Treating Arthritis: Making Gains Against The Pain

23 Jan 2018 Doctors, Edward Petrow, Eric Anctil, Media , , , ,

Although there are 100 types of arthritis, and many forms of treatment, research is getting us close to significant improvements in care. Here are some of the local developments that offer hope.

Arthritis is America’s number one cause of disability, costing the U.S. economy more than $128 billion a year, according to the Arthritis Foundation. The organization’s Southern Arizona Chapter reports that in Arizona alone, approximately 1.1 million people have some form of the disease. Six thousand of those are children.

Considering how prevalent the disease is, there’s still much research, education and drug testing to be done. Arthritis is complicated – it has 100 different forms, including many autoimmune disorders; it can be difficult to diagnose; and despite the number of drugs on the market, there’s no single treatment that works for everyone.

“Arthritis is a Greek word meaning ‘swelling of the joint,'” says Susan Sweeney, executive director of the Arthritis Foundation’s Greater Southwest Chapter. “Osteoarthritis (OA) is the number one disease in our group; rheumatoid arthritis (RA) is second. Then there’s lupus, which can be of the skin or different kinds; fibromyalgia; or psoriatic arthritis,” the type PGA player Phil Mickelson was diagnosed with in 2010. Autoimmune forms of arthritis have very different causes than OA, but they generally all create joint pain.

Two local medical groups are aggressively pursuing advancements in the field of arthritis, with cutting-edge research being conducted at the Arizona Arthritis Center and innovative patient treatments being done at Tucson Orthopaedic Institute (TOI).

Located on the University of Arizona College of Medicine campus, the Arizona Arthritis Center is headed by Eric Gall, MD, the center’s founder and current interim director.

He says the main focus at the center is immunology and inflammation. A current study, led by John Szivek, MD, is exploring a new treatment for OA patients. “Dr. Szivek worked with artificial joints early on. Now he’s studying re-growth of cartilage in damaged joints using non-controversial stem cells,” Dr. Gall explains. “They’re taken from the fat of the abdomen, he grows them and reintroduces them to grow into new cartilage. This is a new approach in this area. His lab is waiting to be FDA approved to do the study in humans.”

Other research underway at the center includes investigating how to control lupus, clinical studies on pharmaceuticals and a look at valley fever in arthritis patients who are on biologic agents. “Fungal infections can come out in these patients,” and they must go off the drugs, Dr. Gall says. In the past, there’s been uncertainty about whether the patients could continue treatment after valley fever symptoms dissipated. “We’re asking, can you treat again after going off the drug?”

Physicians at Tucson Orthopaedic Institute are attracting attention for three progressive procedures that help those with deteriorating joints. Eric Anctil, MD is performing the Scandinavian Total Ankle Replacement (STAR) surgery, which results in greater range of motion than what’s achieved with other options.

The STAR device, states Dr. Anctil, “is the only implant that’s mobile bearing.” Other ankle replacement devices are fixed bearing and therefore limit motion, as does ankle fusion. The procedure was developed by a Danish surgeon and has been commonplace in Europe and Canada for 15 to 20 years. The Food and Drug Administration approved the technique in the U.S. two years ago.

Anctil moved to Tucson from Canada, where he’d been performing the surgery for years. “When I first came here, I didn’t use another replacement; I waited for the FDA approval. I was the first one in Arizona to do it. Now there are one or two doctors who do the procedure in Tucson and some in Phoenix,” he says.

Those who have put off hip replacement surgery in anticipation of something less invasive now have another option, currently being performed by Edward Petrow Jr., DO. “With anterior hip replacement (AHR), instead of cutting muscle to get to the hip joint, we move the muscle to the side from the front. It’s a quicker initial recovery and patients are off the cane or walker in the first week or two. Other advantages are that there are no hip precautions and a much lower risk for hip dislocation.” The incision, he says, is 8-10 centimeters.

Using real time X-ray makes the surgery more precise. “We use the opposite hip as a template to match leg length,” an issue which occasionally arises with other hip replacement techniques, Dr. Petrow notes. AHR is done on a special surgical table that allows extension of the patient’s leg downward, thus giving front access to the hip.

Like Dr. Anctil, Dr. Petrow moved to Tucson from an area where the surgery already was being performed. “I came from Virginia and did it there. I was surprised more people weren’t doing it here.” Dr. Petrow’s primary obstacle was convincing Hospital administrators to purchase the special table at a cost of $70,000 to $120,000, which they eventually did.

The surgery also requires special training. After performing approximately 40 AHR surgeries during his last year in Virginia and a dozen here, Dr. Petrow believes he’s the most experienced AHR doctor in Tucson. “It’s now sweeping the country,” he adds.

Just approved by the FDA is an innovative procedure for improving ee s, one that uses vitamin E to extend the life of the device. When this article was written, Scott Slagis, MD was the only Tucson doctor lined up to perform the surgery, which will begin once the implants are shipped. He explains that plastics in joint replacements are generally radiated during manufacturing to make them more durable. But radiation releases free radicals into the plastic, which can lead to oxidation and subsequent wear.

“You add vitamin E, which is an antioxidant, and it neutralizes the free radicals. It then may last longer and be stronger,” Dr. Slagis reports. He says the procedure is not age restricted, but it’s especially good for younger, active patients because of its longevity.

Dr. Slagis has seen small advancements in knee replacement procedures, which he’s been performing for 20 years. But he believes the vitamin E implant could prove to be significant. “This is one that may have profound implications,” he says.

Children With Arthritis

Although support programs abound for kids with arthritis, medical attention can be harder to come by, with a shortage of doctors nationwide.

“There are no board-certified pediatric rheumatologists in Southern Arizona, states Deborah Jane Power, DO, of Catalina Pointe Arthritis and Rheumatology Specialists, P.C. “I’m the only rheumatologist in Southern Arizona willing to see kids with juvenile arthritis 15 and younger.” She and her partners also treat adults with RA and OA.

Power explains the differences between the two: “Osteoarthritis is a degenerative, wear-and-tear condition. Some is genetic, some caused by obesity or trauma and bad injuries, such as sports related. The distribution in the body is knees and hips, the base of the thumb and the joint closest to the fingernail.” While she said there are no drugs that slow the progression of OA, taking anti-inflammatory drugs can help, as can exercise.

“Rheumatoid arthritis is an autoimmune disease that starts in the joint. The body attacks the joint lining in the synovial capsule.This causes swelling, pain and loss of range of motion. It’s whole-body inflammation.You also can have fatigue and a low-grade fever,” Power notes.

Nutrition plays a part in arthritis, as well, she says. “Dr. Andrew Weil believes dairy is inflammatory. Things like turmeric, garlic, cayenne and green tea help with inflammation, so patients can be given that. Foods in the nightshade family cause inflammation — tomatoes, potatoes and eggplant.” She suggests that people with RA and other autoimmune diseases avoid gluten, as it can stimulate the immune system.

Arthritis Foundation – Greater Southwest Chapter

The foundation’s primary goals, notes Executive Director Susan Sweeney, are to increase awareness of the disease, raise funds for research and provide local support for people with arthritis. “Money raised in Tucson stays to provide programs and services in Southern Arizona,” she says. These include seminars, health fairs, exercise classes, educational material, referrals, scholarships and kids’ camps — all coordinated out of the Arthritis Foundation’s office at 310 S. Williams Boulevard.

“We have community education classes where a physician and I go out to senior centers, senior communities or to the work place. One big thing we do is arthritis exercise classes. Water exercise and Tai Chi are especially good choices for arthritis patients. We train instructors and have partnerships with Tucson Parks & Recreation, for example.”

Often, it can take eight weeks to see a rheumatologist, according to Sweeney, and people want information on the disease while they wait. “We send them support group information, Arthritis Today magazine and a drug guide from the national office.” Her staff can refer callers to one of eight rheumatology groups in town.

Major fundraising events for the foundation include the Arthritis Walk, held each spring; the Jingle Bell 5K Run & Fun Walk in December; and a newcomer last year, the Surgeons vs. Chefs Pumpkin Carving Contest.

Chris Stead, local Arthritis Walk coordinator, reported that this year’s event drew more than 500 participants and raised approximately $40,000 through pledges, donations and sponsorships. Held at Brandi Fenton Memorial Park on May 7, 2011, the one-mile walk was kicked off by Mayor Bob Walkup, followed by entertainment and activities.

“We had community vendors and booths like Sam’s Club, Desert Diamond Casino and orthopaedic teams,” notes Stead. Ronald McDonald performed magic tricks for the kids, a disc jockey played music and a splash pad cooled everyone Down. “There was a dogathon, and K-9 Loyal Companions gave doggie massages. Dogs get arthritis, too,” Stead remarks.

This year’s holiday-themed 5K fundraiser is slated for Dec. 3 at Reid Park, he says.“It’s a timed run, people dress in holiday gear and we give awards. There’s also a contest with dogs; you can dress up your pet. Funds help with juvenile arthritis family camps and other programs.”

The foundation holds three camps each year: Camp Cruz, a week-long summer camp for 11 to 16 year olds in New Mexico; an overnight camp for younger kids; and a family camp held locally.

As published in Tucson Lifestyle Magazine, December 2011

Written by Christy Krueger

Popular Physical Therapy Methods

10 Nov 2017 Physical Therapy , , , , , ,

Whether it’s a short-lived pain from a sporting injury or long-term pain from conditions like arthritis, pain can be difficult to live with and manage. From helping arthritic pain and bursitis, to the recovery from broken and fractured bones, and sprains and strains, physical therapists are highly educated healthcare experts in the movement and function of the human body, called kinesiology.

Physical therapists have a special aptitude for assessing the human body and helping restore it back to optimal performance after injury or surgery. Many people experience pain at some point in their lives, whether it is acute or chronic. Physical therapy has been known to improve function for patients experiencing hip, knee, shoulder, and lower back pain. It may also be an effective method in reducing pain for patients with conditions such as tendonitis.

Armed with cutting edge equipment and a huge background of knowledge, PTs can help diagnose and treat many common conditions and disorders affecting movement and function, which often disrupts and affects someone’s ability to live their life normally. Often, doctors turn to physical therapy methods to try and relieve pain and restore function, before turning to surgery as a last resort.

Therefore, armed with cutting edge equipment and a huge background of knowledge, physical therapists can help diagnose and effectively treat many common problems, and most importantly improve or restore mobility, relieve pain, and reduce the need for surgery and prescription drugs.

Physical therapy is an essential part of total patient care, especially when recovering from injury or surgery. Having a good quality of life depends on our health, and if people are in constant pain and suffering, life can be difficult to navigate. That’s why physical therapists can make all the different in your treatment and recovery process. Attitude and motivation are two important psychological factors that often affect the outcome of a situation. PT’s are trained to encourage their patients, helping them reach their goals, whether they are long-term or short-term.

Physical therapist’s work with their patients on a one-on-one basis, track their progress through treatment, and really make a difference in their lives, by getting them back on their feet, and lifting their spirits, encouraging the patient to keep moving forward. Whether the patient’s problem is a result of injury or disease, the physical therapist is a rehabilitation specialist with one goal in mind: helping patient’s recover by restoring optimal function and mobility, and preventing further disability.

Your PT will complete a full evaluation before making an accurate diagnosis.

Therapeutic exercise and functional training are the cornerstones of a physical therapy treatment plan. Depending on the particular needs of a patient, in order to promote proper movement and function, physical therapists will work with individuals to prevent loss of mobility by developing fitness and wellness oriented programs, for healthier and more active lifestyles.

Popular physical therapy methods include:

  • Ice and heat therapy: Ice is best for swelling and inflammation, while heat is best for muscle spasms and tightness
  • Manual Therapy:  Manual therapy includes dry needling, cupping therapeutic taping, and other techniques such as soft tissue mobilization and IASTM. These techniques can be helpful in restoring tissue mobility, improving muscle and joint function, decreasing inflammation, improving stability, and facilitating weak muscles.
  • Exercises: Exercise is a main go-to strategy to treat and prevent pain. These aren’t just exercises like you do at the gym, PT exercises are specially chosen and specifically tailored to help treat the patient’s specific problem. These exercise techniques are hand-picked to help patients move better by strengthening certain muscles, and addressing any imbalances that may exist.

To learn more about the popular physical therapy methods, call us in East Tucson at (520) 784-6570, Northwest Tucson at (520) 382-8201, or Oro Valley at (520)382-8180, or request an appointment online.

Treating Rheumatoid Arthritis

20 Oct 2017 Rheumatoid Arthritis , , , ,

Rheumatoid arthritis (RA) is an autoimmune disorder for which there is no cure. RA causes painful, swollen joints, and can lead to permanent deformity and loss of joint movement if not treated in time.

However, early detection and treatment can slow or even prevent the progression of this disease. The treatment for rheumatoid arthritis may involve trying several strategies, and can change over the course of the disease.

Treatment focuses on reducing or eliminating inflammation. There are several types of drugs that have been shown to be effective. Because of the possible side effects of some drugs, doctors recommend more conservative treatments and shorter courses of drug treatments. Since rheumatoid arthritis is a life-long condition, treatment needs to be appropriate for the long haul.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are commonly recommended to alleviate symptoms of RA, and are available over the counter or by prescription.

Steroids can slow the progression of rheumatoid arthritis, but can cause serious side effects such as cataracts, elevated blood sugar levels, osteoporosis, and others. Although extremely effective, steroids are usually used as a short-term treatment to get symptoms under control.

Disease-modifying antirheumatic drugs (DMARDs) are an extremely effective class of medication that halt inflammation. Some have an inadvertent weakening effect on the immune system, but there are new drugs being developed that act with precision on RA-affected joints.

Physical therapy can help patients at any stage in RA. Exercises can help maintain range of motion and alleviate needless stress on the joints by learning new ways to accomplish tasks. Surgery to remove affected tissue or to replace joints such as the knee of hip may sometimes be indicated if the joint is severely damaged. And last but not least, certain diet and lifestyle choices can have a profound effect on treating the symptoms of RA.

Tucson Orthopaedic Institute’s orthopedic physicians are experienced in the diagnosis and treatment of joint damage. They work with our own certified physical therapists to help patients keep moving with as little pain as possible. Expert care is available to all our patients. Contact one of our convenient locations in the Tucson, Arizona area for an appointment today, or request an appointment online.

The Training Required for a Physical Therapist

6 Oct 2017 Physical Therapy , , , ,

Physical Therapists (PT) help people regain strength and movement and alleviate pain, often through modalities such as stretching and exercise. A rehabilitation plan following an injury or to correct an orthopedic condition often includes physical therapy as an important part of the treatment and/or recovery process. Licensed Physical Therapists are highly-trained professionals with many years of study and experience to understand how the body moves and works, to help people feel better and live better lives.

Physical therapists are required to have a Doctor of Physical Therapy (DPT) degree from a program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE). DPT degrees usually take about three years to complete.

Acceptance into a DPT program requires a bachelor’s degree and relevant coursework, which may include anatomy, biology, physics, and chemistry. The DPT program includes study in the areas of physiology, neuroscience, pharmacology, biomechanics and psychology. The degree requires 30 weeks of clinical experience under the supervision of licensed PTs.

Following graduation as a Doctor of Physical Therapy, PTs complete a one-year residency for additional experience in various areas of care, such as for acute injuries like bone fractures, spinal cord injuries, as well as for conditions usually affecting older patients, such as arthritis. PTs also help people with genetic disorders affecting movement. Fellowships are available to further specialize a physical therapist’s area of expertise following his or her residency. DPTs can be board-certified by The American Board of Physical Therapy Specialties.

Licensing of physical therapists is administered at the state level, and requirements vary by state. However, every state requires that PTs pass the National Physical Therapy Examination. This extensive training and licensing program prepares a physical therapist to be an integral member of a patient’s healthcare team during recovery from an injury or illness.

Physical therapists at Tucson Orthopaedic Institute work directly with physicians to develop a treatment plan that is customized for each patient to maximize therapeutic benefit and produce the best possible outcome. Our physical therapists are an integral part of the practice, and orthopedic treatments often cannot be fully realized without their expertise. Contact one of our fully equipped and state-of-the-art Tucson physical therapy centers today for a consultation. You can also request an appointment online right now.

Is Your Pain Stemming from Arthritis?

26 May 2017 Arthritis , , ,

Though pain is never pleasant, it’s an important signal our bodies use to warn there’s something wrong. Usually, what’s wrong is that you have an injury of some kind, or in some cases your body can even be misfiring pain signals.

When you have an injury – in the case of arthritis, an injury to your joints – the damaged tissues release chemicals that alert nearby sensory nerves. These nerves carry the message up your spinal cord to your brain. Your brain processes the message and sends a signal to your motor nerves to take action.

So how do you know if your symptoms are caused by arthritis or something else? While joint pain and stiffness are the most common terms used to describe arthritis, the warning signs are quite specific. Here’s what you need to know to get the right diagnosis, and the best treatment.

Symptoms of arthritis include:

  • Joint pain and tenderness
  • Inflammation in and around the joints
  • Restricted movement of the joints
  • Warm, red skin over the affected joint

Technically, pain is considered chronic when it lasts three to six months or longer, but arthritis pain can last a lifetime. The symptoms of arthritis depend on the type that you have and the location. While there are multiple types of arthritis, the two main types are rheumatoid arthritis and osteoarthritis.

Osteoarthritis is the most common type of arthritis, which often gets worse with age and is caused by wear and tear. This type of arthritis affects the smooth cartilage lining of the joint. This makes movement more difficult than usual, leading to pain and stiffness. Once the cartilage lining starts to roughen and thin out, the tendons and ligaments have to work harder. This can cause swelling and the formation of bony spurs, called osteophytes. Severe loss of cartilage can lead to bone rubbing on bone, altering the shape of the joint and forcing the bones out of their normal position.

Rheumatoid arthritis occurs when the body’s immune system targets affected joints, which leads to pain and swelling. The outer covering of the joint called the synovium is the first place that becomes affected. This can then spread across the joint, leading to further swelling and a change in the joint’s shape, and may cause the bone and cartilage to break down. Unfortunately, people with rheumatoid arthritis can also develop problems with other tissues and organs in their body.

Tips for relief from the painful symptoms of arthritis:

1. Exercise: Light to moderate physical activity is often one of the best things for the body. Remember to stay hydrated and don’t overdo it. You can often get a specific exercise plan catered to your specific needs or condition, made up by your healthcare professional.

2. Use hot and cold therapy: This often depends on the type of tightness or swelling involved, but it’s best to speak to a doctor or physical therapist about the proper ice or heat therapy to stick to.

3. Eat a healthy diet: Believe it or not, there is a whole list of different types of food that are known to either cause or reduce inflammation in the body.

4. Manage your weight: Simply put, the less weight and pressure put onto bones and joints, the better.

If you’re living with chronic pain due to arthritis, it may be time to take a closer look at your symptoms and explore treatment options. For more information about arthritis and other painful joint conditions, call Tucson Orthopaedic Institute at our East Tucson office at (520) 784-6200, Northwest Tucson office at (520) 382-8200, or Oro Valley office at (520) 544-9700. To request an appointment, you can call or use our secure online appointment request form.

Get Hip to What You ‘Kneed’ to Know

1 Apr 2016 Doctors, Edward Petrow , , ,

In the article, “Get Hip to What You Kneed to Know”, from the April issue of Tucson Lifestyle, Total Joint Replacement Surgeon, Edward Petrow, D.O., and other local experts share their knowledge for patients considering joint replacement surgery for osteoarthritis (OA).

Dr. Petrow believes “Motion is life,” so when lack of mobility and pain cause quality of life to suffer, it may be time to see a physician.

Dr. Petrow says, “The biggest misinformation about knee and hip replacement is that surgeons used to tell people to wait to get a replacement as long as they could and that information has turned out to be incorrect. I always tell people that pre-operative function equals post-operative function. In other words, the better shape you go in, the better shape you leave. Overall, it helps the patient have an easier recovery.”

For Dr. Petrow, the biggest benefit is improving the quality of life for his patients so they can return to the activities they enjoy most.

Read the full article for more information about symptoms of knee and hip arthritis, surgical treatment options, and the advancements of procedures.

And learn more about Total Joint Replacement at Tucson Orthopaedic Institute and our hip and knee surgeons.

Something More: Osteoarthritis

1 Jan 2012 Doctors, Edward Petrow, Media , ,

Most of us know better than to drain the oil from our car and let the motor run. The heat from the friction would soon cause it to seize, destroying it in minutes.

Osteoarthritis, the most common form of arthritis, is another example of what happens when protection against friction is removed. It occurs when the cartilage, the smooth tissue covering the ends of bones where they meet at our joints, breaks down and wears away. The bones rub together, causing pain, swelling, and stiffness. Bone spurs develop, permanently changing the joint’s shape.

The result, as the approximately 27 million Americans who are afflicted with osteoarthritis know too well, is painful and even crippling.

Osteoarthritis is incurable, and no cure is expected in the foreseeable future. Still, advances in medical technology and research have made inroads both in treatment and prevention.

While osteoarthritis is simply wear and tear on joints, genetics and lifestyle are factors in predicting who may experience osteoarthritis. Trauma to joints from sports and occupations can break down cartilage.

An Ounce of Prevention

People who want to minimize or delay onset of osteoarthritis can take steps, advises Edward P. Petrow, Jr., DO, a physician with the Tucson Orthopaedic Institute.

“The most important thing you can do is lead an active lifestyle,” he says. “The saying that a rolling stone gathers no moss applies to our bodies. We peak around age 25 and are in a state of decline from then on. The only thing that seems to slow that down is diet and exercise.”

The onset of osteoarthritis doesn’t mean activity should end, he notes, but it might require switching gears. Giving up exercise can make it worse.

“People with arthritis sometimes have to change gears,” Petrow says. “They may switch from running to cycling or swimming.”

Runners may feel they are losing exercise benefits, for example, if they switch to walking, but walking burns the same amount of calories per mile covered as running. It takes longer to cover the distance, but walking also can be more enjoyable.

It’s important to choose an alternative you enjoy, he adds.

“I ask people, ‘What do you love to do?'” he says. “If you love to run and I tell you to swim and you hate to swim you’re not going to do it. Find an activity that you can modify to fit your lifestyle.

“I think Tai Chi is fantastic,” Petrow continues. “I encourage our patients to practice it, more for balance and proprioception. Balance is like muscle: you can train and improve it.

Better balance and muscle tone help prevent falls, and can decrease pressure on joints.

“Every little bit helps,” he says, but people should not expect total relief.

“Muscles are shock absorbers and exercise can help,” he says, “but when you have bone on bone, it doesn’t matter how much muscle tone you have.”

As with most medical conditions, a healthy diet is important in minimizing damage to joint, and that’s a lot less complicated than some people may realize. Expensive supplements, for example, are likely to be a waste of money.

“A lot of the information about supplements is voodoo,” Petrow says. “Keeping a healthy body weight will by far help your joints more. Every extra pound of body weight exerts three to four pounds of force on you knee joints, every step, every day.

“Calories are just a number, and you need to look at how to deduce them,” he adds. “It’s simple math.”

Fad diets and supplements come and go, he notes, and some might do actual harm.

“Study results are published in a vacuum, and often the media grabs one tidbit and it becomes the new in thing to do,” he says, adding that mainstream media can play a role in popularizing unproven diets and supplements.

Not Your Grandmother’s Joint Replacement

People contemplating joint replacement may be reluctant to consider it because of past experiences by friends and relatives. They may want to take another look; a lot has changed, even in the past 10 years.

“The marriage of techniques and technology has helped orthopedics deliver a better lifestyle,” says Petrow.

People who were advised to delay replacement because the joints wear out now can expect them to last 20-25 years. And the surgery techniques have improved significantly. The practice of “banking blood ahead of time for transfusions during surgery is no longer needed, for example, and the hospital stay has decreased from three weeks to a few days. 

“We are delivering joints through smaller incisions, which are less invasive,” Petrow said. “When you combine that with improved technology we’re entering a golden age of what we are able to do.”

“The nuts and bolts are the same,” he continues. “We have better instrumentation to make more accurate incisions, and we’ve improved our techniques.”

Surgeons now do hip replacement through the front, which reduces the amount of muscle to cut, making recovery faster.

Technology and improved methods help, but Petrow says the skill and experience of the surgeon remain the most critical considerations for people seeking joint replacement.

Drug Therapies: Relief, but at a Cost

Medication can relieve the pain, but Petrow urges caution in using drugs to treat arthritis.

“I remember a pharmacology professor telling us that all medicines are poison, and we should try to avoid taking poisons,” he says. “Nutritional therapies like glucosamine and injectibles will not bring back what’s gone; they just treat the symptoms, and they come with a price.”

Sometimes the price can be higher than people realize.

“Celebrex was a popular arthritis prescription drug, then we learned about heart disease and stroke issues,” Petrow says, adding that with medications, “less is better, so use them only when you need to.”

At some point, Petrow says, science will allow doctors to harvest cartilage out of a joint, grow it in a laboratory and transplant it to a patient, but as of now such procedures are just a dream.

“Growing and transplanting cartilage is the Holy Grail in orthopedics right now,” he says. But it’s a long way off.”

Osteoarthritis is incurable, but incurable does not mean hopeless. People with osteoarthritis have a variety of treatment options, and going over them with a physician could minimize the impact on their enjoyment of life.

“If you have pain in your joint that limits your lifestyle, you should talk to someone about it,” Petrow advises. “People may think they are too old or too young to undergo treatment for arthritis, but you’re never too old or too young to enjoy your life, and you only get one.

Don’t assume that what was true for a friend or relative 10 or 20 years ago applies today.

“A lot of misconceptions have lingered from the earlier days of orthopedic surgery,” he says. “Motion is life. If you can’t enjoy your life, sit down and talk to someone about it – no matter what your age is.”

Written by Mark Flint

As published in Tucson Osteopathic Medical Foundation publication, “Something More for You, the Osteopathic Patient”, Vol. 14, Issue 1, 2012

Treating Arthritis: Making Gains Against The Pain

1 Dec 2011 Doctors, Edward Petrow, Eric Anctil, Media , , , ,

Although there are 100 types of arthritis, and many forms of treatment, research is getting us close to significant improvements in care. Here are some of the local developments that offer hope.

Arthritis is America’s number one cause of disability, costing the U.S. economy more than $128 billion a year, according to the Arthritis Foundation. The organization’s Southern Arizona Chapter reports that in Arizona alone, approximately 1.1 million people have some form of the disease. Six thousand of those are children.

Considering how prevalent the disease is, there’s still much research, education and drug testing to be done. Arthritis is complicated – it has 100 different forms, including many autoimmune disorders; it can be difficult to diagnose; and despite the number of drugs on the market, there’s no single treatment that works for everyone.

“Arthritis is a Greek word meaning ‘swelling of the joint,'” says Susan Sweeney, executive director of the Arthritis Foundation’s Greater Southwest Chapter. “Osteoarthritis (OA) is the number one disease in our group; rheumatoid arthritis (RA) is second. Then there’s lupus, which can be of the skin or different kinds; fibromyalgia; or psoriatic arthritis,” the type PGA player Phil Mickelson was diagnosed with in 2010. Autoimmune forms of arthritis have very different causes than OA, but they generally all create joint pain.

Two local medical groups are aggressively pursuing advancements in the field of arthritis, with cutting-edge research being conducted at the Arizona Arthritis Center and innovative patient treatments being done at Tucson Orthopaedic Institute (TOI).

Located on the University of Arizona College of Medicine campus, the Arizona Arthritis Center is headed by Eric Gall, MD, the center’s founder and current interim director.

He says the main focus at the center is immunology and inflammation. A current study, led by John Szivek, MD, is exploring a new treatment for OA patients. “Dr. Szivek worked with artificial joints early on. Now he’s studying re-growth of cartilage in damaged joints using non-controversial stem cells,” Dr. Gall explains. “They’re taken from the fat of the abdomen, he grows them and reintroduces them to grow into new cartilage. This is a new approach in this area. His lab is waiting to be FDA approved to do the study in humans.”

Other research underway at the center includes investigating how to control lupus, clinical studies on pharmaceuticals and a look at valley fever in arthritis patients who are on biologic agents. “Fungal infections can come out in these patients,” and they must go off the drugs, Dr. Gall says. In the past, there’s been uncertainty about whether the patients could continue treatment after valley fever symptoms dissipated. “We’re asking, can you treat again after going off the drug?”

Physicians at Tucson Orthopaedic Institute are attracting attention for three progressive procedures that help those with deteriorating joints. Eric Anctil, MD is performing the Scandinavian Total Ankle Replacement (STAR) surgery, which results in greater range of motion than what’s achieved with other options.

The STAR device, states Dr. Anctil, “is the only implant that’s mobile bearing.” Other ankle replacement devices are fixed bearing and therefore limit motion, as does ankle fusion. The procedure was developed by a Danish surgeon and has been commonplace in Europe and Canada for 15 to 20 years. The Food and Drug Administration approved the technique in the U.S. two years ago.

Anctil moved to Tucson from Canada, where he’d been performing the surgery for years. “When I first came here, I didn’t use another replacement; I waited for the FDA approval. I was the first one in Arizona to do it. Now there are one or two doctors who do the procedure in Tucson and some in Phoenix,” he says.

Those who have put off hip replacement surgery in anticipation of something less invasive now have another option, currently being performed by Edward Petrow Jr., DO. “With anterior hip replacement (AHR), instead of cutting muscle to get to the hip joint, we move the muscle to the side from the front. It’s a quicker initial recovery and patients are off the cane or walker in the first week or two. Other advantages are that there are no hip precautions and a much lower risk for hip dislocation.” The incision, he says, is 8-10 centimeters.

Using real time X-ray makes the surgery more precise. “We use the opposite hip as a template to match leg length,” an issue which occasionally arises with other hip replacement techniques, Dr. Petrow notes. AHR is done on a special surgical table that allows extension of the patient’s leg downward, thus giving front access to the hip.

Like Dr. Anctil, Dr. Petrow moved to Tucson from an area where the surgery already was being performed. “I came from Virginia and did it there. I was surprised more people weren’t doing it here.” Dr. Petrow’s primary obstacle was convincing Hospital administrators to purchase the special table at a cost of $70,000 to $120,000, which they eventually did.

The surgery also requires special training. After performing approximately 40 AHR surgeries during his last year in Virginia and a dozen here, Dr. Petrow believes he’s the most experienced AHR doctor in Tucson. “It’s now sweeping the country,” he adds.

Just approved by the FDA is an innovative procedure for improving ee s, one that uses vitamin E to extend the life of the device. When this article was written, Scott Slagis, MD was the only Tucson doctor lined up to perform the surgery, which will begin once the implants are shipped. He explains that plastics in joint replacements are generally radiated during manufacturing to make them more durable. But radiation releases free radicals into the plastic, which can lead to oxidation and subsequent wear.

“You add vitamin E, which is an antioxidant, and it neutralizes the free radicals. It then may last longer and be stronger,” Dr. Slagis reports. He says the procedure is not age restricted, but it’s especially good for younger, active patients because of its longevity.

Dr. Slagis has seen small advancements in knee replacement procedures, which he’s been performing for 20 years. But he believes the vitamin E implant could prove to be significant. “This is one that may have profound implications,” he says.

Children With Arthritis

Although support programs abound for kids with arthritis, medical attention can be harder to come by, with a shortage of doctors nationwide.

“There are no board-certified pediatric rheumatologists in Southern Arizona, states Deborah Jane Power, DO, of Catalina Pointe Arthritis and Rheumatology Specialists, P.C. “I’m the only rheumatologist in Southern Arizona willing to see kids with juvenile arthritis 15 and younger.” She and her partners also treat adults with RA and OA.

Power explains the differences between the two: “Osteoarthritis is a degenerative, wear-and-tear condition. Some is genetic, some caused by obesity or trauma and bad injuries, such as sports related. The distribution in the body is knees and hips, the base of the thumb and the joint closest to the fingernail.” While she said there are no drugs that slow the progression of OA, taking anti-inflammatory drugs can help, as can exercise.

“Rheumatoid arthritis is an autoimmune disease that starts in the joint. The body attacks the joint lining in the synovial capsule.This causes swelling, pain and loss of range of motion. It’s whole-body inflammation.You also can have fatigue and a low-grade fever,” Power notes.

Nutrition plays a part in arthritis, as well, she says. “Dr. Andrew Weil believes dairy is inflammatory. Things like turmeric, garlic, cayenne and green tea help with inflammation, so patients can be given that. Foods in the nightshade family cause inflammation — tomatoes, potatoes and eggplant.” She suggests that people with RA and other autoimmune diseases avoid gluten, as it can stimulate the immune system.

Arthritis Foundation – Greater Southwest Chapter

The foundation’s primary goals, notes Executive Director Susan Sweeney, are to increase awareness of the disease, raise funds for research and provide local support for people with arthritis. “Money raised in Tucson stays to provide programs and services in Southern Arizona,” she says. These include seminars, health fairs, exercise classes, educational material, referrals, scholarships and kids’ camps — all coordinated out of the Arthritis Foundation’s office at 310 S. Williams Boulevard.

“We have community education classes where a physician and I go out to senior centers, senior communities or to the work place. One big thing we do is arthritis exercise classes. Water exercise and Tai Chi are especially good choices for arthritis patients. We train instructors and have partnerships with Tucson Parks & Recreation, for example.”

Often, it can take eight weeks to see a rheumatologist, according to Sweeney, and people want information on the disease while they wait. “We send them support group information, Arthritis Today magazine and a drug guide from the national office.” Her staff can refer callers to one of eight rheumatology groups in town.

Major fundraising events for the foundation include the Arthritis Walk, held each spring; the Jingle Bell 5K Run & Fun Walk in December; and a newcomer last year, the Surgeons vs. Chefs Pumpkin Carving Contest.

Chris Stead, local Arthritis Walk coordinator, reported that this year’s event drew more than 500 participants and raised approximately $40,000 through pledges, donations and sponsorships. Held at Brandi Fenton Memorial Park on May 7, 2011, the one-mile walk was kicked off by Mayor Bob Walkup, followed by entertainment and activities.

“We had community vendors and booths like Sam’s Club, Desert Diamond Casino and orthopaedic teams,” notes Stead. Ronald McDonald performed magic tricks for the kids, a disc jockey played music and a splash pad cooled everyone Down. “There was a dogathon, and K-9 Loyal Companions gave doggie massages. Dogs get arthritis, too,” Stead remarks.

This year’s holiday-themed 5K fundraiser is slated for Dec. 3 at Reid Park, he says.“It’s a timed run, people dress in holiday gear and we give awards. There’s also a contest with dogs; you can dress up your pet. Funds help with juvenile arthritis family camps and other programs.”

The foundation holds three camps each year: Camp Cruz, a week-long summer camp for 11 to 16 year olds in New Mexico; an overnight camp for younger kids; and a family camp held locally.

As published in Tucson Lifestyle Magazine, December 2011

Written by Christy Krueger

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