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Joint Diseases

Arthritis, osteoporosis and bone cancer cause pain that can dramatically affect your activities of daily living. Walking, stooping, keyboarding, even writing with a pen – all can be excruciating when you have a joint disease. Unfortunately, most joint diseases require long-term treatment and coping skills.

Texas Health Resources has a multidisciplinary team of experts who can walk with you every step of the way through your joint disease diagnosis and long-term treatment. Specialists on the medical staff, physical therapists, occupational therapists, dietitians, psychiatrists and others work together to help you have the best possible quality of life.

Arthritis

For the nearly one in five adults in the United States who have arthritis, it is often the smallest tasks that are the biggest challenge. Twisting the top off a soda bottle, using scissors, gripping a pen, getting up out of a chair – all can be extremely painful for a person with arthritis. The chronic pain, stiffness and limited movement caused by arthritis can significantly impact a person's quality of life. However, new medications, treatments and strategies can help arthritis sufferers manage the impact on their life.

Arthritis is inflammation of one or more joints, which results in pain, swelling, stiffness and limited movement. It involves the breakdown of cartilage. Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint. Without the usual amount of cartilage, the bones rub together, causing pain, swelling and stiffness.

Arthritis actually refers to more than 100 different diseases that affect areas in or around joints, including osteoarthritis, rheumatoid arthritis and fibromyalgia.

Texas Health Resources has a multidisciplinary team of experts who can quickly and effectively diagnose arthritis and provide you with a range of treatment options. Plus, you can try these tips for preventing arthritis and arthritis pain.

Don't have a physician? Texas Health has many physicians on the medical staff who specialize in treating arthritis. Find the right arthritis specialist for you.

Prevent arthritis and arthritis pain

    From protecting your joints to choosing healthy lifestyle habits, you can take steps to prevent arthritis:
  • Eat a healthy, well-balanced diet to help maintain your weight.
  • Discuss vitamin and mineral supplements with your physician.
  • Exercise regularly to strengthen the muscles around your joints.
  • Don't smoke and limit your alcohol intake.
  • Reduce repetitive strain on your muscles and joints.
  • Exercise regularly.
  • Stay hydrated; water makes up 70 percent of the cartilage in your joints and plays a significant role in the lubrication and shock absorbing properties of healthy joints.
  • While being active, protect your joints from damage that can lead to arthritis later on.
    If you have arthritis, you can take the following steps to lessen or manage the pain:
  • Exercise regularly.
  • Protect your joints by avoiding pushing, pulling and twisting motions that are painful.
  • Get enough sleep so your joints are rested.
  • Use the strongest joint available for the job.
  • Avoid keeping your joints in the same position for long periods of time.
  • Balance times of rest and activity during the day so you do not overwork your joints.

Diagnosing arthritis

Your physician will diagnose your type of arthritis based on the findings of a medical history, physical exam and diagnostic tests.

    For your medical history, the physician may ask questions such as:
  • When did you first begin experiencing joint pain?
  • Which joints are affected by pain?
  • Do you feel the pain continuously or off and on?
  • What activities seem to aggravate the pain?

During the physical exam the physician will look for signs and symptoms that point to arthritis, including redness/warmth around a joint, joint stiffness or tenderness and limited range of motion.

    Depending on the findings of the medical history and physical exam, your physician may use one or more of the following tests to determine the cause of your joint pain:
  • Blood test
  • X-rays
  • Magnetic resonance imaging (MRI)

Three of the most commonly diagnosed forms of arthritis are osteoarthritis, rheumatoid arthritis and fibromyalgia.

Treatment options – osteoarthritis

The most common form of arthritis, osteoarthritis is characterized by the breakdown of cartilage. Cartilage is the firm, rubbery tissue that cushions your bones at the joints, and allows bones to glide over one another. Cartilage can break down and wear away, causing the bones to rub together resulting in pain, swelling and stiffness. Osteoarthritis is particularly related to aging with symptoms usually appearing during middle age.

Osteoarthritis is a chronic disease for which there is no cure, and it usually becomes worse over time. However, osteoarthritis symptoms can be controlled.

    Treatment options for osteoarthritis include:
  • Medications – Over-the-counter pain relievers, corticosteroid injections, supplements and artificial joint fluid injections can all help relieve osteoarthritis symptoms.
  • Lifestyle changes – Exercise (particularly aquatic exercise), getting rest, losing weight if you are overweight and protecting your joints can relieve pain.
  • Physical therapy - Physical therapy can help improve muscle strength and the motion of stiff joints, as well as your sense of balance. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after six to eight weeks, then it likely will not work at all. Massage therapy may also help provide short-term pain relief.
  • Braces – Splints and braces can sometimes support weakened joints.
    Surgery - Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:
  • Arthroscopic surgery to trim torn and damaged cartilage
  • Changing the alignment of a bone to relieve stress on the bone or joint (osteotomy)
  • Surgical fusion of bones, usually in the spine
  • Total or partial replacement of the damaged joint with an artificial joint (knee replacement , hip replacement , shoulder replacement , ankle replacement , elbow replacement )

Treatment options – rheumatoid arthritis

Rheumatoid arthritis is a long-term autoimmune disease that leads to inflammation of the joints and surrounding tissues. The body's immune system normally fights off foreign substances, like viruses. But in an autoimmune disease, the immune system confuses healthy tissue for foreign substances. As a result, the body attacks itself.

In rheumatoid arthritis, the immune system particularly attacks the synovium, a thin membrane that lines the joints. Fluid then builds up in the joints, causing systemic (body-wide) pain and inflammation, and eventually destroys joints.

    Rheumatoid arthritis is a chronic disease that cannot be cured and usually requires lifelong treatment. Early, aggressive treatment for rheumatoid arthritis can delay joint destruction. Treatment options include:
  • Medications – Disease modifying antirheumatic drugs (DMARDs) are the current standard of care for rheumatoid arthritis. Anti-inflammatory medications, antimalarial medications and corticosteroids are also medication options for treating rheumatoid arthritis.
  • Biologic agents – Biologic agents such as white blood cell modulators, tumor necrosis factor (TNF) inhibitors and interleukin-6 inhibitors may be recommended when other medications for rheumatoid arthritis have not worked.
  • Surgery – Sometimes surgeries such as knee replacement , hip replacement , shoulder replacement , ankle replacement or elbow replacement may be recommended.
  • Physical therapy – Range-of-motion exercise and exercise programs prescribed by a physical therapist can delay the loss of joint function. Aquatic therapy can be particularly helpful in relieving pain.

Treatment options – fibromyalgia

Fibromyalgia is a common form of arthritis in which people experience long-term, body-wide pain and tender points in joints, muscles, tendons and other soft tissues. Fibromyalgia is also linked to fatigue, sleep problems, headaches, depression, anxiety and other symptoms.

    Treatment of fibromyalgia focuses not only on relieving symptoms but also on helping patients learn how to cope with their symptoms. Treatment often includes:
  • Physical therapy and low-impact exercise (such as aquatic exercise)
  • Medications such as antidepressants, anti-seizure drugs and medications approved for specifically treating fibromyalgia
  • Cognitive-behavioral therapy to help with coping skills
  • Participation in support groups
  • Lifestyle changes, such as avoiding caffeine, can improve the quality of sleep

Orthopedic Oncology & Complex Reconstruction

From diagnosis to treatment, specialists on the medical staff work with physical therapists, occupational therapists, dietitians, psychiatrists and others to provide the best possible care for orthopedic oncology and complex reconstruction. An orthopedic oncology navigator is available to guide patients through their journey.

Bone Cancers

Tumors within the bone destroy normal bone tissue and most often begin as cancer that has spread from another organ, such as the breasts, lung or prostate. Often, simple observation with physical exams or X-rays is all that is necessary for benign conditions, while more complex benign and malignant tumors usually require surgical removal.

Diagnosing Bone Cancer

Physicians on the medical staff can quickly and effectively diagnose bone cancer. Diagnostic tests may include X-rays, blood tests, bone scan, computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, biopsy and angiogram. Once a diagnosis is made, orthopedic oncology specialists on the medical staff can perform advanced surgeries, as well as make recommendations about other treatments.

Treatment Options

As with other cancers, treatment options include surgery, chemotherapy and radiation therapy. Physicians on the medical staff are committed to preserve as much bone and functionality as possible.

Surgery is the most common treatment for bone cancer, with the surgeon removing the entire tumor. Chemotherapy, the use of anticancer drugs to kill cancer cells, and radiation therapy, high-energy X-rays that kill cancer cells, is usually used in conjunction with surgery.

Physicians on staff also specialize in the treatment of metastatic bone disease, cancers that have spread from other sites to the bones, and are among only a handful of surgeons to provide comprehensive care for metastatic bone disease patients in Texas. Our goal is to treat these complex patients in the least invasive manner possible while controlling pain and preserving function. Minimally invasive techniques are utilized to make certain each patient has the optimal outcome.

After Treatment

After your initial treatment, your physician may prescribe physical therapy. Texas Health Resources offers rehabilitation services with advanced equipment and experienced therapists. Rehabilitation usually includes training and exercise with a physical therapist.

In addition, bone cancer can reappear in another organ or come back at the same location or in other bones. Therefore, people who have been diagnosed with a bone cancer should see their physician regularly and immediately report any unusual symptoms.

Complex Reconstruction

Physicians on the medical staff treat a variety of orthopedic conditions. Surgeons on staff perform a large volume of complex reconstructive cases, including revision of infected or failed joint replacement of the knee, hip, elbow, and shoulder. They also manage general orthopedic issues in oncology patients who require multidisciplinary care.

Often, patients come to us as a last resort for limb salvage surgery. In 95 percent of cases a successful outcome is obtained with individualized treatment plans.

Osteoporosis

Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine and wrist, although any bone can be affected. People cannot feel their bones getting weaker. They may not know that they have osteoporosis until they break a bone. A person with osteoporosis can fracture a bone from a minor fall, or in serious cases, from a simple action such as a sneeze or even spontaneously.

Texas Health Resources has a multidisciplinary team of experts who can quickly and effectively diagnose osteoporosis and provide you with a range of treatment options. Plus, you can try these tips for preventing osteoporosis.

Don't have a physician? Texas Health has many physicians who specialize in treating osteoporosis. Find the right osteoporosis specialist for you.

Preventing osteoporosis

    Certain people are more likely to develop osteoporosis than others. Factors that increase the likelihood of developing osteoporosis and broken bones are called "risk factors." Risk factors include:
  • Being female
  • Older age
  • Family history of osteoporosis or broken bones
  • Being small and thin
  • History of broken bones
  • Low estrogen levels in women, including menopause
  • Low levels of testosterone and estrogen in men
  • Diet
  • Low calcium intake
  • Low vitamin D intake
  • Excessive intake of protein, sodium and caffeine
  • Inactive lifestyle
  • Smoking
  • Alcohol abuse
    Together, the following five steps can optimize bone health and help prevent osteoporosis:
  • Get the daily recommended amounts of calcium and vitamin D.
  • Engage in regular weight-bearing and muscle-strengthening exercise.
  • Avoid smoking and excessive alcohol, and limit caffeine.
  • Talk to your health care provider about bone health.
  • Have a bone density test, and take medication when appropriate.

You should also pay attention to your diet to help optimize bone health. As you age, your body may need less food to maintain your weight. However, the need for vitamins and minerals may stay the same or even increase.

Choosing a variety of nutrient-rich foods is very important. Small bouts of physical activity with some muscle strengthening should also be a part of your daily routine as recommended by your doctor.

Nutrients Needed

    Unique Nutrient Needs and Amount per Day:
  • Calcium – 1,200 milligrams (mg), Vitamin D – 400 International Units
      (IU) for adults 51-70 and 800 IU for those over 70 years of age:
    • For strong bones
    • Will aid in preventing hip fractures from occurring/reoccurring
    • Nonfat or lowfat milk offer an excellent source; Nonfat dairy products offer the best sources
    • Consider calcium + vitamin D supplement twice daily if your intake is not adequate to meet needs
  • Vitamin B12 – 2.4 micrograms (mcg)
    • May not efficiently absorb B12 found in animal products, therefore vitamin B12-fortified foods such as breakfast cereals or supplements are better absorbed
    Additional Reminders/Tips:
  • Check with your physician or health care provider before taking vitamins or other supplements to make sure they do not interfere with other medications you may be taking. You should never exceed recommended dosages.
  • Also, contact your health care provider when your food choices are limited over a period of time due to illness, difficulty chewing, lack of or decreased appetite, or inability to shop or prepare food. A basic multivitamin and mineral supplement may be warranted.
  • Oral nutritional supplements are excellent alternatives to supplement your food intake when appetite has decreased or for promoting weight gain. Discuss oral supplements with your doctor or registered dietitian.

Diagnosing osteoporosis

    Physicians diagnose osteoporosis based on the findings of a medical history, physical exam and diagnostic tests. Diagnostic tests include:
  • Bone mineral density testing (specifically a densitometry or DEXA scan), which measures how much bone you have
  • A special type of spine computed tomography (CT) scan
  • In severe cases, a spine or hip X-ray may show fracture or collapse of the spinal bones. However, simple X-rays of bones are not very accurate in predicting whether someone is likely to have osteoporosis.

Treatment options

    The goals of osteoporosis treatment are to:
  • Control pain from the disease
  • Slow down or stop bone loss
  • Prevent bone fractures with medicines that strengthen bone
  • Minimize the risk of falls that might cause fractures

Medications

    Medications are used to strengthen bones when:
  • Osteoporosis has been diagnosed by a bone density study.
  • Osteopenia (thin bones, but not osteoporosis) has been diagnosed by a bone density study, if a bone fracture has occurred.

Medications include bisphosphonates, calcitonin, hormone replacement therapy, parathyroid hormone and raloxifene.

Lifestyle changes

    Exercise - Regular exercise can reduce the likelihood of bone fractures in people with osteoporosis. Some of the recommended exercises include:
  • Weight-bearing exercises -- walking, jogging, playing tennis, dancing
  • Resistance exercises -- free weights, weight machines, stretch bands
  • Balance exercises -- tai chi, yoga
  • Riding a stationary bicycle
  • Using rowing machines

Diet - Get at least 1,200 milligrams per day of calcium and 800 - 1,000 international units of vitamin D3. Vitamin D helps your body absorb calcium. Your doctor may recommend a supplement to give you the calcium and vitamin D you need.

Follow a diet that provides the proper amount of calcium, vitamin D and protein . While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses to form and maintain bones is available.

    High-calcium foods include:
  • Cheese
  • Ice cream
  • Leafy green vegetables, such as spinach and collard greens
  • Low-fat milk
  • Salmon
  • Sardines (with the bones)
  • Tofu
  • Yogurt

Stop unhealthy habits - Quit smoking, if you smoke. Also limit alcohol intake. Too much alcohol can damage your bones, as well as put you at risk for falling and breaking a bone.

    Prevent falls - It is critical to prevent falls. Avoid sedating medications and remove household hazards to reduce the risk of fractures. Make sure your vision is good. Other ways to prevent falling include:
  • Avoiding walking alone on icy days
  • Using bars in the bathtub, when needed
  • Wearing well-fitting shoes

Monitoring - Your response to treatment can be monitored with a series of bone mineral density measurements taken every 1 - 2 years.

Women taking estrogen should have routine mammograms, pelvic exams, and Pap smears.

Related surgeries - There are no surgeries for treating osteoporosis itself. However, a procedure called vertebroplasty can be used to treat any small fractures in your spinal column due to osteoporosis. It can also help prevent weak vertebrae from becoming fractured by strengthening the bones in your spinal column. The procedure involves injecting a fast-hardening glue into the areas that are fractured or weak. A similar procedure, called kyphoplasty, uses balloons to widen the spaces that need the glue. (The balloons are removed during the procedure.)

Frequently asked questions

Q: How common is osteoporosis?

A: According to the American College of Rheumatology, about eight million women in the United States and two million men have osteoporosis. Those over the age of 50 are at greatest risk of developing osteoporosis and suffering related fractures. In this age group, one in two women and one in six men will suffer an osteoporosis-related fracture at some point in their life.

Q: What are the signs of osteoporosis?

A: Osteoporosis does not have symptoms. Most people who have osteoporosis never know they have it until they break a bone. By that time, the disease is advanced, and treating it is more difficult.

Q: Is osteoporosis hereditary?

A: Osteoporosis has a number of risk factors, and a family history of osteoporosis or broken bones does increase your risk.

Q: What type of doctor treats osteoporosis?

A: Many different types of doctors treat osteoporosis, including family practitioners, internal medicine specialists, rheumatologists, gynecologists and gerentologists.