Arthritis and Rheumatology

Stanton Shanedling: Hello, everybody! Welcome to Health Chatter. Today's show is on arthritis and rheumatology, and I've got some personal experience with this. It's going to be an interesting show with our guest, Dr. Paul Waytz. I’ll introduce him in just a second. We have a great crew as always—Clarence and I are here to make these shows successful for you, the listening audience. Research is done by Maddie Levine-Wolf, who's also doing the recording today. Thanks, Maddie! Aaron Collins, Deandre Howard, and Sheri Ni Guard also contribute to research and marketing. Matthew Campbell handles our production. Without him, this wouldn’t come out to you in perfect form. So thanks to all of them.

Also, a big thank you to our sponsor, Human Partnership, a community health organization that does wonderful things in the community. You can visit their website at humanpartnership.org. You can also check out our website at healthchatterpodcast.com. If you really love us, feel free to leave a review!

Today, we have Dr. Paul Waytz. Paul and I are neighbors, and we bumped into each other once when he was walking back from the library with a backpack full of books. I thought he’d be a great guest for our show, so here we are. Paul did his undergrad at Washington University in St. Louis, completed his Internal Medicine Residency and Rheumatology Fellowship at the University of Minnesota, and did a lot of work in arthritis and rheumatology, including research. He retired but still does great volunteer work, including mentoring students and gardening. He’s also got a wonderful family, and I know some of his relatives who live nearby. Welcome to the show, Paul!

Paul Waytz: Thanks for having me!

Stanton Shanedling: Arthritis, right? I’ve read through some of the background research, but I’ll be honest—sometimes I feel like I can just say, “It hurts!” since I have some arthritis myself. So, let’s start with some definitions. What do we need to know about arthritis and rheumatic diseases?

Paul Waytz: Well, first of all, the term itis means inflammation. We hear it in terms like pharyngitis (inflammation of the throat) or tendonitis (inflammation of a tendon). So arthritis technically means inflammation of a joint, but it’s a very broad term. “Rheumatic disease” is a more comprehensive term, covering over a hundred different conditions, some of which don’t involve the joints. These could be inflammations of blood vessels, muscles, and other tissues. So when people talk about arthritis, it’s just shorthand. Rheumatic disease is the bigger umbrella term, with many types that are still being identified.

Stanton Shanedling: Why is arthritis specifically linked to rheumatology, though? I mean, there are other “itises” like carditis. Why does arthritis have this specific connection to rheumatology?

Paul Waytz: Great question. Some “itises” like pharyngitis or carditis are caused by infections like strep. But inflammation itself is complicated. The root of most rheumatic diseases is inflammation, which is often caused by a malfunction of our immune system. Our immune system normally protects us from outside threats, but sometimes it turns on our own tissues. That’s where things like rheumatoid arthritis come in, which are autoimmune in nature. Osteoarthritis, on the other hand, is primarily caused by wear and tear rather than an immune response. It’s more of a degenerative process that involves cartilage damage.

Stanton Shanedling: How do rheumatologists work with orthopedics? I mean, orthopedists deal with inflammation as well, right?

Paul Waytz: The difference is that orthopedics focuses more on the mechanical consequences of inflammation. For example, when inflammation damages a joint, causing bone-on-bone contact or other mechanical problems, that’s where orthopedics comes in. Rheumatologists are more focused on treating the inflammation itself to prevent it from getting to the point where you need orthopedic intervention. We want to manage the pain and prevent the need for surgical procedures if possible.

Stanton Shanedling: So, rheumatologists are more proactive, whereas orthopedics deals with end-stage damage?

Paul Waytz: Exactly. Rheumatologists try to manage the disease before it causes irreversible damage, while orthopedics steps in when those structural problems occur.

Clarence Jones: Does food affect arthritis and rheumatology?

Paul Waytz: That’s a great question. A lot of people say there’s no evidence that food affects arthritis, but that’s actually not true. There are some foods that can contribute to inflammation. For example, things like excess sugar, processed foods, and unhealthy fats can worsen inflammation. On the other hand, an anti-inflammatory diet with foods rich in omega-3 fatty acids, like fish, can help reduce inflammation.

Clarence Jones: I see. So, it’s a combination of managing inflammation and also making dietary changes to help reduce it.

Paul Waytz: Exactly. It’s not just about the medicine we take; lifestyle factors, including diet, physical activity, and stress management, all play a role in how our bodies respond to arthritis and other rheumatic diseases.

Stanton Shanedling: That makes sense. So, let’s talk a little about treatment. When someone comes in with arthritis or a rheumatic disease, what kind of treatments do you typically consider?

Paul Waytz: Well, treatment depends a lot on the type of arthritis or rheumatic disease they have. For example, with osteoarthritis, we often start with non-invasive options like physical therapy, anti-inflammatory medications, and lifestyle changes. If those don’t work, we might consider joint injections or other procedures to relieve pain.

For autoimmune diseases like rheumatoid arthritis, we would focus on suppressing the immune system to reduce inflammation. That might involve disease-modifying anti-rheumatic drugs (DMARDs) or biologic agents. These medications can be very effective at controlling the disease and preventing further joint damage.

Stanton Shanedling: So the treatment is really tailored to the individual and the specific type of disease?

Paul Waytz: Yes, exactly. The treatment plan is highly individualized. Rheumatology is all about identifying the right approach for each patient based on the specific disease, how it’s affecting them, and their overall health.

Stanton Shanedling: It sounds like a lot of it is about early intervention and preventing long-term damage.

Paul Waytz: Absolutely. Early diagnosis and treatment are key. The earlier we can intervene, the better the outcomes are for patients. We want to slow the progression of the disease and maintain joint function as much as possible.

Clarence Jones: I’ve heard a lot about biologics. What exactly are they, and how do they help with arthritis?

Paul Waytz: Biologics are a newer class of drugs that are designed to target specific parts of the immune system. In diseases like rheumatoid arthritis, the immune system is mistakenly attacking the joints. Biologics can help by blocking certain proteins in the immune system that are involved in the inflammatory process. These medications can be very effective for controlling disease activity, especially when other treatments haven’t worked.

Stanton Shanedling: Are there any potential side effects with biologics?

Paul Waytz: Like any medication, biologics come with potential side effects. They can increase the risk of infections because they suppress parts of the immune system. But for many patients, the benefits of controlling their arthritis outweigh the risks. We monitor patients closely while they’re on these medications to make sure we catch any issues early.

Clarence Jones: Are there any lifestyle changes people can make that could improve their symptoms?

Paul Waytz: Yes, definitely. In addition to diet, physical activity is really important. Regular, low-impact exercise like walking, swimming, or cycling can help maintain joint mobility and reduce pain. Weight management is also crucial, especially for people with osteoarthritis. Extra weight puts additional stress on the joints, so maintaining a healthy weight can help reduce symptoms.

Stress management techniques like yoga, meditation, or mindfulness can also help. Stress can worsen inflammation, so finding ways to relax and manage stress can make a big difference.

Stanton Shanedling: It seems like a holistic approach is really important for managing these conditions.

Paul Waytz: Exactly. Rheumatic diseases don’t just affect the joints; they can impact the whole body. So, it’s important to address not only the physical symptoms but also other aspects of health, like emotional well-being, to get the best outcomes.

Paul Waytz: Everybody's different. And if you have some inflammation, I don’t think a food problem causes arthritis. But I think food. Some people have sensitivities such that if they eat a certain thing, it might flare their arthritis over time. There are numerous diets that people propose for helping arthritis, and some of them have no basis in science. But if a person thinks eliminating a certain food helps, I would be the last person to say, "Don’t do that." There's certainly a placebo effect, and when I say placebo effect, I don’t mean to diminish that—it's very important. But it’s an individual thing. For some people, if they eat, say, tomatoes, their arthritis flares, yet for most people, it won’t be a problem. It's like the immune system—it's very individual.

Clarence Jones: Okay, thank you.

Stanton Shanedling: You bring up a really interesting point. As soon as something hurts—especially joint-related—people don’t necessarily... well, for sure, they think of going to orthopedics first. What’s going on? Is there a lack of good communication about what rheumatologists do?

Paul Waytz: Yeah, you know, rheumatologists aren’t as “sexy” as orthopedics. It’s that old surgical adage: "A chance to cut is a chance to cure." They think, “I’ve got a knee problem, they’ll scope me or do a procedure and I’ll be fine.” Whereas rheumatology... when you say "rheumatologist" at a party, it’s usually a showstopper. But I think people are getting more knowledgeable these days. They have friends who have rheumatic problems, and they might say, "My knee hurts, do you have other joints that hurt?" And then they might be directed to see a rheumatologist. Rheumatology is a relatively new field, while orthopedic procedures have been around for more than a century.

Stanton Shanedling: So, again, it seems like it’s very complementary with orthopedic, for sure. Alright, let’s talk about these...

Paul Waytz: I’ll just interrupt here... It is, but with the development of new medications over the last 50 years, our ability to change the course of various kinds of arthritis has improved significantly, especially rheumatoid arthritis. For years, it was known as "the great crippler." And it still can be, but we’ve got amazing medications and insights into treatment. For our listeners, there’s a window—a couple of years—where, if you start appropriate treatment within that window, you can do a lot of work to prevent joint damage. Once the cartilage is damaged, you can’t repair it. It may lead to progressive problems, but early intervention can change lives.

Stanton Shanedling: Good point. Good point. Barry, Dr. Barry?

Barry Baines: Yeah. You know, trying to go down this path, it seems like treatments for arthritis have markedly changed over the past 20 to 30 years—remarkably so. For most arthritis conditions, pain and swelling are very common symptoms. People go to treat the pain so they can do things. But at a higher level, could you give us an overview of what you've seen in rheumatology over the past 20 years? It seems like every time I watch commercials, there are these new immunologic agents that are hard to pronounce. Can you talk about that from a rheumatologist's perspective and how it relates to us as consumers?

Paul Waytz: Sure. When I started out in private practice in 1980, people thought, “All you can do is remove the inflammation or treat the inflammation.” But then some bright people said, “We should do more.” So, medications were developed that not only removed inflammation but also prevented inflammation from getting to the joint. One of the first medications was elemental gold. People thought tuberculosis (TB) caused rheumatoid arthritis, and since gold treats TB, they thought gold would work for arthritis. It did reduce inflammation, but with side effects. Then came hydroxychloroquine, which is also used to treat malaria. People realized it had some benefits for rheumatoid arthritis. Then we started using cancer drugs like methotrexate for rheumatoid arthritis. Low doses of methotrexate reduce inflammation in a different way than cancer treatment doses.

Barry Baines: So, things have evolved quite a bit.

Paul Waytz: Exactly. And then, after a couple of decades, people were escaping methotrexate’s effects, and that’s when biologic drugs like Infliximab came in. These drugs work by preventing inflammation from getting to the joint and other areas. When I retired 10 years ago, there were about 4 biologics. Now, there are probably 10, with more in the pipeline, targeting different aspects of inflammation that damage joints.

Barry Baines: That’s fascinating.

Paul Waytz: Yeah, it really has evolved.

Clarence Jones: Well, Paul, since we’re going back in time... you mentioned the century, and we talked about 10, 15, 20 years ago. This is health chatter—I used to remember about the King and having gout. And now I’m hearing some of my friends talk about having gout. What in the world is gout?

Paul Waytz: You know, I’ll send you a check for asking that question. Gout is caused by an excess of uric acid. We all make uric acid, but some people make more than others. It can be genetic or familial. Eating too many fatty foods, and alcohol can increase uric acid production and slow down the kidneys’ ability to get rid of it. The excess uric acid builds up in the joints and forms needle-like crystals, which cause inflammation. It’s a different kind of inflammation from rheumatoid arthritis, but it leads to severe pain, redness, warmth, and swelling. It usually starts in the big toe, but it can affect other joints. If untreated, it can lead to multiple joints being affected and cause damage similar to rheumatoid arthritis.

Clarence Jones: Wow, that’s interesting. But how do you recognize it and know when to catch it earlier?

Paul Waytz: The typical symptoms of gout are sudden, severe pain, redness, warmth, and swelling—usually in the big toe. However, about 30% of initial attacks affect more than one joint. To confirm the diagnosis, we can take fluid from the joint with a needle and look at it under a microscope to identify the uric acid crystals. We can reduce the inflammation with one drug and then give another drug to lower the uric acid. The key is catching it early. If you catch it early, you can prevent damage. But if untreated, it can damage joints over time.

Clarence Jones: So, what are the treatments for gout?

Paul Waytz: Gout is a treatable condition. We have medications that lower uric acid with low risk and side effects. If treated early, we can prevent damage. For example, I treated a lineman for the Vikings who had gout. He took the medication, felt great, but stopped taking it. Within a month, he had a flare-up that brought him to tears. He was a tough guy, but the pain was unbearable. If you catch gout early and stay on medication, it can be controlled.

Stanton Shanedling: So, why is it a lifelong medication?

Paul Waytz: The uric acid stays in the system, and if you stop the medication, it can build up again and cause more flare-ups. That’s why it’s important to continue the treatment lifelong to prevent further attacks.

Stanton Shanedling: Heavy.

Paul Waytz: End up, Napoleon!

Stanton Shanedling: That was the 1860s. You know.

Paul Waytz: I think Napoleon had gout. I think some of the Tsars had it, and there’s talk about wars that were either won or lost because somebody had gout, or you know, and they couldn’t show up or...

Stanton Shanedling: Yeah, right? Exactly. Yeah, it’s an interesting historical disease, for sure.

Paul Waytz: Exactly. Yeah, it is.

Stanton Shanedling: Clarence! Go ahead!

Clarence Jones: Paul, I have another question for you, another... another...

Paul Waytz: So at least.

Clarence Jones: Question for you. Lupus.

Paul Waytz: Just...

Clarence Jones: It’s interesting to me, and I don’t know. I’m gonna make a statement. And you know it. It just seems to me like everyone that I know that has lupus is a female.

Paul Waytz: That’s...

Clarence Jones: And so, you know, what is it?

Paul Waytz: Okay, so lupus is an autoimmune disease that generally affects women 10 times more than men. So you’re correct there, and like with rheumatoid arthritis that primarily involves the joints, you can get joint involvement with lupus. But, generally speaking, you have other organ systems involved, such as the skin, the lining of the lungs, the lining of the heart. So you have multiple symptoms. You have joint pain, you have chest pain, you have shortness of breath.

Paul Waytz: The bad thing with lupus—the really bad thing is, I think the statistics are, let's just say a good proportion, over 50%, will have kidney problems that the inflammation attacks the kidney, which causes kidney failure. And there’s several different kinds of kidney failure such that you really need to recognize what’s going on. So part of a lupus evaluation includes looking at a urine specimen and doing blood tests that look at kidney function. Lupus can affect the brain. It can affect not only the lining of the heart but the heart itself. It can affect other blood vessels. So it is potentially a life-threatening disease, whereas rheumatoid arthritis tends to not be life-threatening but chronic and painful. You can have life-threatening issues, and just like rheumatoid arthritis, it’s a disease of young people, especially young women, women between the ages of 20 and 40.

Stanton Shanedling: Wow, wow! Wow! So alright, I’m gonna go back to arthritis a little bit. Okay.

Stanton Shanedling: Seems to me, you know, in many ways sports, you know, and how we’re involved with sports today has a tendency to lead to more arthritic types of problems. For instance, even in orthopedics. It’s like, you know, they call it sports medicine now. I mean, it’s like, you know. Alright, so...

Stanton Shanedling: Is, first of all, is that true? Second of all, because of that, are we seeing people becoming more arthritic sooner or not necessarily because it’s really more connected to your genetics than anything else? So does overuse through our, you know, through sports, whatever, lead to more arthritic conditions?

Paul Waytz: Yeah, yeah, the... yes, overuse can certainly lead to more wear-and-tear arthritis. And again, it’s probably the idea of pounding that cartilage in the knee or hips, or the shoulders with people, whatever they’re doing, twerking or lifting weights. And this type of thing that you’re putting an unusual amount of force. Cartilage is made to absorb a certain amount of force. If you overdo it for too long, then that’s gonna create some problem there. So that nice cushioning of the cartilage provides falters and then it sets off, you know, a process that then includes inflammation that just aggravates the process.

Paul Waytz: Now, people said, well, does running or does running cause or not cause arthritis of the knees, and there have been studies that looked at marathon runners. Over years, early studies suggested that it doesn’t—that running doesn’t, you know, marathon running. Now, you have to factor in a couple of things...

Paul Waytz: You have to really look at more than a few years after... as time goes on. So maybe 10, 15, 20 years, and that data still doesn’t exist in clear fashion. Yet. The other thing is, marathon runners tend to be very athletic. So they’re not overweight, and they’re taking good care of themselves, and they’re eating properly and this type of thing. So it can be multifactorial. The other thing is, is that a prior injury? Someplace? So say you... I don’t know... fell down some stairs when you’re a kid, and you’ve got a bad knee.

Paul Waytz: That is a precursor to running, aggravating the knee problem. So if there’s something underlying going on, then you’re gonna have issues. So, overuse can certainly lead to wear-and-tear arthritis, but we’re talking decades down the line. We’re talking...

Stanton Shanedling: Yeah.

Paul Waytz: Now let me just... you know I love stories there. We’re autopsy studies of Korean war casualties.

Paul Waytz: So, young men in their twenties and thirties. And I think the original data suggests that 30% of Korean war casualties had wear-and-tear arthritis in their neck already noted.

Stanton Shanedling: Hmm.

Paul Waytz: So the process may start early. Now, you may not have symptoms for a long time.

Paul Waytz: But, we know something may well be going on, which then goes back to say, well, maybe there is a genetic issue with wear-and-tear arthritis. Maybe there is a disturbance of the autoimmune system that leads to this as well. So it’s a fascinating study.

Stanton Shanedling: You know, one of the things that I noticed when I... you know when I help knee replacement patients is this whole idea of compensation. So it’s like, if your knee hurts on the right side, you have a tendency to compensate, and how you walk, or what have you? Then all of a sudden your hip hurts on your left side.

Paul Waytz: Yeah, yeah.

Stanton Shanedling: And so it’s like this kind of back and forth and back and forth until you’re able to treat one or the other, whether through, you know, prevention of some sort or intervention. Surgical intervention in this case. So, alright...

Paul Waytz: So before Barry... before Barry. So, and then you have to rehab that other side too.

Stanton Shanedling: Exactly, exactly. So. It’s like you can’t win.

Paul Waytz: Go ahead. Sorry to interrupt you, Barry.

Stanton Shanedling: Yeah, go ahead. Derek.

Barry Baines: Yeah, so I’m gonna stick my neck out a little bit here. Because of what you were talking about with that other study. One of the things over the past... you know decades, is that we spend more and more time sitting in front of the screen, the computer...

Barry Baines: And so I’m just... when I know that you know hand things as well from, you know, keyboarding and stuff like that. So I’m just wondering, you know, how what we do in our daily activities, how that has brought up or impacted the prevalence of some of these things. And then, my, and it’s sort of a second part of the question that goes beyond that. But that is there...

Barry Baines: There are things that we can do that don’t have to be medication. There are, you know, a lot of lifestyle things that really make can make a big difference in its impact on arthritis. Certainly osteoarthritis, and I, I would imagine, as well rheumatoid arthritis. But I was just wondering if you could...

Barry Baines: You know touch on how, you know, this has really changed. What? What some of the arthritis conditions that we’re seeing is an impact from our daily activities.

Paul Waytz: Sure. Yeah, and you know, starting right there with working on a computer, is...

Paul Waytz: As I was winding up my career, we were seeing a lot more neck problems because of the position you need to get into to work on a computer. So, you know, we talk about, you know, raising the screen so that it’s at eye level. Not that you’re bending over it. We see a lot of overuse issues with the hands. Not only carpal tunnel syndrome because of the hand use on keyboards and things like this, the tendonitis. And, you know...

Paul Waytz: Potentially, even some wear and tear in small joints and things like that because of overuse. So again, an overuse of small joints. You have the...

Paul Waytz: Kind of the sedentary issue of...

Paul Waytz: You know, sitting at a desk for 6, 7, 8 hours. So all of that contributes.

Paul Waytz: So that’s part of the answer. So I think we’re seeing a new phase over the last 2 decades of people with wear and tear problems in the shoulders as well. Yeah, lifestyle changes. You know, weight loss is huge. If you look at people with osteoarthritis, and this is... it’s pretty obvious that the extra weight, particularly in the knees and hips, does contribute to a faster progression of the osteoarthritis. So weight management is one of the most important things that we can do. Then, a general exercise program, strengthening and stretching, to keep that mobility and flexibility. And then for rheumatoid arthritis, again, diet is a huge issue in terms of whether or not they should, you know, follow, for example, a Mediterranean-style diet. A lot of data on how people... who follow that diet, particularly in Mediterranean countries, seem to have fewer problems with inflammatory diseases, including arthritis.

Paul Waytz: Yeah. And that's a multi-factorial thing with lupus. People die from kidney disease, or they can also die from brain disease. There are other kinds of inflammation, and again, people who don’t even have joint problems can have inflammation of blood vessels that reduces blood flow, possibly to the brain or the heart. It’s almost as if there’s a clot, and they could experience strokes or heart attacks.

Paul Waytz: The other thing, especially with rheumatoid arthritis, is that with new medications, things have changed. People used to be very sick, bedridden, unable to exercise or move. They’d get pneumonia more easily, and generally, they would be chronically ill, to the point where they couldn’t participate in daily activities. These people would have earlier heart attacks and be more susceptible to pneumonia, which could lead to death. Thankfully, things have improved with newer medications.

Paul Waytz: With rheumatoid arthritis, in particular, there are two issues: one is that people’s cholesterol and lipid levels tend to rise. This adds to cardiac issues. The other issue is that inflammation in our systems can elevate lipid levels. That’s why, when you visit a cardiologist, they might test your CRP (C-reactive protein), which is a marker of inflammation, to help identify at-risk individuals. It’s a secondary effect of the disease. Again, we’re doing better, but it’s important to manage all of these factors. As rheumatologists, we’ve learned to act almost like primary care doctors for our patients.

Stanton Shanedling: Our great research team has compiled some telling statistics here. Please correct me if I’m wrong, but these are some key numbers:

• 36 million ambulatory care visits annually
• 744,000 hospitalizations
• 9,300 deaths
• 19 million people with activity limitations

This shows how widespread the issue is.

Stanton Shanedling: Looking at race and ethnicity, there are some interesting trends. For instance, 39.1% of non-Hispanic white adults report being diagnosed with arthritis, compared to 6 million non-Hispanic Black adults. There seems to be a higher prevalence of arthritis among white populations than Black populations, which is interesting given that Black communities are at higher risk for many other diseases.

Paul Waytz: And as you mentioned earlier, Black women with lupus have the highest mortality rate.

Paul Waytz: In Minnesota, which is quite a white state, we may not see as much of this. But I trained in Chicago, where there were different dynamics. There’s a lot going on here, including some considerations around race and access to healthcare.

Paul Waytz: There’s also research showing that people of color tend to do better when they see a doctor who looks like them. If I were a Black man seeing a white doctor, I might not feel as comfortable voicing my concerns about aches and pains. This lack of comfort could impact the care I receive. So, is it about incidence, or is there a bias involved? It’s a complex issue that we’re still trying to understand.

Stanton Shanedling: Absolutely. There are still many nuances in these statistics.

Paul Waytz: Just to go back to those stats—many people who have arthritis don’t actually go to the doctor. So, the numbers we’re seeing are only for those who seek care. Rheumatoid arthritis affects about 1-2% of the population, but when you consider the broader impact, it’s actually a significant number. Among those affected, about 5% are under the age of 16, which brings up the condition called juvenile inflammatory arthritis.

Paul Waytz: People in underrepresented groups may not be getting the care they need, which could be why they don't do as well. This could be a matter of genetics, lack of access to care, or other factors. It’s a multifaceted issue that we need to continue addressing.

Stanton Shanedling: Well, that’s a lot to think about. To wrap up, I think a big takeaway is that there are ways to be proactive in managing arthritis and inflammation before resorting to surgical interventions. It’s a broad field, but we’ve made great strides in recent years. Last thoughts, Paul?

Paul Waytz: Yeah, we could do a whole show on inflammation—it’s a huge topic with many facets.

Stanton Shanedling: Absolutely. There’s inflammation from COVID, for example. It’s a growing area of concern.

Paul Waytz: Of rheumatoid arthritis. The other interesting thing along those lines is, I saw a number of patients, let's say, a half a dozen. So, that's a number, not a number who are identical twins. And one twin had rheumatoid arthritis and the other didn’t. What's that all about? They ate the same food, they had the same cousins there...

Stanton Shanedling: (chuckles) That's okay. I'm kidding.

Paul Waytz: So, the takeaway here, as we wind up, is that there’s a lot of us with arthritis out there. The second thing is, if you have persistent problems, if something doesn't seem right, you should have that evaluated. I'd suggest going to your primary care doctor to start with.

Paul Waytz: I mean, private practice doctors are great people and they know what's going on. You can say, "I think this is arthritis, I think this is rheumatoid, I think this is something a little more complicated," and then go see a specialist if needed.

Paul Waytz: And we do have these windows of opportunity. If you can get in and treat sooner rather than later, you can prevent a lot of problems down the line. Now, that's not to say that you can cure arthritis. We don’t talk about curing it here, although I’d like to think we could cure it with just a pill every day or something.

Paul Waytz: But I think early diagnosis and when necessary, early treatment or changes in lifestyle can go a long way in helping people.

Stanton Shanedling: Barry.

Barry Baines: You know, my biggest takeaway, and this is for our listeners out there, is that oftentimes we have joint pain, and we go to see the doctor for that. But sometimes, we don’t mention the other joints that hurt. What I’m coming away with is that earlier recognition can have a tremendous impact on long-term disability. So, my takeaway is, if you go to the doctor and your knee hurts, be proactive. Mention if other joints hurt, even if it's not as severe. That will raise red flags, and it’s more than just thinking, "Oh, it’s just arthritis."

Barry Baines: This could have a great impact on long-term results. We need to make sure we expand the view of symptoms. Even as patients, we should raise awareness about all our aches and pains.

Paul Waytz: Yes.

Stanton Shanedling: Absolutely, yeah.

Paul Waytz: Perfect.

Stanton Shanedling: Clarence?

Clarence Jones: Thank you, Dr. Paul. I’ve enjoyed this conversation and have learned a lot.

Paul Waytz: Good, good. That's great.

Stanton Shanedling: So, maybe my takeaway is, hey Doc, it hurts, but I do this, you know, with my elbow. Don’t do that.

Paul Waytz: (laughs) There are a lot of jokes!

Stanton Shanedling: Yeah, yeah. Paul, thanks so much. Your insights have been golden. I’ve learned it’s a much broader topic than I imagined.

Clarence Jones: Thank you.

Stanton Shanedling: And I hope our listening audience realizes that as well and acts accordingly. We’ll have research available on our website. Paul, if you have anything else you want to add for our audience, please forward it to me and I'll get it on the site. Thanks for being with us.

Paul Waytz: Thanks for having me.

Stanton Shanedling: It’s been great.

Paul Waytz: Yeah.

Stanton Shanedling: Our audience, we’ve got great shows coming up. Our next show will be about infant mortality. Until then, everybody, keep healthy and keep chatting away!