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CNN Sunday Morning
Weekend House Call
Aired November 16, 2003 - 08:29 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning and welcome to WEEKEND HOUSE CALL.
Seventy million adults, or one in three suffer from arthritis or chronic joint pain. Most people know about this. A deadly disease that comes in many forms from bursitis to lupus and osteoarthritis, and there's no cure in sight.
But, there are new treatments on the horizon and some simple things you can do now to help keep the pain in check.
Christy Feig has this report.
(BEGIN VIDEOTAPE)
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): Delores O'Brien moves slowly on cold mornings.
DELORES O'BRYANT, ARTHRITIS SUFFERER: I get up and it's like you take about five or ten minutes to get out of the bed because sometime I have trouble with my back.
FEIG: She has arthritis in her spine and knees. She says it also affects everyday movements.
O'BRYANT: When I try to get something off the floor or get underneath the bed to pull things out. I get down there and take me about 10 or 15 minute to get up.
FEIG: There are more than 100 different types of arthritis.
(on camera): The most common is osteoarthritis. It affects more than 20 million Americans and dates back centuries. Evidence has even been found in Egyptian mummies. That developed some protective cartilage around the bone, deteriorates.
(voice-over): Treating it is problematic. So says the head of rheumatology at the Washington Hospital Center.
DR. ARTHUR WEINSTEIN, WASHINGTON HOSPITAL CENTER: We don't have a drug that changes the cartilage breakdown. So our treatments are really focused on the pain.
FEIG: Rheumatoid arthritis is less common, but still affects more than 2 million Americans, most of them women, according to the Arthritis Foundation. And it's much more debilitating than osteoarthritis. Rheumatoid arthritis is caused by inflammation that can actually deteriorate the bone.
WEINSTEIN: So, if you have rheumatoid arthritis, the chances of you becoming significantly disabled is very high. Probably over 50 percent of patients with rheumatoid arthritis, at least in the old days, developed significant disability.
FEIG: Experts predict in the next ten years treatments for rheumatoid arthritis will improve dramatically. For now experts suggest arthritis sufferers keep those joints moving and keep their weight in the normal range as it puts less of a burden on the knees.
Christy Feig, Washington.
(END VIDEOTAPE)
GUPTA: And as Christy points out, staying active is important for treating arthritis, but it is also a good way to help prevent early symptoms. Exercise helps in two ways, it keeps joints flexible and helps maintain your weight. Other strategies, try to avoid sport injuries, especially the joints, and if you think you may have arthritis, go see your doctor, now. Because the earlier you get diagnosed, the faster you can start treatments to slow down the disease.
Speaking of treatments, incidentally, a new study out, this week, is giving hope to those suffering from rheumatoid arthritis. Researchers say a new drug's out there that stops the body from attacking itself and can dramatically reduce pain and swelling. More tests, obviously, under way before it goes before the FDA, but a very interesting thing out there.
We've got a lot to talk about with regards to arthritis. We want to hear from you, 1-800-807-2620, or e-mail us, housecall@cnn.com.
Helping us sort through all this information this morning, Dr. Peter Gorevic, he's chief of rheumatology at Mount Sinai Hospital in New York.
Good morning, doctor.
DR. PETER GOREVIC, MT. SINAI HOSPITAL: Good morning.
GUPTA: First of all, tell us that rheumatologists -- are you the type of doctor that people should go see if they're having any kind of aching in their joints or should they go to their family doctor first?
GOREVIC: Well, many patients go to their family doctors first. But, I think a rheumatologist has an important role in trying to figure out all the different causes of aches and pains. A rheumatologist is an internist who specializes in diseases of muscle, bone, and specifically joints.
GUPTA: And, there's a lot of treatments out there for arthritis and you just mentioned one of these new ones potentially coming out, there. First of all, what is it and should people be excited about this new treatment?
GOREVIC: Well, I think a lot of us are very excited about this new treatment. It represents a different approach to treating rheumatoid arthritis than what's already on the market. And, there have been an explosion of new treatments that are either under testing or have been released in the last two to three years. This is a drug which acts on something called the activated t-cell. And the results in this study are very, very promising.
GUPTA: Just really quickly before we move on here, what typically causes arthritis? A lot of people at home, sort of, very novice to this. What is the underlying process that causes this problem?
GOREVIC: Well, we think of arthritis, all different types of arthritis, as being a combination of environmental factors, so the environmental factors might be stress or might be trauma to a joint, and genetic factors. And, it probably factors out about 50-50. And a lot of the research is to segregate out the causes -- the different causes, both environmental and genetic.
GUPTA: OK, Lots of e-mail and calls coming in on this topic. Let's start with one from Laura from Massachusetts who writes:
"I have arthritis in my lower back, my neck, and my knees. What can I do to prevent it from getting progressively worse?"
I imagine that's one of your most common questions, Dr. Gorevic.
GOREVIC: I think Laura's question is absolutely right. The important thing is basically to diagnose it correctly. There are a lot of causes of pain in the back and the knees and also even in the knees. And it may not even be arthritis. So, I think the important thing is to get a thorough evaluation to look at it, and to try to see what things are actually going wrong, whether it's in the joint or around the joint. And then to develop -- and that's where a rheumatologist comes in, is to try to develop a very structured program, to try to help it , to determine how far along it is, and to help it from progressing further.
GUPTA: And, we're going to have some tips later on to prevent it from ever getting to that point, as well. But, let's go to our phone lines, now.
Allen from Illinois, good morning and welcome to WEEKEND HOUSE CALL.
ALLEN, ILLINOIS: Yes, I've been diagnosed with tendonitis in the arm and I was wondering -- what relief can I get for that?
GUPTA: And tendonitis, Dr. Gorevic, not arthritis. They're different. Talk about the differences, first.
GOREVIC: Well, tendonitis is an inflammation or an irritation of tendon, where as arthritis is actually in the joint, like the knee joint or the shoulder joint. There are tendons around joints, and so it's important to try to make that distinction. So it's again, what we do is we try to analyze which tendons are involved, and then we can try to structure specific therapies which may include trying to reduce down any stress that's on that tendon, to even physical therapy or even injection therapy has a role.
GUPTA: OK, and would you say one is more severe than the other, tendonitis or arthritis or are they both pretty treatable?
GOREVIC: I think they're both pretty treatable. It's hard to generalize, but we can do a lot for both of those.
GUPTA: All right, we're going to take a short break, now. Are you still trying to figure out at home which treatment might be best for you? Well stay tuned, we're going to give you some self-help alternatives, as well. This is a big topic. That's coming up when we come back.
And, of course, we want to hear from you, taking your calls at 1- 800-807-2620 or e-mail us at housecall@cnn.com.
You can also e-mail us your questions about some winter woes from cold and flu to not getting enough light, known as Seasonal Affective Disorder.
You're going to get answers to those questions in a couple of weeks, so stay tuned to WEEKEND HOUSE CALL.
(COMMERCIAL BREAK)
GUPTA: Welcome back to WEEKEND HOUSE CALL we're talking about living with arthritis. As in other fields, doctors who treat arthritis are looking outside of Western and traditional therapies to try and find ways to fight the pain and swelling in this disease. Yoga, meditation and massage are just a few of your options. All three of these distress people which helps relax muscles and can potentially ease pain. Tai Chi, that's the Chinese art of graceful exercises, takes joints gently through their range of motion and sometimes better than yoga when people are actually experiencing a flair up in their pain.
As for acupuncture, we looked into that, as well. Studies go both ways, some show it relieves pain, and the others show no improvement. We're talking with Dr. Peter Gorevic, he's helping us sort through all this. He's from -- he's the head of rheumatologist at Mount Sinai hospital.
First of all, Doctor, do you recommend any of these alternatives to your patients?
GOREVIC: I don't recommend them, but I try to incorporate them. Because I would say probably 40 to 60 percent of my patients are using various alternative medicines and I'd like to try to make sure that I'm tracking it and to help them along with it. But, we don't recommend it in that some of them are of some limited benefit.
GUPTA: How long have you been practicing rheumatology now, Doctor?
GOREVIC: About 25 years.
GUPTA: Have you seen a change in the number of people using alternative therapies over that time?
GOREVIC: Absolutely. Absolutely. It's really quite amazing how many people are using some of these complementary medicines, and there is a real need to try to develop some guidelines for using them.
GUPTA: Yes, and I think that's underway, as well. Lots of interest in this particular topic. Let's go straight to our phone lines, now.
Terry from Illinois, good morning and welcome to WEEKEND HOUSE CALL.
TERRY, ILLINOIS: Good morning, Doctors. I've heard that Glucosamine and Chondroitin sulfate and possibly regenerate cartilage. Have there been any studies showing the effectiveness of these substances, also have there been any studies indicating long-term adverse side effects of these substances?
GUPTA: Good question and Dr. Gorevic, this is something that is becoming widely used, just like we were talking about.
GOREVIC: Yeah. Well, thank you Terry, for that question, it's very, very important. That 40 percent to 60 percent of people that I am taking care of, many of them are taking both of these supplements. and there is some information that they may have a modest benefit. The problem in this area is a couple of fold: No. 1, is that there haven't been, at least up till recently, very, very good controlled studies to show that they absolutely work. Second of all, most the people are using it for osteoarthritis, and it is not clear that it really has a role for what we were talking about before, which is rheumatoid arthritis. The third thing that you need to understand is that this is not a prescription item. It's not a regulated drug and therefore, there are some problems in terms of keeping all the different preparations under some sort of firm control. And the last thing is very important and that is that current plans do not cover this type of, what I call neutralceutical, and so people who are on fixed incomes need to think very careful about this because it's not cheap and it does cost a significant amount of their income, especially if you're on a limited income. Having said all of that, I think there's still a lot of information that needs to come out, and I think what Gupta was referring to is that there's a very big study that's ongoing that's funk -- that is funded by the National Institutes of Health that is looking at the role of this for osteoarthritis of the knee, and we're all waiting to see what the results will come out. Probably within the next year.
GUPTA: Lots of useful information there. A couple of things as well, these supplements can some -- are something you should talk to your doctor about, right? Because I've read that people who are allergic to shell fish, people who are on blood thinners, and people who have severe problems with blood sugar, as in diabetics, may have problems with this medication, as well?
GOREVIC: That's right. I think you have to think about that with Glucosamine for diabetes. Shrimp is a real problem in patients who take SAM-e, for example, if they have any sort of liver disease or if they're on a drug called Methotrexatem which we often use for rheumatoid arthritis, should be very, very careful and let the doctor know.
GUPTA: And, we go another -- that's good advice, Doctor. And, we have another question coming in, sort of about prevention.
Carol in Ontario writing: As someone who is just starting to see the signs of arthritis in her baby finger, it as it turns out in this case, is there something she can do to add to her diet, or take that will slow the progress of this particular disease? Doctor?
GOREVIC: Well, thank you for that question, Carol, I think the important thing is to just make sure that it really is arthritis. And, then to look very carefully at the things that may be aggravating the situation. Diet really has only a very limited role here, there've been a lot of discussion about this. We pay a lot of attention to diet. When my patients tell me they think their arthritis is made worse by a specific diet, I pay a lot of attention to it and try to analyze it. But in most cases, it doesn't seem as if diet is really going to change anything.
GUPTA: OK, we're talking to Dr. Peter Gorevic, a rheumatologist out of New York. Lots of useful information. This is not a disease that just affects adults, as many people know, juvenile arthritis is a painful condition that is more common than diabetes or cystic fibrosis in kids. Next we'll take a look at one boy who is battling the disease. Stay with us.
(COMMERCIAL BREAK)
GUPTA: Welcome back to WEEKEND HOUSE CALL. Many people think arthritis affects only older people, but 70,000 children are also living with the disease. We met one of those children. Ethan Hamilton, is one of those kids.
(BEGIN VIDEOTAPE)
GUPTA (voice-over): For a long time Ethan Hamilton has been waiting for a better way to treat his pain.
ETHAN HAMILTON: The bed isn't always made, but I try to keep this stuff in order.
UNIDENTIFIED FEMALE: He has gone through more in his life than I have ever -- you know, childbirth, any of that, is nothing.
GUPTA: 11-year-old Ethan was diagnosed with juvenile arthritis at the age of 5.
HAMILTON: Sometimes I'm really, really sore. Like, when I was -- first had it, I was so sore I couldn't get out of bed. GUPTA: The symptoms include fever, anemia, rash, fatigue and of course, the arthritis itself, which can eat away at the bones and joints.
UNIDENTIFIED FEMALE: Ethan, if he wasn't being treated, I'm quite sure that Ethan would be bed bound.
GUPTA: Up to 70 percent of children with juvenile arthritis respond well to therapy and fully recover. But Ethan's type of arthritis is one of the most difficult to treat. And, the treatment itself includes chemotherapy and steroids which causes terrible problems including weight gain and stunted growth.
HAMILTON: Lots of people see my cheeks and I'm a lot shorter than I am. They think that I'm younger and fatter than I am. I used to be very, very skinny and one of the tallest in my grade. But, this is all because of the medicine that I take.
UNIDENTIFIED FEMALE: He gets seven shots a week and an infusion every other week, and about 12 to 13 pills a day.
GUPTA: But, now researchers are looking at other approaches including a new class of drugs including Biologics.
UNIDENTIFIED FEMALE: Instead of suppressing the entire immune system, they target a small area that's thought to be involved in arthritis.
UNIDENTIFIED FEMALE: You start off hoping that it's going to go away. And you go through these steps. And as you fail, there is medications and go on to the bigger ones.
GUPTA: Ethan has already shown some response to Biologics. Of course, he insists he doesn't spend too much time thinking about his disease.
HAMILTON: I do think it will go away. I don't know when, but I think it will.
(END VIDEOTAPE)
GUPTA: And, juvenile arthritis, a very crippling condition. Ethan, a very cute kid. Juvenile arthritis very difficult to treat, but as you saw a new class of drugs, not just helping children, but also adults. We're going to talk about that and helping us is Dr. Peter Gorevic. He's chief of rheumatology at Mount Sinai Hospital.
Dr. Gorevic, this new class of drugs, Biologics, can it as Ethan said, make his arthritis one day go away?
GOREVIC: Well, it's very, very important. The study that we talked about a few minutes ago is an example of one of the Biologics which is just undergoing testing. These are drugs which target the immune system or something called cytokines, which are proteins that are very important in arthritis and there are now at least three-- four of these Biological that are -- have already been released by the FDA, and it's very likely that there are going to be more of them. They're primarily being tested for rheumatoid arthritis, but people with other types of arthritis, such as kids who have what we call, juvenile arthritis are probably next on line to be treated with these drugs and a lot of the early results are very, very promising.
GUPTA: Well, that's good news for Ethan, as well. Let's stay on this juvenile arthritis theme now, actually a teenager.
Robin from Minnesota asking: "My 17-year-old daughter has difficulty opening containers and her arms are very stiff for a few hours in the morning. We were told it was repetitive motions disorder, but now that I've seen that young women can get arthritis, as well. How can you tell the difference?"
How about it, Doctor? How do you know, I mean, a lot of parents watching this show right now, how do you know if your child might actually be developing the signs of arthritis?
GOREVIC: Well, children are -- sometimes have symptoms that are a little bit different than adults, although we consider a 17-year-old pretty much of an adult. Again, this is what we talked about before. It's really having somebody take a look at it and see whether it is repetitive stress, which is usually occupational, but also to examine the joints, to just see whether it is truly arthritis, whether it might be the tendonitis that we talked about, which is sometimes associated with the arthritis, and to try to analyze that carefully and then prescribe specific therapy to try to reduce down the pain, the inflammation, if it's there, and to protect the part of the body that's being affect by this.
GUPTA: And, really briefly, is there a blood test, is it x-rays, just a physical exam? How does the diagnosis of arthritis get made?
GOREVIC: The first way, from my perspective, is the physical diagnosis and what the person tells you is the most important thing, is spending the time just going over it. A rheumatologist does a very specific physical exam when we're examining all of those things. And then we may ask for blood tests, there are blood tests that are particularly helpful to see if there's inflammation or not. And x- rays, and now there are a number of other ways of looking at joints and tendons that go beyond standard x-rays, are being increasingly used by people who practice our subspecialty to try to dissect this out and then come to some sort of conclusion about what's going on and then to treat it appropriately.
GUPTA: OK. Well, let's switch gears a little bit, and something else that you treat, a question from Vuong in California who writes:
"How can you best manage gout? Is food intake modification the best way or is it medication? To date, my doctor has only prescribed pain medication and anti-inflammatory drugs to manage the symptoms, but how can I fix or cure the root cause?
OK, Doctor, what is gout, first of all, what is the best treatment, do you think, for this disease? GOREVIC: Well, gout's a very important problem. There are probably at least 1 million to 2 million people who have gout, and it's a very treatable type of arthritis. The first thing is to make sure that it is gout. Because some things that look like gout are not gout. The second thing is to try to modify things that may be influencing the gout, and that would certainly include diet, to some extent, although we pay more attention to alcohol intake because excess alcohol intake, specifically beer, is very, very important in this. And, then there are drugs that we use to try to control the gout. And, then I would say 80 percent to 90 percent of times we're able to adequately control it if we do the right things.
GUPTA: OK, good advice and gout, for anybody who's ever had it, one of the most painful things out there. Stay where you are. When we come back, we're going to tell you where you can get more information on arthritis treatments.
But first, let's check out some of this week's medical headlines in this edition of "Your Health."
(BEGIN VIDEOTAPE)
GUPTA (voice-over): A new study in the journal "Neurology" suggests high levels of vitamin C can help smokers reduce their risk of having a stroke. Smokers with diets high in vitamin C were more than 70 percent less likely to have a stroke than smokers with diets low in vitamin C.
Also, a new report shows 13 percent of workers surveyed lost time in the workplace due to chronic pain. The study released in "The Journal of the American Medical Association," this week, showed headaches were their number one complaint.
(END VIDEOTAPE)
(COMMERCIAL BREAK)
GUPTA: Check out www.arthritis.org, the Arthritis Foundation. They've got the latest on medications and treatments for all types of arthritis. Also, try cnn.com/health, from there you can go to the Mayo Clinic Web site where you're going to find information about alternative treatments and exercises you can do to feel better, plus much more about arthritis.
Dr. Peter Gorevic has been joining us. A final Dr. Gorevic, we talk about treatment for arthritis. Can you actually reverse this disease process?
GOREVIC: I think that the short answer is that we can't yet, but we're awfully close. Some of these new Biologicals have some promise in that regard. Some very early information is exciting, and there's a lot of studies that are going on of ways to trying to put new cartilage into those joints that are affected by osteoarthritis. So my final answer is, stay tuned.
GUPTA: Final answer. All right, Dr. Gorevic, thank you so much for joining us.
Viewers at home, thank you, as well. We're out of time for today. Thank you, from all of us that called in and e-mailed us, as well. Make sure to watch next weekend, we're going to be talking about breaking bad habit, like smoking, overeating, and even biting your nails.
Thanks for watching, I'm Dr. Sanjay Gupta. "CNN Sunday Morning" continues, now.
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Aired November 16, 2003 - 08:29 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning and welcome to WEEKEND HOUSE CALL.
Seventy million adults, or one in three suffer from arthritis or chronic joint pain. Most people know about this. A deadly disease that comes in many forms from bursitis to lupus and osteoarthritis, and there's no cure in sight.
But, there are new treatments on the horizon and some simple things you can do now to help keep the pain in check.
Christy Feig has this report.
(BEGIN VIDEOTAPE)
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): Delores O'Brien moves slowly on cold mornings.
DELORES O'BRYANT, ARTHRITIS SUFFERER: I get up and it's like you take about five or ten minutes to get out of the bed because sometime I have trouble with my back.
FEIG: She has arthritis in her spine and knees. She says it also affects everyday movements.
O'BRYANT: When I try to get something off the floor or get underneath the bed to pull things out. I get down there and take me about 10 or 15 minute to get up.
FEIG: There are more than 100 different types of arthritis.
(on camera): The most common is osteoarthritis. It affects more than 20 million Americans and dates back centuries. Evidence has even been found in Egyptian mummies. That developed some protective cartilage around the bone, deteriorates.
(voice-over): Treating it is problematic. So says the head of rheumatology at the Washington Hospital Center.
DR. ARTHUR WEINSTEIN, WASHINGTON HOSPITAL CENTER: We don't have a drug that changes the cartilage breakdown. So our treatments are really focused on the pain.
FEIG: Rheumatoid arthritis is less common, but still affects more than 2 million Americans, most of them women, according to the Arthritis Foundation. And it's much more debilitating than osteoarthritis. Rheumatoid arthritis is caused by inflammation that can actually deteriorate the bone.
WEINSTEIN: So, if you have rheumatoid arthritis, the chances of you becoming significantly disabled is very high. Probably over 50 percent of patients with rheumatoid arthritis, at least in the old days, developed significant disability.
FEIG: Experts predict in the next ten years treatments for rheumatoid arthritis will improve dramatically. For now experts suggest arthritis sufferers keep those joints moving and keep their weight in the normal range as it puts less of a burden on the knees.
Christy Feig, Washington.
(END VIDEOTAPE)
GUPTA: And as Christy points out, staying active is important for treating arthritis, but it is also a good way to help prevent early symptoms. Exercise helps in two ways, it keeps joints flexible and helps maintain your weight. Other strategies, try to avoid sport injuries, especially the joints, and if you think you may have arthritis, go see your doctor, now. Because the earlier you get diagnosed, the faster you can start treatments to slow down the disease.
Speaking of treatments, incidentally, a new study out, this week, is giving hope to those suffering from rheumatoid arthritis. Researchers say a new drug's out there that stops the body from attacking itself and can dramatically reduce pain and swelling. More tests, obviously, under way before it goes before the FDA, but a very interesting thing out there.
We've got a lot to talk about with regards to arthritis. We want to hear from you, 1-800-807-2620, or e-mail us, housecall@cnn.com.
Helping us sort through all this information this morning, Dr. Peter Gorevic, he's chief of rheumatology at Mount Sinai Hospital in New York.
Good morning, doctor.
DR. PETER GOREVIC, MT. SINAI HOSPITAL: Good morning.
GUPTA: First of all, tell us that rheumatologists -- are you the type of doctor that people should go see if they're having any kind of aching in their joints or should they go to their family doctor first?
GOREVIC: Well, many patients go to their family doctors first. But, I think a rheumatologist has an important role in trying to figure out all the different causes of aches and pains. A rheumatologist is an internist who specializes in diseases of muscle, bone, and specifically joints.
GUPTA: And, there's a lot of treatments out there for arthritis and you just mentioned one of these new ones potentially coming out, there. First of all, what is it and should people be excited about this new treatment?
GOREVIC: Well, I think a lot of us are very excited about this new treatment. It represents a different approach to treating rheumatoid arthritis than what's already on the market. And, there have been an explosion of new treatments that are either under testing or have been released in the last two to three years. This is a drug which acts on something called the activated t-cell. And the results in this study are very, very promising.
GUPTA: Just really quickly before we move on here, what typically causes arthritis? A lot of people at home, sort of, very novice to this. What is the underlying process that causes this problem?
GOREVIC: Well, we think of arthritis, all different types of arthritis, as being a combination of environmental factors, so the environmental factors might be stress or might be trauma to a joint, and genetic factors. And, it probably factors out about 50-50. And a lot of the research is to segregate out the causes -- the different causes, both environmental and genetic.
GUPTA: OK, Lots of e-mail and calls coming in on this topic. Let's start with one from Laura from Massachusetts who writes:
"I have arthritis in my lower back, my neck, and my knees. What can I do to prevent it from getting progressively worse?"
I imagine that's one of your most common questions, Dr. Gorevic.
GOREVIC: I think Laura's question is absolutely right. The important thing is basically to diagnose it correctly. There are a lot of causes of pain in the back and the knees and also even in the knees. And it may not even be arthritis. So, I think the important thing is to get a thorough evaluation to look at it, and to try to see what things are actually going wrong, whether it's in the joint or around the joint. And then to develop -- and that's where a rheumatologist comes in, is to try to develop a very structured program, to try to help it , to determine how far along it is, and to help it from progressing further.
GUPTA: And, we're going to have some tips later on to prevent it from ever getting to that point, as well. But, let's go to our phone lines, now.
Allen from Illinois, good morning and welcome to WEEKEND HOUSE CALL.
ALLEN, ILLINOIS: Yes, I've been diagnosed with tendonitis in the arm and I was wondering -- what relief can I get for that?
GUPTA: And tendonitis, Dr. Gorevic, not arthritis. They're different. Talk about the differences, first.
GOREVIC: Well, tendonitis is an inflammation or an irritation of tendon, where as arthritis is actually in the joint, like the knee joint or the shoulder joint. There are tendons around joints, and so it's important to try to make that distinction. So it's again, what we do is we try to analyze which tendons are involved, and then we can try to structure specific therapies which may include trying to reduce down any stress that's on that tendon, to even physical therapy or even injection therapy has a role.
GUPTA: OK, and would you say one is more severe than the other, tendonitis or arthritis or are they both pretty treatable?
GOREVIC: I think they're both pretty treatable. It's hard to generalize, but we can do a lot for both of those.
GUPTA: All right, we're going to take a short break, now. Are you still trying to figure out at home which treatment might be best for you? Well stay tuned, we're going to give you some self-help alternatives, as well. This is a big topic. That's coming up when we come back.
And, of course, we want to hear from you, taking your calls at 1- 800-807-2620 or e-mail us at housecall@cnn.com.
You can also e-mail us your questions about some winter woes from cold and flu to not getting enough light, known as Seasonal Affective Disorder.
You're going to get answers to those questions in a couple of weeks, so stay tuned to WEEKEND HOUSE CALL.
(COMMERCIAL BREAK)
GUPTA: Welcome back to WEEKEND HOUSE CALL we're talking about living with arthritis. As in other fields, doctors who treat arthritis are looking outside of Western and traditional therapies to try and find ways to fight the pain and swelling in this disease. Yoga, meditation and massage are just a few of your options. All three of these distress people which helps relax muscles and can potentially ease pain. Tai Chi, that's the Chinese art of graceful exercises, takes joints gently through their range of motion and sometimes better than yoga when people are actually experiencing a flair up in their pain.
As for acupuncture, we looked into that, as well. Studies go both ways, some show it relieves pain, and the others show no improvement. We're talking with Dr. Peter Gorevic, he's helping us sort through all this. He's from -- he's the head of rheumatologist at Mount Sinai hospital.
First of all, Doctor, do you recommend any of these alternatives to your patients?
GOREVIC: I don't recommend them, but I try to incorporate them. Because I would say probably 40 to 60 percent of my patients are using various alternative medicines and I'd like to try to make sure that I'm tracking it and to help them along with it. But, we don't recommend it in that some of them are of some limited benefit.
GUPTA: How long have you been practicing rheumatology now, Doctor?
GOREVIC: About 25 years.
GUPTA: Have you seen a change in the number of people using alternative therapies over that time?
GOREVIC: Absolutely. Absolutely. It's really quite amazing how many people are using some of these complementary medicines, and there is a real need to try to develop some guidelines for using them.
GUPTA: Yes, and I think that's underway, as well. Lots of interest in this particular topic. Let's go straight to our phone lines, now.
Terry from Illinois, good morning and welcome to WEEKEND HOUSE CALL.
TERRY, ILLINOIS: Good morning, Doctors. I've heard that Glucosamine and Chondroitin sulfate and possibly regenerate cartilage. Have there been any studies showing the effectiveness of these substances, also have there been any studies indicating long-term adverse side effects of these substances?
GUPTA: Good question and Dr. Gorevic, this is something that is becoming widely used, just like we were talking about.
GOREVIC: Yeah. Well, thank you Terry, for that question, it's very, very important. That 40 percent to 60 percent of people that I am taking care of, many of them are taking both of these supplements. and there is some information that they may have a modest benefit. The problem in this area is a couple of fold: No. 1, is that there haven't been, at least up till recently, very, very good controlled studies to show that they absolutely work. Second of all, most the people are using it for osteoarthritis, and it is not clear that it really has a role for what we were talking about before, which is rheumatoid arthritis. The third thing that you need to understand is that this is not a prescription item. It's not a regulated drug and therefore, there are some problems in terms of keeping all the different preparations under some sort of firm control. And the last thing is very important and that is that current plans do not cover this type of, what I call neutralceutical, and so people who are on fixed incomes need to think very careful about this because it's not cheap and it does cost a significant amount of their income, especially if you're on a limited income. Having said all of that, I think there's still a lot of information that needs to come out, and I think what Gupta was referring to is that there's a very big study that's ongoing that's funk -- that is funded by the National Institutes of Health that is looking at the role of this for osteoarthritis of the knee, and we're all waiting to see what the results will come out. Probably within the next year.
GUPTA: Lots of useful information there. A couple of things as well, these supplements can some -- are something you should talk to your doctor about, right? Because I've read that people who are allergic to shell fish, people who are on blood thinners, and people who have severe problems with blood sugar, as in diabetics, may have problems with this medication, as well?
GOREVIC: That's right. I think you have to think about that with Glucosamine for diabetes. Shrimp is a real problem in patients who take SAM-e, for example, if they have any sort of liver disease or if they're on a drug called Methotrexatem which we often use for rheumatoid arthritis, should be very, very careful and let the doctor know.
GUPTA: And, we go another -- that's good advice, Doctor. And, we have another question coming in, sort of about prevention.
Carol in Ontario writing: As someone who is just starting to see the signs of arthritis in her baby finger, it as it turns out in this case, is there something she can do to add to her diet, or take that will slow the progress of this particular disease? Doctor?
GOREVIC: Well, thank you for that question, Carol, I think the important thing is to just make sure that it really is arthritis. And, then to look very carefully at the things that may be aggravating the situation. Diet really has only a very limited role here, there've been a lot of discussion about this. We pay a lot of attention to diet. When my patients tell me they think their arthritis is made worse by a specific diet, I pay a lot of attention to it and try to analyze it. But in most cases, it doesn't seem as if diet is really going to change anything.
GUPTA: OK, we're talking to Dr. Peter Gorevic, a rheumatologist out of New York. Lots of useful information. This is not a disease that just affects adults, as many people know, juvenile arthritis is a painful condition that is more common than diabetes or cystic fibrosis in kids. Next we'll take a look at one boy who is battling the disease. Stay with us.
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GUPTA: Welcome back to WEEKEND HOUSE CALL. Many people think arthritis affects only older people, but 70,000 children are also living with the disease. We met one of those children. Ethan Hamilton, is one of those kids.
(BEGIN VIDEOTAPE)
GUPTA (voice-over): For a long time Ethan Hamilton has been waiting for a better way to treat his pain.
ETHAN HAMILTON: The bed isn't always made, but I try to keep this stuff in order.
UNIDENTIFIED FEMALE: He has gone through more in his life than I have ever -- you know, childbirth, any of that, is nothing.
GUPTA: 11-year-old Ethan was diagnosed with juvenile arthritis at the age of 5.
HAMILTON: Sometimes I'm really, really sore. Like, when I was -- first had it, I was so sore I couldn't get out of bed. GUPTA: The symptoms include fever, anemia, rash, fatigue and of course, the arthritis itself, which can eat away at the bones and joints.
UNIDENTIFIED FEMALE: Ethan, if he wasn't being treated, I'm quite sure that Ethan would be bed bound.
GUPTA: Up to 70 percent of children with juvenile arthritis respond well to therapy and fully recover. But Ethan's type of arthritis is one of the most difficult to treat. And, the treatment itself includes chemotherapy and steroids which causes terrible problems including weight gain and stunted growth.
HAMILTON: Lots of people see my cheeks and I'm a lot shorter than I am. They think that I'm younger and fatter than I am. I used to be very, very skinny and one of the tallest in my grade. But, this is all because of the medicine that I take.
UNIDENTIFIED FEMALE: He gets seven shots a week and an infusion every other week, and about 12 to 13 pills a day.
GUPTA: But, now researchers are looking at other approaches including a new class of drugs including Biologics.
UNIDENTIFIED FEMALE: Instead of suppressing the entire immune system, they target a small area that's thought to be involved in arthritis.
UNIDENTIFIED FEMALE: You start off hoping that it's going to go away. And you go through these steps. And as you fail, there is medications and go on to the bigger ones.
GUPTA: Ethan has already shown some response to Biologics. Of course, he insists he doesn't spend too much time thinking about his disease.
HAMILTON: I do think it will go away. I don't know when, but I think it will.
(END VIDEOTAPE)
GUPTA: And, juvenile arthritis, a very crippling condition. Ethan, a very cute kid. Juvenile arthritis very difficult to treat, but as you saw a new class of drugs, not just helping children, but also adults. We're going to talk about that and helping us is Dr. Peter Gorevic. He's chief of rheumatology at Mount Sinai Hospital.
Dr. Gorevic, this new class of drugs, Biologics, can it as Ethan said, make his arthritis one day go away?
GOREVIC: Well, it's very, very important. The study that we talked about a few minutes ago is an example of one of the Biologics which is just undergoing testing. These are drugs which target the immune system or something called cytokines, which are proteins that are very important in arthritis and there are now at least three-- four of these Biological that are -- have already been released by the FDA, and it's very likely that there are going to be more of them. They're primarily being tested for rheumatoid arthritis, but people with other types of arthritis, such as kids who have what we call, juvenile arthritis are probably next on line to be treated with these drugs and a lot of the early results are very, very promising.
GUPTA: Well, that's good news for Ethan, as well. Let's stay on this juvenile arthritis theme now, actually a teenager.
Robin from Minnesota asking: "My 17-year-old daughter has difficulty opening containers and her arms are very stiff for a few hours in the morning. We were told it was repetitive motions disorder, but now that I've seen that young women can get arthritis, as well. How can you tell the difference?"
How about it, Doctor? How do you know, I mean, a lot of parents watching this show right now, how do you know if your child might actually be developing the signs of arthritis?
GOREVIC: Well, children are -- sometimes have symptoms that are a little bit different than adults, although we consider a 17-year-old pretty much of an adult. Again, this is what we talked about before. It's really having somebody take a look at it and see whether it is repetitive stress, which is usually occupational, but also to examine the joints, to just see whether it is truly arthritis, whether it might be the tendonitis that we talked about, which is sometimes associated with the arthritis, and to try to analyze that carefully and then prescribe specific therapy to try to reduce down the pain, the inflammation, if it's there, and to protect the part of the body that's being affect by this.
GUPTA: And, really briefly, is there a blood test, is it x-rays, just a physical exam? How does the diagnosis of arthritis get made?
GOREVIC: The first way, from my perspective, is the physical diagnosis and what the person tells you is the most important thing, is spending the time just going over it. A rheumatologist does a very specific physical exam when we're examining all of those things. And then we may ask for blood tests, there are blood tests that are particularly helpful to see if there's inflammation or not. And x- rays, and now there are a number of other ways of looking at joints and tendons that go beyond standard x-rays, are being increasingly used by people who practice our subspecialty to try to dissect this out and then come to some sort of conclusion about what's going on and then to treat it appropriately.
GUPTA: OK. Well, let's switch gears a little bit, and something else that you treat, a question from Vuong in California who writes:
"How can you best manage gout? Is food intake modification the best way or is it medication? To date, my doctor has only prescribed pain medication and anti-inflammatory drugs to manage the symptoms, but how can I fix or cure the root cause?
OK, Doctor, what is gout, first of all, what is the best treatment, do you think, for this disease? GOREVIC: Well, gout's a very important problem. There are probably at least 1 million to 2 million people who have gout, and it's a very treatable type of arthritis. The first thing is to make sure that it is gout. Because some things that look like gout are not gout. The second thing is to try to modify things that may be influencing the gout, and that would certainly include diet, to some extent, although we pay more attention to alcohol intake because excess alcohol intake, specifically beer, is very, very important in this. And, then there are drugs that we use to try to control the gout. And, then I would say 80 percent to 90 percent of times we're able to adequately control it if we do the right things.
GUPTA: OK, good advice and gout, for anybody who's ever had it, one of the most painful things out there. Stay where you are. When we come back, we're going to tell you where you can get more information on arthritis treatments.
But first, let's check out some of this week's medical headlines in this edition of "Your Health."
(BEGIN VIDEOTAPE)
GUPTA (voice-over): A new study in the journal "Neurology" suggests high levels of vitamin C can help smokers reduce their risk of having a stroke. Smokers with diets high in vitamin C were more than 70 percent less likely to have a stroke than smokers with diets low in vitamin C.
Also, a new report shows 13 percent of workers surveyed lost time in the workplace due to chronic pain. The study released in "The Journal of the American Medical Association," this week, showed headaches were their number one complaint.
(END VIDEOTAPE)
(COMMERCIAL BREAK)
GUPTA: Check out www.arthritis.org, the Arthritis Foundation. They've got the latest on medications and treatments for all types of arthritis. Also, try cnn.com/health, from there you can go to the Mayo Clinic Web site where you're going to find information about alternative treatments and exercises you can do to feel better, plus much more about arthritis.
Dr. Peter Gorevic has been joining us. A final Dr. Gorevic, we talk about treatment for arthritis. Can you actually reverse this disease process?
GOREVIC: I think that the short answer is that we can't yet, but we're awfully close. Some of these new Biologicals have some promise in that regard. Some very early information is exciting, and there's a lot of studies that are going on of ways to trying to put new cartilage into those joints that are affected by osteoarthritis. So my final answer is, stay tuned.
GUPTA: Final answer. All right, Dr. Gorevic, thank you so much for joining us.
Viewers at home, thank you, as well. We're out of time for today. Thank you, from all of us that called in and e-mailed us, as well. Make sure to watch next weekend, we're going to be talking about breaking bad habit, like smoking, overeating, and even biting your nails.
Thanks for watching, I'm Dr. Sanjay Gupta. "CNN Sunday Morning" continues, now.
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