S02_E17 - Arthritis - it's a Pain in the Joint!

Speaker 1: 0:00

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Speaker 2: 0:04

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare and what matters to you. And now here's our host, Dr. David Hilden .

Speaker 3: 0:21

Hey everybody, it's Dr. David Hilden, your host of the Healthy Matters podcast. And welcome to episode 17. Today, I am going to be joined by an old friend and colleague, Dr. Rahad Nasser , to talk about arthritis. We've all heard there's lots of kinds of arthritis, everybody's joints hurt. We're gonna break all that down and find out what's the real scoop on your joints and keeping them healthy. Rahad great to have you on the show. Great.

Speaker 4: 0:46

Uh , to be here, David, it's always a pleasure to join , uh, your podcast or your radio show, <laugh>.

Speaker 3: 0:51

So, so Rahad , you are the director of rheumatology, and I'm gonna just go right out there and say nobody knows what that is, <laugh>, but, but it is a doctor that deals with connective tissues in joint care and systemic problems that are related to that. But today we're gonna talk about arthritis. So I'm gonna ask you just straight up what is arthritis? Uh,

Speaker 4: 1:12

Arthritis , uh, is a term used to describe conditions that cause joint pain , uh, swelling and stiffness and other joint symptoms sometimes like redness and warmth over the joint. So it's a broad term to describe the conditions that cause these symptoms in the joints.

Speaker 3: 1:27

And there's lots of kinds of it. Yes,

Speaker 4: 1:29

There's many types of arthritis. The main two types we think about in a general manner is whether the arthritis is inflammatory, it's caused by inflammation, or whether the arthritis is non-inflammatory caused by wear and tear and damage to the joints.

Speaker 3: 1:44

Are those , uh, which is more common, I guess is what I'm trying

Speaker 4: 1:47

To say. The most common arthritis , uh, we see in clinic and in the United States is o osteoarthritis. So osteoarthritis is wear and tear arthritis. It comes as we age and use our joints. Main risk factors for this type of arthritis is aging genetics. There is genetic component damage to the joint obesity. Mm-hmm . <affirmative> . And so o osteoarthritis, what causes it? If you, if you're in a job that requires you to do a repetitive motion to a certain joint that predisposes that joint to get osteoarthritis. If you're an athlete and you get an injury in a joint that predisposes it to get osteoarthritis. We mentioned obesity, aging also, and genetics. That's why you see arthritis has become more common or more diagnosed because we've done so well in healthcare over the years that we've prolonged people's age. And so as they age, they develop osteoarthritis.

Speaker 3: 2:37

So is it inevitable that as we get older that our joints are gonna wear down? Because I, I'm gonna guess there are loads of people out there and those listening to this are thinking, yep , that's me. My joints hurt.

Speaker 4: 2:48

Absolutely. So in the United States, there are about 33 million people who were diagnosed with arthritis. So about 25% of the populations, one out of four people will be diagnosed with arthritis. 80% of people as their age will get osteoarthritis. 60% of them will have symptoms <laugh>

Speaker 3: 3:05

Okay.

Speaker 4: 3:05

From it. That's

Speaker 3: 3:06

Almost everybody though. That's almost

Speaker 4: 3:07

Everybody. Almost everybody.

Speaker 3: 3:09

And so what is going on in a person's body , um, when they have osteoarthritis, say more about what's actually going on in your joints.

Speaker 4: 3:17

So the joint, you know, is usually two bones and then there's cartilage in between. And the cartilage is like the cushion between the bones and the joint when it moves. So what happens is that cartilage wears and tears and becomes thinner and thinner and the bones become closer to each other. And so as that cartilage become thinner, when you move the joint, the bone hits the bone 'cause it lacks that cushion and that's when it hurts. So it's really wear and tear of the cartilage between the bones or also when that cartilage thins, some of it calcified and you start to have calcifications in the joint. And also the ligaments, which are the tissues around the joint, they become also more prone to injury. 'cause they're losing that thickness of the joint.

Speaker 3: 3:57

It sounds like the brake pads in your car, they're wearing down. Exactly,

Speaker 4: 4:01

Exactly.

Speaker 3: 4:02

What symptoms would people first start to, to notice that , what are the early signs of arthritis?

Speaker 4: 4:08

Yep . The early signs of arthritis is joint pain, pain in the joint, sometimes stiffness in the joint, and sometimes they will notice swelling in the joint. Now the , the first symptom is pain. If you look at the arthritis foundation and their recommendations for people when to watch for arthritis is if you develop joint pain that is lasting more than three days. And if you're having more than three episodes per month, so if it's a prolonged joint pain and it's episodic and starting to become more persistent, it means the patient is developing arthritis.

Speaker 3: 4:36

So those are the early symptoms. You get joint pain here and there. First I wanna ask you a two part question. What happens as it progresses? And then the second question I want to ask you, which joints are affected?

Speaker 4: 4:46

Yeah , great questions, David. So as, as the, as the cartilage wears and tears become thinner as the arthritis progresses, what happens is you start to lose range of motion of the joint. Because when you bend the joint or extend the joint, it hurts. We tend not to bend them and extend them as we should. And so with time, we lose range of motion if we don't address that. The other thing that could happen is the pain could become so severe that it's present at rest even so it, it wakes up the patient from sleep or it hurts even with sitting. And that's when it becomes really advanced when you have persistent pain, regardless of the motion of the joint. And also when you start to notice loss of range of motion with the joint.

Speaker 3: 5:25

So at the beginning it's mostly the pain is when you're trying to move the joint. Correct. It's amazing what the human body can do. All of the joints of your body that can move in all these different directions, from your hands to your knees to your spine, there's joint , there's uh , uh, more joints than people realize. Where are the common places in your body which joints are most commonly affected? You

Speaker 4: 5:44

Know, it depends again on the type of arthritis. You know, we discussed there's wear and tear arthritis and there's inflammatory arthritis. So we're kind of focusing on the wear and tear arthritis in the wear and tear arthritis. The most common joints are the thumbs, the distal knuckles, the knuckles that are close to your nails in the hands.

Speaker 3: 6:00

Distal, the ones closest to your fingernails.

Speaker 4: 6:02

Exactly. Mm-hmm. <affirmative> , um, the knees , um, the big toes, big toe. Yes. <laugh>, the big toes <laugh> . Um, and um, uh, and the hips. Um, however, in inflammatory arthritis, it's a different distribution of joint involvement. And I wanna mention also that in inflammatory arthritis, when it starts, the pain could happen at rest. It doesn't have to be with motion. Also, there's more swelling, more redness, more warmth , uh, more pain with inflammatory arthritis. And the joints involved are different. They're more with the knuckles that are more closer to your wrist. Uh, the small knuckles in the, in the hands that are more closer to the wrists. It's usually the wrists, elbows, shoulders, all the toes instead of just the big toes.

Speaker 3: 6:45

So say more about , um, so just so to be clear for people about the other inflammatory or threads , I've learned that right? Uh , uh, what are the other types of inflammatory arthritis conditions?

Speaker 4: 6:55

So for inflammatory arthritis conditions, the common one is rheumatoid arthritis, which is , uh, autoimmune inflammation affecting the joints. But it has a lot of cousins if you want. There's psoriatic arthritis when patients have psoriasis and develop inflammation, the joints, there is a form of arthritis called crystal arthritis. Probably people have heard of gout, which is triggered by uric acid crystals in the joints that cause inflammation. And there's a lot of different of inflammatory arthritis. Uh, we can go over, for example, there's inflammatory arthritis due to connective tissue disease like lupus for example. There's inflammatory arthritis that affect the back, the spine and the sacro iliac joints in the back and the hips, it's called ankylosing spondylitis. So with the years go by, we were able to sub classify if you want inflammation in the joints or inflammatory arthritis to many different forms. In the past it was mostly rheumatoid arthritis, but now we have rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout, et cetera.

Speaker 3: 7:51

Lots of 'em . And they're all treated differently. What is on the rise? Um, oh , and what is on the decline are , are all of these conditions getting more common, less common? Where, where , where does that sit? The

Speaker 4: 8:01

Arthritis that is on the rise is osteo arthritis because the

Speaker 3: 8:03

Wear and tear. Yeah. Because

Speaker 4: 8:05

Patients are living longer. And if you look at arthritis in general, between 1990 and now, the diagnosis has increased by about 111%. As I said, most probably. 'cause people are living longer. They're living longer. Yeah. And you know, the inflammatory arthritis usually occurs in younger age. Um , osteoarthritis occurs usually at a older age. And

Speaker 3: 8:23

So what would be an average , um, time of onset for, we're going back to osteoarthritis. The wear and tear arthritis,

Speaker 4: 8:29

Osteoarthritis is more common. Patients are 50 years and above. Inflammatory arthritis is more common between 20 and 40. Although some of them, we call them biphasic, which means can occur in two stages of life, you know, early, which is 20 to 40 in older age.

Speaker 3: 8:43

So I'm on a certain side of age 50. Um , <laugh> ,

Speaker 4: 8:46

I'm behind you. Yeah .

Speaker 3: 8:47

<laugh> one day. You too . But so, and that's simply because of the passing of the years and the wear and tear and the use of your, your body, right? Correct.

Speaker 4: 8:57

It's , uh, wear and tear use of the body. Obesity is a risk factor.

Speaker 3: 9:00

Why is obesity a risk factor?

Speaker 4: 9:02

It's a great question. So there's two things about obesity that we know. One, when we have more weight, the weight bearing joints have to handle this weight. So that put more strain on our ankles, knees, and hips. However, interestingly, studies have shown that obesity also is associated with osteoarthritis in our hands. Um, right.

Speaker 3: 9:19

And you're not putting weight on your hands .

Speaker 4: 9:21

Exactly. So I think there's two components. There's the weight bearing, you know, we're putting more weight, which causing more stress on the weight bearing joints. But also there is a signal that there is some mild inflammation that happens in the body as we gain weight. And that can cause wear and tear arthritis in the hands. Now you'll tell me, well wear and tear arthritis is wear and tear. Right. Overuse. However, you know, recent studies have shown that even in wear tear arthritis, some mild inflammation happens in the joints. Mm-hmm . It's not the inflammation of inflammatory arthritis like rheumatoid arthritis, but it's a mild inflammation that's triggered by that wear and tear. And that is being studied more extensively because the challenge in wear and tear arthritis, we don't have a medicine that reverses the process or stops the process. Our treatments or interventions are to help with the symptoms, the pain. However, if we can do more research on that mild inflammation, we can probably try more, more medications that could help reverse the process.

Speaker 3: 10:15

What that'd be the ultimate goal there would be ultimate . After our break, we are gonna talk about what treatments , um, are available for these various types of arthritis on osteoarthritis. Is it more common in certain , uh, patient populations specifically? Is it more common in men or women?

Speaker 4: 10:29

Yeah , so osteoarthritis and rheumatoid arthritis are more common in females , uh, than males. Mm-hmm . <affirmative> gout is more common in males than females. So there is a difference. Um, actually female being female is a higher risk for osteoarthritis. It's a risk factor for osteoarthritis as well as rheumatoid arthritis, while male is a risk factor for gout, for example.

Speaker 3: 10:47

Okay. So how do you diagnose it? Do you, do you simply just listen to a patient and and say, yep , that's what you got? Or, or what do you do? Um, when someone comes into you with joint pain,

Speaker 4: 10:57

It brings the question, what do rheumatologists do?

Speaker 3: 11:00

Exactly. I was kidding at the beginning when I said, nobody knows what you do for a living. I know what you do for a living. And, and it , it is one of the most fascinating areas of medicine, if I would say.

Speaker 4: 11:08

Absolutely. Rheumatology.

Speaker 3: 11:09

You've got your hands in all kinds of parts of people's lives, you know.

Speaker 4: 11:11

Exactly. And to correctly diagnose a disease in rheumatology, you have to do three, four things. One, you have to listen to the patient, you have to listen to the patient, you have to take very good detailed history. Then you have to examine them, particularly the joints on physical exam, signs of inflammation or we talking about signs of wear and tear. We order labs, blood tests, sometimes a connective tissue disease, urine test . But usually for arthritis, they're mostly blood tests and then x-rays. Sometimes we perform ultrasound over the joint or MRIs of the joints. And to diagnose it, you have to have the full picture, the history of the patient, the examination and the test all have to point to where the diagnosis to confirm a diagnosis or get a diagnosis. When

Speaker 3: 11:53

Should they come to see you as opposed to their, their primary care doctor?

Speaker 4: 11:56

You know, we mentioned when the patient start to develop pain in the joint that is persistent and very frequent and episodic , uh, they need to see us to, to examine them because the early we diagnose inflammatory arthritis, the early we intervene, the better it is because we can calm the inflammation earlier and prevent damage in the future. So it's very important to see us early in the stage to see if this is where arthritis or inflammation, inflammatory arthritis. 'cause there is a big difference in treatment and outcome because of the early intervention , early treatment we can do in inflammatory arthritis.

Speaker 3: 12:29

Makes sense. So we're gonna take a short break and when we come back we're gonna discuss treatments, available medications, and if there are any preventive measures you can take to prevent the development of arthritis. So stay with us. We'll be right back.

Speaker 2: 12:42

You are listening to the Healthy Matters podcast with Dr. David Hilden. Got a question or comment for the doc, email us at Healthy matters@hcme.org or give us a call at six one two eight seven three talk. That's 6 1 2 8 7 3 8 2 5 5 . And now let's get back to more healthy conversation.

Speaker 3: 13:05

And we're back. We're talking to Dr. Rahad Nasser. He's the director of rheumatology at Hennepin Healthcare and a friend and colleague of mine here in downtown Minneapolis. Uh, I have heard it said just this past week, a person said to me in the hallway, Dr. Nasser is the best rheumatologist in the state of Minnesota. That was an unsolicited comment from another physician colleague. And so we are absolutely privileged to hear Rahad give us his wisdom about arthritis. We're gonna move now into what can be done about it. We've all seen that commercials on the tv ask your rheumatologist if X, y, Z is right for you. So there's a lot of stuff out there. So I wanna ask you the basic question. Is arthritis curable?

Speaker 4: 13:49

So for osteoarthritis, there is no medication right now that reverses the process or prevents it from happening. Uh, currently with the evide , with the current evidence , um, we have, for those osteoarthritis, we have medications or interventions that help with the symptoms. Now for inflammatory arthritis, what I tell patients, we don't have actually a cure per se. What we have are medications that suppress the immune system to stop the inflammation, to stop the immune system from attacking the joints to stop the inflammation so you don't have damage to the joints. So we have medications that temper down the immune system, temper down the inflammation, so we don't get symptoms and we don't get damage to joints. So whether you consider that a cure or not, yeah , it's not clear. You know. Um , maybe in the future the cure would be gene therapy or I don't know. Um , but right now this is what , where we are in terms of treatments. Yeah.

Speaker 3: 14:40

And when doctors talk about treatments, it's sometimes a little bit different from , uh, uh, what the public might always consider. Are there treatments? Yes, there's treatments to treat your symptoms. We do our best to treat your symptoms, but are there treatments to reverse the course of the disease? And that's a different kind of a treatment. And that's what you're talking about is that there are some for the inflammatory arthritis and then people wanna know, is there just a cure? Stop it, make it go away forever. And , and so there's different forms of treatments. Let's dive into that just a little bit. How do we treat the symptoms, the pain of osteoarthritis?

Speaker 4: 15:14

Yeah , so for osteoarthritis , uh, what we do , uh, first we , uh, recommend , uh, physical therapy , uh, basically a program to strengthen the muscles around the joints to preserve as much, strengthen the joint. And that decreases usually pain improves range of motion , uh, improves stability of the joint. So physical therapy is very important , uh, individualized to the joint and to the patient.

Speaker 3: 15:36

But doctor, it hurts to move the joint. Yes . You're telling me to go move it more. Uh , can I tell you how many times I've heard that? I don't even know zillions of times. So in

Speaker 4: 15:43

Order to help patients with the pain in physical therapy or in general, there are many , uh, medications we prescribe or recommend. One, you know, acetaminophen or Tylenol for pain, of course with a dose that is not too much, you know, a , a controlled dose. Second are what we call NSAIDs , nonsteroidal anti-inflammatory drugs. Like I ibuprofen, Aleve , um, meloxicam . There is also , um, a medication that is a cousin of nsaid like Celebrex for example. Uh, there's also gels and uh , creams. For example, diclofenac gel, which is volar and gel. It's like ibuprofen and gel that you rub over the you

Speaker 3: 16:17

Rub your

Speaker 4: 16:17

Skin. Yeah, exactly. Or there's new medications that are like, for example, duloxetine. It's an antidepressant, but it works on pain. And there's some studies that showed help with pain. Uh, for example, arthritis of the knees. Uh, so that's a new medication we use in , in case there is contraindication to give somebody the other medications. Tylenol and non-steroidal anti-inflammatory drugs.

Speaker 3: 16:36

In your experience, you've just listed of half a dozen classes of medications, you've listed physical therapy, you have not listed controlled substances such as opioids and those things that, you know, people are asking about. How effective are these things that you've just mentioned? Not even opioids, but everything. Well, and opioids, I guess we

Speaker 4: 16:56

Usually start with, as I said, Tylenol, nonsteroid, antiinflammatory drugs, you know, duloxetine opioids might have a role in treating pain from osteoarthritis in , in patients who cannot tolerate or have contraindications for the medications we mentioned. Um, obviously with opioids there have to be a discussion with the patient. There's risks with opioid intake from dependence , uh, to many things. And they have to be, usually we have to do it through a pain clinic setting where everything is , um, monitored for the patient's safety. Nothing

Speaker 3: 17:24

Else . Certainly not the first line choice. Is it not

Speaker 4: 17:26

The first line choice? Absolutely. We do also cortisone shots, you know, steroid injections in the joints. They're not, and I tell patients it's not the cure. This is a symptomatic therapy. We , we helps you with the pain. Uh , so steroid injections is an option. So

Speaker 3: 17:39

Steroids are, you know, when we say steroids, again for the, for people listening, we're not talking bodybuilding steroids, we're talking anti-inflammatory steroids. How does that work in osteoarthritis, which is got a little bit of inflammation, but's primarily wear and tear. Why would it work correct to inject steroids in there? It's

Speaker 4: 17:55

A great question. There's two things we inject, actually. We inject steroids and the numbing medicine called lidocaine. Uh , first of all, there's evidence that lidocaine by numbing up those nerves around the joint actually helps and last longer than we think. And number two, the steroid, they suppress that mild inflammation that the new studies are showing in o osteoarthritis. Um, and it's localized in the joint so it doesn't have as much side effects as cortisone or steroids that we take by mouth or by um, by IV in the , in the blood vessel. So for

Speaker 3: 18:22

Those people who get some relief from, we use the word cortisone injection, it's not cortisone , um, you know, it's a cousin of cortisone, we use a , a corticosteroid. Right? Um, how long can they expect relief? And then the corollary to that is how often can you get it done?

Speaker 4: 18:38

Yep . So corticosteroid injections in the joints can last up to three months. Some patients, you know, we inject one time and that does the trick for a year or two. Some patients need it every three months. And you know, depending on the joint, we also as physicians sometimes are reluctant to do more than one or two injections, particularly the shoulder. The shoulder is a complex area in the body. There's two, three joints there. There's multiple tendon and um, and ligaments. So we inject one or two times in the shoulder. On the other hand, the knee, again, we individualize therapy for the patient. Uh, you know, there's always risk and benefit with anything we do. But in the knee you can do it more frequently. That's

Speaker 3: 19:14

Interesting about the shoulder. I think a lot of people don't realize there's two or three joints in the shoulder. Yes . There's not just one thing. It's so complicated. It's why, it's why , uh, we can, a baseball pitcher can throw a hundred mile an hour fastball as that shoulder has got incredible , uh, abilities. But you don't inject it quite as often, you said correct. Couple times a year or three times a

Speaker 4: 19:31

Year? Yeah . Yeah, a couple times. You know, because steroid injections, the joints is has, you know, potential side effects. They're low, but you know, it can make the ligaments and the tendons a little bit weaker around the joint. More prone to be, you know, ruptured or, or torn. So we, we do this judiciously and depending, you know, on the patient's situation, there are other injections that we do in the joint. For example, we call it hyaluronic acid injections, which are like cartilage supplement if you want. Um, does that work? You know, it works in about 60% of patients and I tell that patients before we inject it and if it works, it lasts for six months. Usually we use it bridging to surgery. 'cause the other intervention that might happen when the cartilage has completely gone and the joint is bone and bone, then surgical intervention or replacing the joint would be kind of your last resort for the patient. Yeah, we

Speaker 3: 20:16

Haven't got to that yet, but I'm glad you did because we've talked about physical therapy, we've talked about medications. Let's talk just a little bit more about surgery. Who should get their joint replaced? When is it time?

Speaker 4: 20:26

There's many factors we talk about when we do , uh, when we recommend surgery for the joint one , uh, on the x-rays on the imaging, you know, the cartilage is gone, it's bone on bone. Number two, how much is the patient's daily function being affected by the joint? So if they're having pain all day, the joint is limited in range of motion, they can't walk, walk, they can't lift their shoulder, then that's another consideration. Number three, what is the health condition, the general health condition of the patient? Will they tolerate the surgery? So those are the three factors that determine when to do surgery to a joint. And

Speaker 3: 20:59

They're , it's pretty successful. Yeah . Yep . Surgeries are

Speaker 4: 21:01

Very high successful, very high successful rate of joint replacements, you

Speaker 3: 21:05

Know , and I know it's a big deal, but especially knees and hips. I, I, that's , those are the ones at least I know the most about. Um, aren't those the most common ones? Knees and hips?

Speaker 4: 21:12

They are correct. Knees and hips are the most common one. The most successful ones.

Speaker 3: 21:15

What about other non-medication, non-surgical treatments? Do other things work? Um, other range of motion things , uh, tai chi, acupuncture, any of that stuff? What, what other things are out there?

Speaker 4: 21:25

Yeah, so that brings me a little bit to the topic of trying to prevent, to develop. Yeah, we

Speaker 3: 21:30

Were

Speaker 4: 21:30

Talk about prevention of arthritis. Mm-hmm. <affirmative> . Um, and in general for health , um, you know, we say eat well, exercise well, sleep well. All of that for general health would apply for arthritis. I think. Um, one of the most important parts is staying active and moving the joints and doing exercises around strengthening muscles, around joints. Uh, number two, eating healthy and trying to , uh, not to be obese. And I , and I know that's, that's hard. It's not, it's , it's easy for me to sit here, you know, trying not to gain weight. It's, it's a hard , uh, thing to achieve. But one of the preventative features, if, if we can , um, help us lose weight, you know, there's studies that showed if you lose 10% of your weight, pain improves in the joints, whether it's in the hands or in the feet or the knees. Also, interestingly , uh, for example, smoking , uh, not to smoke, smoking has been associated, for example, with rheumatoid arthritis. One of the biggest risk factors for rheumatoid arthritis. So, so avoiding some uh, environmental exposures or not smoking also helps

Speaker 3: 22:29

All the time. I keep hearing another thing that smoking does. Yes .

Speaker 4: 22:32

Yes, absolutely. What

Speaker 3: 22:34

About acupuncture? Yeah,

Speaker 4: 22:36

So for acupuncture it can certainly have a role in helping with pain. It's not preventative. But yes, acupuncture might have a role in pain. Also chiropractor maneuvering in some joints or the spine can be helpful for pain. Um, you know, acupuncture, what I tell patients to try it. 'cause in some patients it has success and some patients it doesn't. But certainly it has a role. You mentioned tai chi. Yoga can help Tai chi. It's a Chinese martial arts that help relax the body and relax the muscles and nerves around the joints that can help. Uh, yoga can help. Now yoga always caution if somebody has hypermobility, their joints are very mobile. You wanna be cautious about yoga or overdoing it on the joint. 'cause that can actually trigger pain or accelerate wear and tear arthritis in the joint. I never

Speaker 3: 23:16

Even thought of that.

Speaker 4: 23:17

Yep . So hyper morbidity , joint syndrome , uh, it's common. It's patients who are more flexible in their peers or double jointed , is

Speaker 3: 23:23

That what people say is double jointed? Yes. You don't have two joints, no

Speaker 4: 23:26

<laugh> , but they can do maneuvers with their joints that others can do. And it's about one in 10 people and there's no like treatment for that. But the prevention in that case is to still do the exercises or the sports you do, but to be aware of not overdoing it. So a lot of movements that they do that are normal for them, they're actually abnormal to their joints. Hmm . So it's more like , uh, controlled physical therapy or controlled exercise program where you're not overdoing it on a joint. 'cause that can predispose to osteoarthritis even at a younger age than 50. So

Speaker 3: 23:55

If you could leave our listeners with three tips regarding osteoarthritis, wear , tear, arthritis, the one that 80% of older adults might end up with, what would those three tips be?

Speaker 4: 24:05

Exercise as much as your body lets you listen to your body. Exercise. Try to move as much as you're able to eat. Well, sleep well, don't smoke to prevent it. I think we come back to the basics of preventative medicine, which is trying to live as much as we are able to. I mean, life has challenges. Yeah , exactly. But if we can try to prevent it, honestly, that's the best way. If we can.

Speaker 3: 24:25

Solid tips. And I think that is a great way to leave us. We've been talking with Dr. Rahad Nasser Rahad , thanks for being on the show.

Speaker 4: 24:32

Absolutely. Thanks for having me, David. It's always a pleasure.

Speaker 3: 24:34

We've been talking with Dr. Rahad Nasser, the director of rheumatology at Hennepin Healthcare, A brilliant doctor and a good friend to me. I really appreciate him being on the show and I hope you've enjoyed the show today. If so, tell your friends and leave us a review. I hope you'll join us for our next episode. And in the meantime, be healthy and be well.

Speaker 2: 24:52

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden. To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. You got a question or a comment for the show? Email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. And finally, if you enjoy the show, please leave us a review and share the show with others. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive producers are Jonathan, CTO and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.