good evening.

Thank you so much for watching PBS Fort Wayne tonight and Health nine I'm Mark Evans, your host tonight a very important topic I think all the topics as a matter of fact that we discuss on health are very important and relatable because how about me throwing this out?

Rheumatoid arthritis how many people are watching right now who have it or who know someone who has it?

And we're going to discuss various things how it's different from other types of arthritis, the symptoms, the treatment, how it may affect life expectancy among other talking points.

Our very special guest tonight is Dr. Dean Obeidallah and he is a rheumatologist perfect for this topic.

>> Thank you for being here.

Well, thank you, Mark, for having me.

I appreciate you inviting me in here.

>> Yeah, and it's the very first time on HealthLine so I told him to look, I'm a griller.

>> I'm going to give you a tough time.

Well, we're ready for it so came in prepared today actually that we're just glad to have you here and it's a very important topic and we want to go ahead and stress that we have a phone number to give a phone call to tonight.

It's 866- (969) 27 two zero call that number any time during the show we will take your question whether you tell us verbally over the air or if you want us to transcribe your question, we'll do that because the important thing is is you get the information that you need and again call us at any time.

>> Let's go and get started.

I did some research and I didn't realize there were six different types of arthritis and I'll just list those real quick.

>> I can do it but let's see if I pronounce them correctly.

You can go ahead osteo arthritis which seems to be the most common and it's true rheumatoid which is what we're going to focus on tonight fibromyalgia.

>> You got it.

Gout I didn't know I didn't realize gout was actually a form of arthritis.

>> Well, it is yeah.

It makes sense because it makes your feet hurt your toes here.

>> That is true.

Lupus and psoriatic psoriatic arthritis.

>> Indeed it is.

All right.

And so I mentioned earlier that the osteoarthritis, the most common rheumatoid arthritis seems to be a close number two .

That is true.

>> And so what is rheumatoid arthritis and how is it different from osteoarthritis?

So rheumatoid is a chronic systemic inflammatory autoimmune condition which means that it's a disease that happens to be involving multiple organs in the body.

It's not only a joint disease persay though it is characterized by a certain way of involvement for the joints.

Typically it is a chronic which means that it is a long term disease and it's an autoimmune condition which means that the immune system for some reason starts to mistakenly think that the organs inside of the body coming from the outside.

>> Now the way that is different from the osteoarthritis which is the more common type of arthritis is that that type of arthritis happens to be more of a weight on a change.

It happens with ages.

The older we get the more weight change that we're going to be having and that's how they're particularly different in terms of the way that they present and rheumatoid is about inflammation of the joints.

>> Right.

And then osteo is not necessarily inflammation but it's more of like the grinding the cartilage and that so there is what we call the systemic inflammation.

There's what we call the local inflammation.

Osteoarthritis does have indeed local inflammation that does not have any systemic manifestations.

OK, however though with rheumatoid we see that there is more systemic inflammation that is going on.

>> OK, all right.

And how many Americans would you say have rheumatoid arthritis?

>> According to the latest data out there, there's almost one percent of America that has been diagnosed with rheumatoid arthritis.

So we're looking at according to the research I did is like thirty to was it a one?

>> No, hold on.

It's it's somewhere got to be somewhere about thirty two million that is true.

Whereas rheumatoid at one point three million Americans have is correct from the information I have I think you're talking about the osteoarthritis and the rheumatoid so with osteoarthritis it's a little bit more common.

About seventy five percent of the population above the age of 50 tend to be having osteoarthritis as it's quite the common condition to deal with well rheumatoid although it's the second most common kind of arthritis, it is way less common than what osteo is.

It's almost one percent of the population.

It's almost about thirty three million American who's been dealing with rheumatoid in total.

>> Yes.

And the rheumatoid is is clearly visible by people who have it with when their finger their fingers and their hands start to deform as well as their feet I've seen in some cases so we'll get into that and how it dampens what actually causes aaargh I mean one of the risk factors here well that's the million dollar question that we're talking about.

>> I wish that I can tell you straight ahead what is causing rheumatoid unfortunately we do not know the answer to that one.

However, though we do know that it's an autoimmune disease, the immune system typically is a thing that happens to be inside of the body to be fighting off infection and anything that comes from outside of the body but for some reason and patients who have autoimmune diseases like rheumatoid is thought to mistakenly think that our self antigen is coming from the outside causing this constant chronic inflammation to go on for many years to come.

Unfortunately though we do not know what causes rheumatoid.

We have multiple theories about this and we have some risk factors that we were able to identify for the most part that has been shown to increase the risk of rheumatoid those can include genetic risk factors.

We see that rheumatoid can cluster in some certain families and we see that there is some environmental factors that play a part as well including infections.

We have linked rheumatoid to infections like parvovirus hepatitis and even CMBS, EMV and EBV virus.

We also have noticed that smoking can increase significantly the risk for rheumatoid.

There's always almost twenty one fold increase in risk and rheumatoid patients who smoke there is also there is an increased risk in people who have mucosal infection, dental infection.

So those are the kind of risk factors that we were able to identify that could be leading into rheumatoid though we were not able to identify a specific cause for rheumatoid.

I also know people between 30 and 60 generally that's when you see the beginning stages of it.

>> So rheumatoid can affect any age.

It can affect people who are one year old and it can go all the way up to the peak of rheumatoid happens to be between the ages of 40 and 60.

>> There's a slight female predominance when it comes to the arthritis there's almost two to three to one type of shift between female to male proportions and also obesity.

Obesity can play a big part in the active inflammation we see rheumatoid more commonly in patients who are obese.

>> That is true.

OK, Doctor, I want to stop here for just a second because we have a call here and it looks like Peter is calling him with this question.

He prefers to be offline so that means I'll read it for him.

He says I have rheumatoid arthritis and I've been told that there are different medications that can be taken Celebrex or Mobic.

>> Which do you recommend would actually work better now I know that you would I don't know if you can recommend anything right now without seeing a patient but can you tell us some differences about these drugs?

>> So it is a very good question and to be quite honest I may not be able to give a straight up answer today and I apologize about that.

Probably you will need to be following up with the rheumatology to know what is the best course of action that we should be taking regarding your care.

But the medications mentioned as Celebrex and Mobic on Biloxi Cam , both of these are what we call nonsteroidal antiinflammatory medications.

Typically there can be good for controlling pain and local inflammation.

However, though they do not stop the progression of rheumatoid which is the biggest part of treating the rheumatoid arthritis.

So we have other medications that can treat rheumatoid that will stop the progression of the disease and even the systemic inflammatory effect that it can have on our bodies.

>> OK. Hope that answered your question, Peter and thank you very much for your call and good luck with that.

>> Just as Peter did call the number on your screen 866- (969) to seven to zero with your question and we have a rheumatologist on hand, Dr. Dean Obeidallah just in case you are joining just recently, let's go ahead and talk about the common symptoms that you had mentioned about the swollen joints.

>> But there are some other things that go along with that that is true and this is one of the main distinguish that we have between rheumatoid and asked as we were talking about rheumatoid is a joint disease that mainly is notorious of causing active inflammation.

Now that typically happens to be in the shape of swelling and stiffness in most of these joints and typically it like to involve those smaller joints we're talking about the hands is the most common place for rheumatoid but it's still kind of like many other joints as well, including the elbows, the shoulders, the hips, knees and even the feet anywhere there's a joint except for the spine.

Oh and what we call the distal interphalangeal joints those are the joints that we see at the tip of the fingers right over here.

If for some reason it does not like to involve these joints specifically we don't know why but it seems like it involves all the other joints in our bodies so typically no lower back involvement with rheumatoid that is opposite to what we see with osteoarthritis which is quite common place fatigue, fever, loss of appetite.

Now those are quite common symptoms that we see from rheumatoid perspective as as we mentioned before, this is a systemic disease which means that the inflammation happens to be throughout the whole body.

Now when you have an active inflammation there's going to be a lot of nonspecific symptoms that happens as you mentioned, there's fatigue feeling tired all the time, something we called rheumatoid fatigue.

As a matter of fact, you're going to be seeing patients.

We're not feeling too well.

They're not sleeping too well.

They're just feeling overall this tired feeling throughout the day.

They may also be complaining of lightheadedness, hair loss and feeling dizzy most of the times.

But we have also more specific systemic problems that can happen to people who have rheumatoid as well that have nothing to do with the joints.

Rheumatoid can affect the lungs, it can affect the eyes, can fix the skin, can affects even the vessels inside of our body causing inflammation of the vessels, what we call vasculitis and in people who have an active inflammation there's an increased risk of having plaques inside of the arteries causing more patients having more heart attacks and even more strokes if you're not treating the correct way.

Wow.

Well, let's just take a break here before we get into more of this.

>> What kind of research is being done and how long is this been going on?

>> It's a very good question.

So Rheumatoid has been in there for quite a while.

It's actually considered to be a newer disease believe it or not.

The first case of rheumatoid was described back in the eighteen hundreds before that we did not know about trauma to it a whole lot but it's probably been around for a long, long time.

>> Surprisingly not a whole lot .

How about that?

Yes, that is actually a very interesting piece of literature in terms of history of rheumatoid.

The first evidence of any rheumatoid arthritis in a skeletal human body was discovered back in the seventeen hundreds before we did not have a whole lot to go by.

So you can imagine just in the span of two hundred we did not know a whole lot about this rheumatoid arthritis business and now it covers about one percent of the population.

So it's quite a common disease nowadays and we do believe that there is some of the risk factors that we mentioned before may play a big part in that.

And why do we have more rheumatoid arthritis patients now?

Ever since the treatment for rheumatoid has significantly improved over the last let's say 50 to 80 years, especially over the 30 years we've have a new generation of medications that have significantly improved the overall health for rheumatoid patients as well.

Yeah, and I want to talk more about the treatment and management about that.

>> Let's go before we get to the treatment, how would you know for sure?

I guess the bottom line question is how is rheumatoid arthritis diagnosed so well?

>> Rheumatoid arthritis can be tricky to diagnose.

There's a criteria that we go by as rheumatologist which we call the American College of American College of Rheumatology and the European League Against Traumatism criteria from 2010 which compromised multiple factors including blood work as well as clinical symptoms.

>> And those depend on the number of joints involved with what type of joints are involved, what kind of inflammation markers are elevated in the body and what certain antibodies can be seen elevated inside of the blood.

Something called the rheumatoid factor can be elevated as well as a CRP antibody that can be also be elevated.

So it can be quite tricky sometimes some patients may have a positive rheumatoid testing in the blood but they still do not have rheumatoid while some other patients can have negative testing in blood but they still can have a little bit worried and this is where it kind of gets tricky and it's very important that we look into a sign and symptoms that people are actually expressing through their daily life and daily activities and this is how you make that diagnosis eventually.

>> So for some it takes a little while to confirm the diet that is definitely true.

Wow.

It is also important to identify these symptoms and signs right away because we want to get those patients to treatment as soon as possible because rheumatoid can be quite aggressive in some patients unfortunately.

>> So can we have another question coming?

It's from Don.

He is asking us to ask you is it possible to have both osteo arthritis and rheumatoid rheumatoid arthritis at the same time?

>> It definitely is possible we see this all the time almost about seventy five percent of America between the ages 50 and above they do have osteoarthritis which is quite common.

All of us at one point in our lives as human beings will have some form of osteoarthritis.

Some of us will be suffering from that more than the other people while only one percent of patients will have rheumatoid.

So in most patients who have rheumatoid they have some form of osteoarthritis as well that is ongoing at the same time.

So it is common that we see that rheumatoid and also happen to the same patient in a lot of cases.

>> OK, I want to go ahead and dove into the treatment and management we were starting to do that earlier but you were talking about some of the medications that were out there.

What are some of the current treatment options that seem to be the most successful?

>> And that's a very good question here now over the years the treatment for rheumatoid have changed drastically.

Initially when we discovered that we not have no treatment for it, we were just giving patients pain medications hoping that things will be better in the future, that they don't work for a lot of our patients unfortunately.

>> Then when INSETs came into place, aspirin, ibuprofen and so many other medications came to be the first line of treatment for a long period of time which did not slow down the progression of the disease.

Unfortunately those patients but then the 1970s kicked in and we started to be having what we call a disease modifying agents and those were the real change when it comes to the treatment for rheumatoid patients.

We started to be noticing improvement with the overall health decrease in mortality and decreasing the overall progression of the disease.

Some medications which rheumatoid patients can be very familiar with including methotrexate Lofland might hydroxy chloroquine and self SLAC have all been used for many years right now to treat rheumatoid and there is a huge jump in terms of the quality of life and patients once we started these medications unfortunately though these medications were only able to put almost only 40 percent of patients who have rheumatoid into remission or low disease activity and this is what the second jump with treatment in rheumatoid came in place which we call the biological disease modifying agent came in place.

It happened almost about twenty five years ago and this is what truly changed how we treat rheumatoid nowadays.

Those medications happens to be very strong, very effective and they do bring patients into remission and low disease activity much faster than they used to have.

And we have a large number of patients most of our patients who have rheumatoid nowadays they do tend to be having a low disease activity or even remission with these medications.

>> You mentioned remission.

Yes, but is there a cure?

Unfortunately as of now we do not have a cure for rheumatoid arthritis.

We're searching for it.

I don't think it's there yet but we put patients into remission all the time.

We do have patients with low disease activity.

We have patients are controlled very well with the current medications that we have.

>> Well, how important is it to get an early diagnosis?

It is very important.

So one of the core principles and treatment when it comes to rheumatoid arthritis happens to be that we have to treat early.

We typically would like to start patients on medications within three to six months of having the first symptom and that is to avoid any chronic complications that can happen with rheumatoid that can be reversible with late treatment and also we can improve mortality even with early treatment, improve internal organ damage that we can see if we start patients quite early with treatment as well.

Well, during the treatment stage the role of lifestyle changes I mean how are we going to conform to help ourselves when we have rheumatoid arthritis?

>> That's a very good question as well.

Unfortunately this area in the human body has been lacking in terms of the research on it with rheumatoid arthritis.

We do have some studies that suggest that some certain ways that we can adjust our diet and lifestyle has been improving rheumatoid activity overall and that includes stopping smoking, eating healthy diet or antiinflammatory diet such as staying away from sugar, carbohydrates and so forth.

Also staying away from infections can all improve the overall survival rate in patients who have rheumatoid improve the activity of rheumatoid also weight loss in people who are having obesity can also improve the overall control with rheumatoid arthritis though most of these are great options to help with rheumatoid activity on their own.

For the most part they're not enough to treat rheumatoid and most patients will need to be on added medications to help with the remission or the low disease activity.

>> OK, another call coming in from Carol.

She says My mother has been a steroid for a long time and she is now being weaned off the steroid and she is in constant pain.

>> Why would her doctor wean her off the steroid that has been so helpful?

Yeah, it's a very good question.

We like steroids.

They're magical drugs.

Unfortunately though they do carry a whole lot of side effects if we don't win them off and we continue with the same dose of steroids for a long period of time, they can be causing a lot of trouble.

They can be causing weight gain diabetes high blood pressure increase the chances strokes, heart attacks and so many other more things thinning of the bone fracture of the bone osteoporosis.

So you can tell that there's a lot of bad side effects that can happen when you take Stilnox was such a long period of time and this is where it comes that all of those disease modifying agent that we were talking about before implementing those medications to improve the rheumatoid activity without the use of steroids for a long period of time and yes, something you said just triggered this thought the old cracking of the knuckles.

Is that something people should not do?

Oh, you know, I'm going to say on TV, OK, it doesn't do anything doesn't mean so it's completely OK so that cracking your knuckles out of habit is not a bad thing.

>> It's not going to cause your rheumatoid arthritis.

I know so many pros and cons about that.

You know I used to have somebody worked at my office because I do that once in a while.

If I get stressed you stop cracking your knuckles.

You're going to have arthritis.

>> No, it doesn't do that.

I mean there has been studies about this and it showed that there is no increased risk of having rheumatoid and people who crack there.

>> I'll be darned.

OK, well I'm glad we can clear the air on OK. >> It's one of those questions I was dying to know.

All right.

We still have about five, six, seven minutes here left in the program.

If you have a question regarding rheumatoid arthritis, please give the phone number on the screen.

Call 866- (969) 27 two zero.

We're talking to Dr. Dean Obeidallah who is rheumatologist.

>> All right.

So let's move on to some other things here.

When is it time to see a doctor if you think you have rheumatoid arthritis?

>> I think I think as long as a patient is having any symptom or any pains of any sort that is chronic giving you any trouble of any sort, I think it's always good to talk to your primary care physician about it if it's giving you a life compromising situation if unable to function properly, then it's time to talk to your physician about it.

Now in terms of rheumatoid more specifically we're talking mainly about the swollen joints, especially when it happens to be in your hands, especially when you're stiff in the morning that pain that gets better when you're trying to be more active.

This is the type of pain that can resemble rheumatoid and this will be a good time to talk to your primary care physician to be checked for rheumatoid arthritis, maybe doing a physical examination, doing blood work to check for rheumatoid.

That will be a good next step or even doing some imaging like X-rays to look into that possibility.

>> And once you've seen your primary care physician who more likely would refer someone to you who has what he suspects is rheumatoid arthritis, how important is following up with that rheumatologist once you've been diagnosed and possibly been given some medication?

>> That's also a very good question in here.

So it is very important to continue following up with a rheumatologist to get the medication that you'll need to be in remission, a low disease activity.

You know what is so tricky about these autoimmune diseases?

They're not always in the same activity level.

>> They keep changing throughout the years.

It can be more active, less active and it can be even in remission and completely not causing any problem in the future.

But at the same time we're giving medications that can have implications and side effects at the same time.

So it's very important that we check for these side effects profile doing blood work frequently to make sure that we're not messing up with the blood count or or the liver or the liver profile or any of that sort of things.

Patients who have rheumatoid they have also some of them may have systemic conditions like lung problems and heart problems and so forth.

So it's very important to continue to follow up with the rheumatologist to ensure that all things aligned for rheumatoid in terms of activity and we're not causing any side effects with the medication that we're doing and that's good advice.

>> Yes.

Does rheumatoid arthritis affect one's life expectancy?

>> Indeed it does so and untreated rheumatoid can definitely increase the chances of having heart attacks and strokes as well as it can increase the complications related to the kidneys, lungs, eyes and so forth.

With that it increases mortality.

We see that patients may die earlier if they have rheumatoid that is not well treated.

>> What would you say the average amount of time would be?

I read in my research ten years possibly could not ten years off your life's lifespan would you agree with that?

It differs from one patient to another and depends on how active the rheumatoid is, what organs are involved and how extensive the inflammation is.

I mean it's really hard for me to give you a number right now in terms of how many years but I would say ten years makes sense if you're not treating rheumatoid.

Yes.

OK, one final question.

I think we've got about a minute left on the show.

Rosano is calling Rosano does not want to be on the line tonight.

That's that's fine.

Doesn't want to be heard I guess.

But more reader's question he says he has I'll get it over here.

I have a condition where I have bone to bone if untreated, how worse will it get?

>> I guess bone to bone contact so the bone on bone is what we call the osteoarthritis which is the mechanical type of arthritis.

Unfortunately as of right now, Madison, we do not have a treatment for bone to bone arthritis.

There is no medication that we can give that will reverse back to the reverse the bone back to the way that it was before.

So typically there is no specific treatment that we do for these type of arthritis.

We usually control mainly the pain and the functionality of these joints.

So typically we try to give medications to help with the pain, try to make sure that your muscles are acting very well so it takes some of the pressure out of these joints and if this is not working then seeing the orthopedics theme would be a good option to see what they can offer.

They can do injections and in some cases even some joint replacements can be done for these type of conditions.

>> OK, now one last question before we wrap it up.

We've got about a minute left, Dr.

Diet.

Does that have anything to do with the information or any of the pain or any of the treatment when it comes rheumatoid arthritis?

>> Indeed it does.

And to be quite honest, I wish that I can tell you all about the diet and what can do for the auto inflammatory conditions.

>> But we don't have a whole lot of studies about this with lacking we don't have a whole lot of proven ideas of how what diet the patients should be involving to improve their rheumatoid.

We know that having simple sugar in your diet and carbohydrates can definitely increase the inflammatory factors that we see with rheumatoid patients quite a lot.

So I would say at the least cut down the sugar and the carbohydrates for the diet part and that will definitely improve the rheumatoid activity overall and we're talking about alcohol as well.

>> Alcohol as well is also included in that.

Yes.

And then when you have rheumatoid arthritis, do you still need to exercise to try to keep those joints limbered up as much as possible?

100 percent rheumatoid is actually is one of those conditions that get better the more that you do things which is surprising its opposite to what we see with Ossy where it gets worse if the pain is actually sitting in some of the joints.

So activity is very advice.

We like you to be limber.

We like you to be having stronger muscles and joints.

I'm so glad we had this conversation.

I think we getting a lot of people a lot of hope tonight.

Well, I do hope so.

So thank you so much Doctor dear overnight he is a rheumatologist and we appreciate his time tonight and we've got to have you back again.

Well, thank you so much.

>> You're very well.

I appreciate it.

Thank you.

Thank you for your calls tonight and your interest in the program until next Tuesday night.

>> Good night and good