inflammation factors - ESR, CRP
• Imaging
 X-rays
 MRI
 Ultrasound

11. Medical Treatment
• Anti-inflammatories
 Steroids, NSAIDs
• Pain Modalities
• DMARDs = Disease
Modifying Anti-Rheumatic Drugs
 Conventional
 Biologic DMARDs
 Targeted DMARDs

12. Medical Treatment
Rheumatoid Arthritis Psoriatic Arthritis
DMARDs
(conventional)
Methotrexate, Leflunomide,
Sulfasalazine, Hydroxychloroquine
Biologic DMARDs Enbrel, Humira, Cimzia, Simponi, Remicade
Orencia
Actemra, Kevzara
Rituxan
Kineret
Stelara
Cosentyx, Taltz
Targeted DMARDs Xeljanz
Olumiant, Rinvoq
Otezla
cell

13. Comparison of Arthritis
Osteoarthritis Rheumatoid Arthritis Psoriatic Arthritis
Mechanism degenerative autoimmune autoimmune
Prevalence 27 million 1.3 million US 1.5 million US
Onset 50+ 30-60, women >men 30-50, men>women
Causes wear and tear, injury,
obesity, age
genetics, infection gum/bowel,
smoking, hormones, obesity
genetics, smoking, stress, obesity
Symptoms larger joints, stiff <30min smaller joints, swelling, stiffness
>1hr
small/large joints or spine,
swelling, stiffness >1hr
Treatment control pain, maintain
range of motion
immune suppressing medications immune suppressing medications
Prognosis progressive, disability, or
no symptoms
progressive, disability;
associated with lymphoma, heart
disease, eye disease, other
autoimmune disease
progressive or intermittent,
disability; associated with
psoriasis, eye/bowel disease,
heart disease

14. Crystal Arthritis
• Gout
• Pseudogout

15. Diagnosis
• History and Physical Exam
• Laboratory
 Uric acid
• Imaging
• Fluid Analysis

16. Medical Treatment
• Anti-inflammatories
 NSAIDs
 Colchicine
• Prevention
 Diet
 Allopurinol
• Injection
• Surgery

17. Infectious Arthritis
• Viruses – parvovirus
• Bacteria – streptococcus, Lyme

18. Diagnosis and Treatment
• Diagnosis:
 History and Physical Exam
 Laboratory
 Fluid Analysis
• Treatment:
 Pain control, supportive care
 Antibiotics

19. How is Arthritis Treated?
• There is no cure for most arthritis types
yet
• BUT…
• Many treatment options to decrease
symptoms and associated conditions
• Can lead active, healthy lives

20. How is Arthritis Treated?
• Anti-inflammatories
 NSAIDs = Non-Steroidal Anti-Inflammatory Drugs
• Temporary relief of pain and stiffness symptoms
 Steroids
• Relieve joint pain and swelling, also immune suppressing
• Pain Medications
 Tylenol
 Prescription
 Medical Marijuana?

21. How is Arthritis Treated?
• Interventional Treatment
 Joint injections
• Steroids
• Hyaluronic Acid (OA)
 Surgery:
• Joint replacement
• Joint fusion
• Tendon repair

22. How is Arthritis Treated?
• Exercise
 Low-moderate impact
 Stretching, strengthening
 Yoga, Pilates, Tai Chi
• Physical Therapy
• Bracing
• Acupuncture

23. How to Live Well with Arthritis?
• How to:
 Maintain control of disease to prevent flares
 Avoid complications and associated risks
 Cope with the disease
 Feel healthy
• To lead an active, high-quality life

24. Healthy Lifestyle and Self Care:
• Exercise
• Modify activities
• Diet and weight loss
• Don’t smoke
• Heat/Cold therapy
• Topical therapies
How to Live Well with Arthritis?

25. Healthy Lifestyle:
• Manage fatigue
 Get enough sleep
 Rest when needed
 Plan your time effectively
 Exercise
• Treat mood/depression
 Reduce stress
 Social support
 Positive attitude
Arthritis.org.
How to Live Well with Arthritis?

26. Healthy Lifestyle:
• Weight loss
• Healthy well balanced diet
• Mediterranean diet
• Avoid certain foods ?
• Alternative treatments/supplements ?
 Not well studied
 Glucosamine/Chondroitin, Omega-3 fatty
acids, Turmeric
 CBD?
How to Live Well with Arthritis?

27. Follow-up with Doctor Regularly:
• Rheumatologist
 Internist
 Orthopedist
 Physiatrist/Pain Management
• Get treated early, don’t wait
• Take medications consistently
• Monitor for associated conditions
 RA, PsA
How to Live Well with Arthritis?

28. • Ongoing research:
 New OA treatments
• Regenerate cartilage
• New pain medications
• New injections
 RA and PsA
• New medications
 More curative treatments
What’s New?
Sciencedirect.com

29. For More Information
• Arthritis Foundation
 www.arthritis.org
• American College of Rheumatology
 www.rheumatology.org

30. Questions
?

31. Thank you!
Lauren Kennish, MD
Summit Medical Group
Rheumatology
908-277-8640
www.summitmedicalgroup.com
Facebook/SummitMedicalNJ
Twitter: @SummitMedicalNJ