THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Transcripts: 501-1 to 501-5

Week: 501.1 Guest: Doyt Conn,M.D. Topic: Arthritis in 1995 - Part One Host: Richard Roeder Producer: Ed Graham

NEMA: This is a five part series on the management and expense of arthritis. My guest is the Senior Vice President for Medical Affairs from the Arthritis Foundation Dr. Doyt Conn.

NEMA: Dr. Conn, though the term arthritis has been around long enough that most of us probably think we have a pretty good idea what it is, maybe you should start our discussion with a brief explanation of what is really a very complicated and persistent disorder.

CONN: Well, arthritis is a very common disorder and it is complicated because many different types of events can lead to arthritis. There are different causes but arthritis is a common problem. Now arthritis is the involvement of the joints, a joint or several joints and this means that there is actually a process affecting the joint resulting in pain in the joint, swelling in the joint and if this is persistent, loss of motion, limitation of motion of the joint so that's what arthritis is.

NEMA: Is arthritis a disease or like cancer, is it in fact even though it goes under one name, many different diseases?

CONN: Arthritis is by definition involvement of the joint but there are many types of arthritis. There are over 100 different types of arthritis but there are two common types of arthritis that people recognize. One is the very common osteoarthritis or the term that has been used is probably not the best term - wear and tear arthritis. The joint cartilage wears out with time and this is a very common type of arthritis affecting people as they get older. This is osteoarthritis. Then the other common type of arthritis, not as common as osteoarthritis, is rheumatoid arthritis and in rheumatoid arthritis the joint involvement is different. In rheumatoid arthritis, the lining of the joint becomes inflamed and then the joint can deteriorate as a result of that.

NEMA: Is arthritis a disease that is on the increase because there are factors in our lives that are actually causing greater frequency per capita or is it that we're an aging population and arthritis is a part of that aging process?

CONN: Right. I mentioned the fact that arthritis is common today. It's estimated that 40 million plus people have some type of arthritis at this time - one in seven people in our population - and it's estimated that by the year 2020, that number will climb from 40 million to almost 60 million and the reason for that increase, and you've stated it, is the aging of our population because the common type of arthritis is osteoarthritis and that is due to the cartilage between the bones wearing out for one reason or another and this occurs more commonly as the population ages.

NEMA: Join me for part two on arthritis in 1995 with Dr. Doyt Conn.

Transcripts:

Week: 501.2 Guest: Doyt Conn,M.D. Topic: Arthritis in 1995 - Part Two Host: Richard Roeder Producer: Ed Graham

NEMA: This is part two in a five part series on arthritis and its costs and management. My guest is the Senior Vice President for Medical Affairs from the Arthritis Foundation Dr. Doyt Conn.

NEMA: Of the people who say they believe they have arthritis in the United States, they're convinced by their aches and pains that this is so but only a very small percentage of them seek medical attention usually because they say they don't believe there's anything that can be done about it. Why do you think they have this attitude and should they rethink that decision?

CONN: That's a good question. I think that you are absolutely right. Aches and pains are very common. Probably only a percentage of those people with aches and pains will actually have arthritis but aches and pains are very common and why is it that people shrug their shoulders at this even though they may have a persistent problem and may even have some limitation of motion? I think it's been just accepted that this goes along with living and aging and you just have to live with it but as a matter of fact, we can do things for patients with arthritis, any type of arthritis and arthritis of any degree of severity. Particularly in the inflammatory types of arthritis like rheumatoid arthritis and in osteoarthritis, recognizing it early is very important because depending upon the type of arthritis and the severity, something can be done and this will have to be individualized.

NEMA: A recent study actually indicated a very severe cost for the care of people with arthritis and lost productivity from arthritis. How costly is arthritis to the gross national product?

CONN: It's a very costly illness both in terms of the cost of managing the arthritis and the other hidden cost of people not able to work because of arthritis and it's estimated that in 1994, it cost our country about 150 billion dollars or 2.5% of the gross national product. That is a costly item and to a degree and we don't know to what extent but to a degree this can be reduced by diagnosing the illness earlier, by appropriately managing it, by certain lifestyle changes that would delay or limit the impact of the common type of arthritis, the osteoarthritis.

NEMA: There are few areas of medical history that are filled with as many fraudulent cures and devices as arthritis. They've been around for decades if not more. Do you still see a lot of fraud today in the marketing of supposed treatments for arthritis and do you ever investigate some of these claims in hopes of actually finding something that works?

CONN: There are billions of dollars expended for unproven remedies.

NEMA: Join me for part three on arthritis in 1995 with Dr. Doyt Conn.

Transcripts:

Week: 501.3 Guest: Doyt Conn,M.D. Topic: Arthritis in 1995 - Part Three Host: Richard Roeder Producer: Ed Graham

NEMA: This is part three in a five part series on arthritis with the Senior Vice President for Medical Affairs from the Arthritis Foundation Dr. Doyt Conn. I asked Dr.Conn about untested remedies for arthritis.

CONN: Arthritis is common. We've already established that. And there is a perception which we think is wrong that nothing can be done for it and so here is a situation that is ripe for exploitation and that has happened. There are billions of dollars expended for unproven remedies and these people are misled frequently by these unproven remedies. We get comments and inquiries about this all the time and we investigate them to the best of our ability but it is a sad state of affairs. Several things happen as a result of the many many many unproven remedies out there. Number one, the person, by involving themselves in the unproven remedy is possibly delaying more appropriate medical treatment which can be sad. There certainly are potential side effects of approaches that have not undergone good rigorous scientific scrutiny and thirdly, I've already mentioned, this form of management, if you will, drains away good legitimate dollars from the investigational efforts that are so direly needed to manage and to learn more about these disease processes so we can manage them better.

NEMA: So to your knowledge, none of these unusual treatments has ever panned out to be something that actually made a big difference in somebody's arthritic condition?

CONN: No.

NEMA: Talk about some of the research that is ongoing, especially in the area of medications.

CONN: I think that first of all, we have to gather information and this has been done, is being done in terms of what is actually going on with the various types of arthritis and we've learned a good deal about the degenerative arthritis, so to speak, about how the cartilage deteriorates and what factors are involved in accelerating that deterioration and although there is no definite medication that has resulted from that effort, I can tell you that there will be because of the understanding of that process of cartilage deterioration. Now with respect to the inflammatory arthritis, rheumatoid arthritis, by learning about the various ingredients that contribute to that inflammation, there are new treatment approaches being studied right now. For example, one of the major mediators of inflammation is being treated by developing antibodies and enzymes that inhibit that particular mediator and the early results are promising.

NEMA: Join me for part four on arthritis in 1995 with Dr. Doyt Conn.

Transcripts:

Week: 501.4 Guest: Doyt Conn,M.D. Topic: Arthritis in 1995 - Part Four Host: Richard Roeder Producer: Ed Graham

NEMA: This is part four in a five part series on arthritis with the Senior Vice President for Medical Affairs from the Arthritis Foundation Dr. Doyt Conn. I asked Dr. Conn about medication for arthritis.

CONN: We really do a pretty good job in managing rheumatoid arthritis, particularly by using well and early the medications that we do have and do use and this again emphasizes the importance of early recognition of disease and appropriate use of the treatment modalities that we have available. So there are some exciting prospects on the horizon. We can do a good job of using the medicines that we do have at our finger tips in managing the inflammatory arthritis conditions and I will just mention the appropriate use of prednisone, the appropriate use of agents like methotrexate are very important and then, in all types of arthritis but particularly the degenerative type of arthritis, we know that if people maintain a healthy lifestyle, if they maintain their weight, if they keep their muscles well conditioned, chances are they're going to delay if not prevent the deterioration of some of the weight-bearing joints.

NEMA: One of the things you just touched on was exercise but also one of the things that has to be managed carefully, especially for a person who already knows they have arthritis, is exercise. There are a lot of weekend athletes in this country who go out and destroy themselves in an effort to make it all up in the weekend. Talk a little bit about sensible management of your physique when you know you have arthritis.

CONN: Sure. First of all, we and they have to know what is the problem. Do they have a problem with their knee? Have they started to develop a little problem with their hip or a foot? So the joint that's involved and the type of involvement is very important so if a person is starting to have a little trouble with a weight-bearing joint, then it's very important that they maintain their weight, it's very important that they keep those muscles about the joint strong and they're going to need some guidance by their physician in outlining this process but they need to keep the muscles about the joint strong but they should not be vigorously exercising with weight-bearing types of activities such as jogging or tennis because that will at least potentially make the joint problem worse. Now this doesn't mean that they can't condition themselves but it does mean that they will need to be involved in a different type of activity. For example, if a person has a knee problem or a hip problem, maybe they should be involved in bicycling or swimming or some other type of non-bearing activity and this same process would be individualized again depending upon which joint's involved and what type of involvement there is.

NEMA: Join me for part five on arthritis in 1995 with Dr. Doyt Conn.

Transcripts:

Week: 501.5 Guest: Doyt Conn,M.D. Topic: Arthritis in 1995 - Part Five Host: Richard Roeder Producer: Ed Graham

NEMA: This is part five in a five part series on the costs and management of arthritis. My guest is the Senior Vice President for Medical Affairs from the Arthritis Foundation Dr. Doyt Conn. I asked Dr. Conn about repetitive motion problems and arthritis.

CONN: Again depending upon previous problems and depending upon some degree of susceptibility, this type of repetitive motion can cause some tendonous problems in hands and arms. A fixed head position can result in neck strain so there are problems that can result from most types of activity or inactivity. The person has to understand that and realize what they can do to minimize the impact of activity or inactivity.

NEMA: Have you ever seen a convincing link between nutrition and arthritis?

CONN: Sure. I guess the obvious early link and it's still present is the relationship between foods and beverages that increase uric acid in the blood and cause gout. That's an ancient arthritic condition, still with us and you've seen caricatures of individuals with gout. They're a rotund, red-faced person who has eaten too much and drank too much so that's a classic example of the fact of rich foods and beverages.

NEMA: What I need to ask you then is have you ever seen a convincing link between dietary change and curing arthritis?

CONN: Well again, back to gout, by limiting the alcoholic beverages and the more reasonable diet and weight control, this is one of the approaches to managing gouty arthritis but you're really referring to the other types of arthritis. I've already mentioned the effect of too much weight on the osteoarthritis or degenerative arthritis. That is more of a weight relationship to the arthritis. We see claims in health food stores and we read about the effect of minerals and we read about the effect of various vitamins on types of arthritis and there's no good scientific data that would either confirm or refute that.

NEMA: How well is arthritis research being funded as we speak?

CONN: In terms of the impact of arthritis on our population and the potential that we have today in terms of where science is in taking advantage of that information and translating it into new treatment approaches, I think that we are at the threshold but that money is just not coming to arthritis research and in this time of budget battles and reduction of funding at the NIH level, I think that that promise for better management for people with arthritis is seriously being threatened.