If someone asked you what “living well” means to you, what would you say? At Texas Health, we believe living well means more than just getting by; it's about finding a good balance in life. It's about taking care of your body, feeling good mentally, and making connections with others that matter. Living well is about staying strong when things get tough, making healthy choices, and finding happiness in what you do every day. It's about building a life that's not just long but full of energy and meaning.
But what about when it comes to managing a chronic condition like osteoarthritis? What does living well with arthritis look like? For Justin Ezell, D.O., a family medicine physician on the medical staff at Texas Health Family Care, living well with arthritis isn’t just about treating the symptoms but treating the person as a whole. This approach to treating patients is ultimately what led to his decision to follow the D.O. (Doctor of Osteopathic Medicine) path versus M.D. (Doctor of Medicine)
“A large part of what I tell my patients, when I first introduce myself is the reason why I chose the D.O. program is I wanted that philosophical basis of looking at mind, body, and spirit connections,” he explains. “I do feel like a large part of that training helps us gain a better understanding of the social determinants that impact our health. It's not just looking at individual components and prescribing medication.”
That philosophy also encompasses his idea of what it means to “Live Well.” For him, someone who is living well is someone who is healthy not just in body, but mind and spirit as well. So when it comes to treating arthritis, Dr. Ezell works to make sure all three are being met.
Living with Arthritis
According to Dr. Ezell, there are two main types of arthritis: inflammatory arthritis, which can be from rheumatoid or autoimmune conditions, and osteoarthritis, or degenerative joint disease. The latter is the type that most people tend to suffer from, especially as we get older. That’s why it’s commonly referred to as “wear and tear” arthritis.
“Degenerative joint disease or osteoarthritis is actually a bit misleading because there’s no actual inflammation of the joint — it's what we call ‘peri-joint inflammation,’” Ezell explains. “Most joints have synovium or have lubricating fluid. Kind of like the Tin Man from the Wizard of Oz, you need to be lubed up so that you can get moving. When those joints start to wear out meaning the synovium either isn't able to hold on to the fluid as well or it's not producing the fluid as much, that’s when you typically find when you first wake up, you’re very stiff and that stiffness often is described as deep, dull, aching pain. Then with about 15 to 20 minutes of getting up, moving around, maybe taking a hot shower, that will oftentimes get better. Whatever fluid’s left in, the joint kind of wakes up, and you can go off and you can perform for a little while. But then as that joint begins to fail throughout the day, the connective tissue around the joint has to pick up the slack. And that's usually when the end-of-the-day pain kind of creeps back in.”
Arthritis can be caused by various factors, including genetics, aging, or joint injuries, which divides osteoarthritis down even further into primary and secondary.
“So primary osteoarthritis just means you got older, your joints wore out. You know, it's the joy of getting older and another spin around the sun,” Ezell says with a chuckle. “Secondary osteoarthritis is usually more related to previous injury traumas. You often see this in athletes, those in the military or those in blue-collar professions where there are repetitive motions and they’re asking a lot of their bodies. Believe it or not, I see a lot of patients who work in manufacturing or mail/shipment processing.”
The diagnosis of osteoarthritis typically involves a combination of medical history, physical examination, and diagnostic imaging.
“I’m a big fan of just talking to my patients. Learning what they do for a living, what they do for fun, what their history is, like did they play high school football or do competitive cheer in college,” Ezell says. “A lot of times, you can gain a lot of information that may help in a diagnosis or treatment plan just by talking to someone. Again, I like to make sure that we kind of look at the whole picture there, because it's not just treating the joint pain that day, it’s trying to take care of the whole person.”
The treatment for osteoarthritis aims to manage symptoms, improve joint function, and enhance the overall quality of life. The approach to treatment often involves a combination of lifestyle changes, medications, physical therapy, and in some cases, surgical interventions.
Lifestyle changes can include weight management, eating a healthy, balanced diet, and regular exercise. Maintaining a healthy weight is crucial, as excess weight can put additional stress on weight-bearing joints, such as the knees and hips.
“When I was in the army, we would do these training exercises where we’d wear these 30lb. backpacks and go on a 12-mile march. A lot of soldiers would think those 30lbs. wasn’t a big deal or they wouldn’t be feeling it by the end of the march,” Ezell adds. “Let me tell you, everybody felt great at the end of the 12 miles when they took the 30lb. backpack off. What people tend to forget is that the impact is going into your joints and is multiplied multiple times for each pound that you carry. So the correlation is if you can start to unload the connective tissue, you're going to at least slow down wear and tear.”
Low-impact exercises, such as walking, swimming, and cycling, can help improve joint flexibility, help with weight loss and reduce pain. Strengthening exercises are also beneficial to support joint function.
“Other things that we have to think about as most Americans tend to have a diet rich in carbohydrates, which tends to be very pro-inflammatory,” Ezell explains. “There's plenty of links online where they talk about the anti-inflammatory diet, but essentially, what it is, is you want to try to reduce a lot of your simple carbohydrates to a certain degree. And by doing that, by lowering your blood sugars back into a more normal range, that process of causing inflammation to the whole body will reduce and that will help out with joint pain.”
Medications can vary due to the severity of the pain and the condition, but typically, your physician will want to start as conservatively as possible. This often means trying over-the-counter options first. The two most common classes of medications that you can reach for at-home treatment are pain relievers and topical medications. Over-the-counter pain relievers, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), may be recommended to alleviate pain and reduce inflammation. Topical medications such as creams, gels, or patches containing NSAIDs or other analgesic medications can be applied directly to the skin over the affected joint.
“People oftentimes don't think about topical medications,” Ezell says. “Sometimes things like diclofenac gel (Pennsaid, Voltaren) or even topical lidocaine patches (Salonpas, Biofreeze) will sometimes help out with pain.”
Ezell adds that people often ask him about supplements, such as glucosamine, chondroitin and even turmeric.
“I'm a big believer that it's nice if you can kind of point people towards some evidence to support the use of something,” he says. “When it comes to glucosamine and chondroitin, I'll typically recommend that patients try it for three months. If you don't really notice a major change in your pain, then it's probably not going to work for you, especially because there's no strong evidence to support that use.
“With turmeric, we do know that that can be a good anti-inflammatory,” he continues. “So oftentimes, I'll encourage people to supplement with turmeric products that they take with one of their more fatty meals of the day, so they get better absorption through the gut.”
Injections of corticosteroids directly into the affected joint can provide temporary relief from pain and inflammation. Injections of hyaluronic acid, a substance found in joint fluid, may be considered to improve joint lubrication and reduce pain.
“Once you're kind of getting into some of the more aggressive, deeper stages, we will sometimes use oral steroids or injectable steroids or injecting steroids into the joints,” Ezell adds. “But you have to kind of caution people that once you start to go down the steroid pathway, there are some potential long-term consequences with those medications. More specifically knee osteoarthritis. Eventually, steroids will fail to make joint pain better.”
Dr. Ezell notes that physical therapy tends to get overlooked a lot when it comes to treating arthritis. Physical therapists can design personalized exercise programs to strengthen muscles around the affected joints, improve flexibility, and enhance overall joint function. They may also use techniques such as hot or cold therapy.
“Remember that just like you take a bath every day, you need to periodically be doing home exercises to keep the muscles and the connective tissue around it as strong and stretched out as possible,” he adds. “That oftentimes can help manage it or even delay having to move towards a more aggressive procedure.”
If more conservative treatment isn’t helping, the conversation will broaden to more aggressive treatments.
“You know, usually by the time someone comes to see a primary care physician like me, most people have done ice, they've done heat, they've done Tylenol, they’ve done ibuprofen. So a lot of times I'm taking them to a more advanced medication,” Ezell explains. “I do have some people who want to explore things like prolotherapy or platelet-rich plasma. I will educate them about how that works and I have some folks that I know in the area that I'll tend to direct them to for evaluation but unfortunately, it's not covered by insurance, so it’s not always a viable option for everyone.
“If it gets to the point where I feel like we've done everything we can do on the primary level, and there are no more procedures I can offer, then I'm either referring to a pain management physician and also getting surgical opinions,” he adds.
Addressing the Emotional Side of Living with Arthritis
As we mentioned earlier, Dr. Ezell is a firm believer in treating every aspect of the patient, not just the physical. And when it comes to any chronic condition, Dr. Ezell knows just how much of a mental toll it can take.
“In medicine, we tend to kind of overlook the necessity of social support,” he says. “When people feel disconnected from others and that they don't have their community or, you know, the slang is if they don't feel like they have their tribe, it's very easy to start to focus on the things that are bothering you or causing you pain. People need to have that ability to go home to a trusted friend, or a trusted loved one and say, ‘You know, I'm having a hard time today,’ or ‘I'm having a good time today,’ and then just have that help available. Even something as simple as having an activity that you do that you can look forward to that gets you involved with others, just having that human connection, and then the ability to get a little empathy from other humans can be quite helpful.”
The Arthritis Foundation strives to bring connection to those who are living with arthritis, with their Live Yes! Connect Groups. These virtual or in-person groups bring people together for fun social and informative educational events and activities focused on mutual support and positive coping strategies for living well. They offer a place of understanding and encouragement for both people living with arthritis and their loved ones. Group members become self-advocates, develop self-management skills and learn not only how to survive life with arthritis but to also thrive.
When living with a chronic condition, it can be easy to focus on the things you’ve lost or the things you can’t do anymore because of pain, which can be another major emotional blow, but Dr. Ezell says while it may take some getting used to, shifting your perspective can go a long way.
“Are you upset because rose bushes have thorns or are you happy because thorn bushes have roses?” Ezell explains. “When people start to comment on what they can't do, it is important to acknowledge that because that's a sense of loss and you want to make that empathetic connection with the other human in front of you that you acknowledge that what they're going through is difficult for them. But it’s very easy to get into a negative thought pattern that way and you start thinking that you shouldn’t do anything at all.”
Ezell finds it beneficial to challenge yourself to think of what you can do. How can you modify the thing you love so that you can still do it, just a little bit differently? Or can you maybe do the activity for less time than you used to and have those designated times?
“I like to even tell patients that adhering to the medication or treatment plans can buy them more time, so they can still enjoy what they do,” Dr. Ezell adds. I think that coaching is helping people refocus their energies on what's still open, on what's still available, because when people think that there's nothing that they can do about the situation, that's going to lead you very rapidly into a depressed state.”
For some individuals, turning to their spirituality or beliefs can provide comfort and a sense of resilience. It may involve prayer, meditation, or engaging in activities that nourish the spirit.
In conclusion, living well with osteoarthritis is not just about managing physical symptoms but encompasses a holistic approach that includes mental, emotional, and spiritual well-being.
As you navigate the challenges of arthritis, it's crucial to find a balance that promotes a positive mindset, healthy lifestyle choices, and meaningful connections with others. By addressing the emotional aspects and seeking social support, you can enhance your overall well-being and approach the management of arthritis with resilience and a sense of empowerment.
Remember, living well is about staying strong, making healthy choices, and finding happiness every day.