Podcast: Debunking Arthritis Myths

Full Transcript:
Released 2/27/2024

PODCAST OPEN:            
You’re listening to the Live Yes! With Arthritis podcast, created by the Arthritis Foundation to help people with arthritis — and the people who love them — live their best lives. If you’re dealing with chronic pain, this podcast is for you. You may have arthritis, but it doesn’t have you. Here, learn how you can take control of arthritis with tips and ideas from our hosts and guest experts. 

MUSIC BRIDGE 

Bailey Cook: 
Welcome to the Live Yes! With Arthritis podcast. I'm Bailey Cook, today's guest host. You've all heard the misguided assumptions that only old people get arthritis and you're too young to have arthritis. But there are a lot more serious misconceptions that can affect the health and disease activity of someone living with arthritis. From amusing old wives’ tales to potentially harmful beliefs, especially by some people living with the disease, there are many myths and misconceptions about arthritis. In this episode, we'll discuss some of these and get the facts, not only to raise awareness of arthritis in its many forms, but also to help people live better with their arthritis. 

I was diagnosed when I was 8 years old, so I'm very used to the whole, "You're too young to have arthritis," or "Oh, my grandma has arthritis." And sometimes I joke around and say that I'm really just an 80-year-old in a 20-something-year-old's body, which probably doesn't help. But, you know, you’ve got to make the jokes when you can. 

Joining me today is Dr. Eric Ruderman, a rheumatologist at Northwestern Medicine, where he has been practicing since 2000. He has held a number of roles, currently associate chief of clinical affairs for the Division of Rheumatology. He is also a professor of medicine in rheumatology at Feinberg School of Medicine. Dr. Ruderman, welcome to the podcast. Will you tell our listeners a little bit about yourself? 

Eric M. Ruderman, MD: 
Thanks, Bailey. I appreciate the opportunity to be here. I've been at Northwestern for a while. I've actually been practicing rheumatology for almost 30 years now. I've seen a lot in that time. I spend most of my time doing clinical work and seeing patients either on my own or with our trainees or fellows. I've done a number of clinical trials over the years, and I have some administrative responsibility. At heart, I'm really a clinician, and that's what I spend most of my time doing. 

Bailey Cook: 
That's amazing. And I'm sure being a clinician, you have heard plenty of arthritis myths throughout your years. What would you say is the most harmful myth or myths that you've heard from patients or from others? 

Eric M. Ruderman, MD: 
Probably the most pervasive and potentially most harmful is the idea that, if you have arthritis, you shouldn't exercise or you shouldn't use your joints. And nothing could really be further from the truth. You need to know what your limits are. And you need to make sure you're not going to cause more pain for yourself. But at the end of the day, moving is good for arthritis, and physical activity is good for arthritis. It's not going to cure the arthritis itself. But the stronger your muscles are, the better your joints are going to feel. And the better you're going to feel. 

Bailey Cook: 
Yeah. One thing that always gets brought up, no matter what episode we're talking about, is that movement is medicine. And moving those joints is really going to benefit you, obviously understanding that you can't push your limits too far. 

Eric M. Ruderman, MD: 
I always tell people that, if you push too far, you're going to hurt potentially, but you're not going to damage anything. So, just learn your limits, and back off when you seem to get too far. 

The other one I hear a lot, which I think is important, and, you know, having been dealing with this for so many years, Bailey, I think you probably have heard this: all medicine has side effects and risks, and that not taking medicine is a way to avoid those risks. Depending on what kind of arthritis you have, not taking medication when it's appropriate and necessary is potentially a more risky issue than taking the medicine. Because of what the arthritis is going to do to you over the long haul. 

I always tell people that, when we have discussions about medication, it's a shared discussion. We need to work it out between myself and the patient. But some patients come in with the idea that, if they don't take medicine, they're all good. And there's no risks that come with that. And that's really not the case. Because then you let the arthritis get out of control, and it takes its toll on you. 

Bailey Cook: 
Because I was diagnosed so young, I've never known anything besides the medicine. And it's interesting because I don't ever question it. You see the commercials, and you're like, "Oh, I'm taking that." And then they list all the side effects. And honestly, it doesn't even faze me. For someone that was maybe diagnosed at an older age, I can definitely see how that can be terrifying, reading some of the side effects. 

Eric M. Ruderman, MD: 
It absolutely is. And unfortunately, when you see those on TV or you see them in the magazines, the list of side effects is a mile long because they basically list everything that happened to people as they were studying that medicine, whether or not it was associated with the medication. Talk to your doctor, talk to your rheumatologist, who can put some context around it. 

Bailey Cook: 
Right. We will preach all day long to have that good relationship with a rheumatologist and really feel comfortable. Because I know my rheumatologist, she's always told me: “Any medication that you’re willing to try is at least worth it to try.” And she’s like, “I don't want to ever prescribe you something that you don't feel comfortable taking. Because then you're not going to take it, and then it's not going to potentially help you.” And honestly, in my opinion, the side effects are way lower on my worry scale than not being able to go for a walk or, you know, take my dog to the park and things like that. 

Eric M. Ruderman, MD: 
The reality is, these days with the medications that we use now, most people don't get side effects. I mean, you know, it's a list of things that might happen, but they don't usually happen to most people. And it's definitely worth having that conversation. Talk about it and make a plan together. And unfortunately, even in 2024, it's very much trial and error. We don't have a way to know what medicine is going to work for any given person. But until they try, we just don't know. 

Bailey Cook: 
And I think that this brings us to another really interesting myth: that natural therapies can't hurt and they will probably help. What are your thoughts about that myth? 

Eric M. Ruderman, MD: 
It's not really a myth. Look, I get it. People want to be proactive; they want to do things on their own; they want to try to have a more natural approach to disease management. And I'm all for that, and I'm happy to support that, with a few exceptions. And talk to your doc, because there are so-called natural treatments that aren't really natural. They've tested herbal things coming from China over the years and found steroids in them. So, that's not terribly natural and has potential toxicity. But most other things, supplements and other natural things, are going to be fine. 

Where the challenge is, is twofold. Number one, we don't know that they're going to work, and some of it can be pretty expensive. So, I would think twice about what you're going to do. And if you want to give it a try, great. But there are a lot of things that are going to cost you money that don't get anywhere. Just make an assessment after you've tried it; if it's helping you, if it's worth it or not. And the most important thing is that most of those natural therapies are not going to be the answer. They're not going to control your disease. So, they're really useful as an adjunct to whatever you're doing with your rheumatologist, with your physician. But by themselves, in most cases, they're not going to be the answer. 

Bailey Cook: 
Yeah. Along that same note: Diet, that's always one; that if you do this certain diet, it'll improve your arthritis, it'll cure your arthritis. What do you have to say about the myth of the diet? 

Eric M. Ruderman, MD: 
Yeah, it's all over the map. We know that diet can make a difference. We know that diet impacts how you feel. It impacts a number of diseases, not just arthritis. The problem is: We don't entirely understand it. And that's where the struggle is. You read a lot about an anti-inflammatory diet or an anti-arthritis diet. And the reality is, it may work for some people. It's not going to work for everybody, just like any medication doesn't work for every person. We think that a lot of the dietary interventions probably work through the bacteria that you have in your gut. And there's a state called the microbiome, which is the bacteria that you carry. We all carry bacteria in our gut that helps us digest foods. 

And what happens when you eat different foods is: It changes the microbiome. And those bacteria actually communicate with your immune system and can drive some of the diseases like inflammatory arthritis, like rheumatoid arthritis, for example. The challenge is: It's different for everyone, because your microbiome, your bacteria, are dependent on what you eat. They're also dependent on who you live with, because people in households share a lot of the same bacteria. And it's very much dependent on genetics. And so, I struggle with recommending specific diets because I don't know that any one diet is going to be good for everybody across the board, because they all have different genetic backgrounds, and they may respond differently. 

What I often tell people is, if there are foods that you eat that you feel make your arthritis worse, that's fine. I believe that. Then avoid those things. But going to a very strict elimination diet, I just don't know that it's worth the effort. Probably the best thing you can do is just make sure you eat a good healthy diet. That you're getting not as many processed foods, not as much sugar, the sort of standard Mediterranean diet, lots of vegetables, low on meat, that's good overall for your health. And if it helps your arthritis, so much the better. 

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Bailey Cook: 
Let's go into some of the myths maybe that aren't as cut and dry. Cracking your knuckles leads to arthritis. What do you have to say about that one? (laughs) 

Eric M. Ruderman, MD: 
So, the simple answer is no. That's just what your mother told you because she didn't want you cracking your knuckles pretty much. When you crack your knuckles, what we think what's happening is that you get nitrogen coming in and out of solution to your joints. It just sort of causes some noise, but it's not damaging. It doesn't cause any problems, other than it might annoy people in your household who get frustrated by it, but it's not going to damage you. Absolutely not. 

Bailey Cook: 
What about the myth that arthritis is just a part of getting older and everyone's going to have arthritis at some point? 

Eric M. Ruderman, MD: 
To a certain extent, it's not a myth. Because many, many people start to get osteoarthritis as you get older. We think of that as arthritis of aging and that's just wear and tear. While I would say it's not inevitable for everybody, it is, to a certain extent, inevitable because we really can't prevent it. We don't have treatments that prevent osteoarthritis. What we have are ways of sort of mitigating the symptoms, so they don't hurt as much, and it doesn't get in the way. 

There's some evidence that if you just look at people over 65, as many as half of them will have evidence of osteoarthritis on an X-ray of their knee, for example. But they don't all have pain, and they don't all have symptoms. So, there is a disconnect between what you see and what you feel. We all get aches as we get older. And that's sort of inevitable. But serious arthritis, I don't necessarily think it's inevitable. 

Bailey Cook: 
That kind of leads to another one as well: If I have joint pain, it must be arthritis. 

Eric M. Ruderman, MD:  
Yeah, not necessarily true. There's lots of things that can cause pain. On the physical end, there's arthritis in the joints. And for us as a rheumatologist, we think of arthritis as something that affects the joint itself. And that's the cartilage and the bones in the joint. But a lot of times, pain is coming from tendons, from ligaments around the joint, from muscles, from other things around the area. So, it can be more than just arthritis. 

Increasingly, we're recognizing that a lot of people have pain that comes not just from the place where you hurt, but it's more about pain pathways in your body and pain circuitry. There are a lot of people who just have this sort of chronic pain that isn't because of an arthritic joint. But there are reasons that their pain pathway and the way they perceive pain is just sort of heightened. 

Bailey Cook: 
What about the myth that cold and damp weather worsens your arthritis? Or that maybe you need to live somewhere warm because it helps your arthritis? 

Eric M. Ruderman, MD: 
I hear that one all the time. I mean, there's no question that weather affects how you feel. I don't think it changes the nature of your arthritis. It doesn't make you have a flare of your arthritis. Bad weather just makes you sort of feel down, and it's going to make you feel more pain. People with arthritis tell me frequently that they notice when the weather is changing. I think it's changes in weather more than anything. 

And in terms of moving somewhere, that isn't the answer. I have colleagues in Arizona and in Florida, and they tell me all the time: People move down there to feel better. And for a while, they do. But eventually they sort of recalibrate to the weather there. And then the same thing happens again: Changes of weather make them feel worse temporarily. 

People tell me a lot that they feel better when they're on vacation in a warm climate. I don't know how you separate warm climate from vacation because everybody feels better on vacation. You don't have stress, you don't have things to do. You can spend your day doing what you want to do. You spend time in the pool, all those sorts of things. I don't know that that's weather so much as just being on vacation makes you feel better. (laughter) 

Bailey Cook: 
And that's so funny, because I was going to say the same thing. Like, you know, when I'm sitting on a beach, my arthritis pain isn't bothering me one bit. (laughs) 

Eric M. Ruderman, MD: 
You’ve got more things to think about than your arthritis pain at that point in time. 

Bailey Cook: 
Yeah. What about the myth that if you have arthritis, you'll eventually have to have a joint replaced? 

Eric M. Ruderman, MD: 
That's one of those sort of halfway myths. Because if you have osteoarthritis in your knee or your hip, because we don't have a way to prevent it from getting worse, we don't have any treatments that slow down the progression; it does inevitably get worse over time. And I suspect that many, maybe even most, people who have osteoarthritis in the knee or hip will eventually need a new hip or a new knee if you live long enough. And that's the challenge. 

Because for some people, it progresses very slowly. And yes, you would need a new knee if you live to 180; but you're not going to live to 180. So, you're probably fine with the knees you have as long as you're around. But other people, it progresses a little bit more rapidly. And they hit their 60s and 70s, and it really starts to interfere with living their life, and they're looking at a knee replacement. It's not inevitable now. But, boy, if we all live a couple hundred years, yeah, probably. 

Bailey Cook: 
Yeah, at some point, your body's got to just tell you to stop. 

Eric M. Ruderman, MD: 
Exactly, exactly. 

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Bailey Cook: 
You keep bringing up osteoarthritis. And I think that's a really a big myth that there is out there: that arthritis is just one disease, and it's just osteoarthritis. 

Eric M. Ruderman, MD: 
That's degenerative arthritis, that's wear and tear that's osteoarthritis. And that's what many people get as you get older. But much of the arthritis we see is not from wear and tear, it's inflammation. And particularly for someone like you, Bailey, who had this as a kid. You know, your joints weren't wearing out when you were 8 years old, it's inflammation in the joint that causes the damage. And that's things like rheumatoid arthritis or juvenile inflammatory arthritis; this was what you had at that point or lots of different things. There's like a hundred different kinds of inflammatory arthritis. And that's a completely different thing. And those types of arthritis… Actually, we've come a long way in being able to treat them and manage them and prevent them from progressing and causing more problems over time.  

A lot of times I see people and, they have osteoarthritis, and I say, "Well, that's the good news and the bad news." Because the good news: It's osteoarthritis, it's not rheumatoid arthritis. But the bad news is: I can't do much about that. I can help you manage the symptoms, but I can't stop it from progressing. Whereas, in a disease like rheumatoid arthritis, particularly in the last 20 years, we've come to the point where we can actually manage the disease itself, so that you don't even know you have it anymore.

Bailey Cook: 
Right. And that actually brings up another myth: that biologics and now biosimilars are too risky. 

Eric M. Ruderman, MD: 
They're not too risky if they're appropriate. And this sort of goes back to where I started this whole thing: Not taking medicine is the least risky thing you can do. Not true. Because if you have a disease like rheumatoid arthritis, which we know, in most cases, is going to lead to progressive damage to the joints, and your joints are just going to get worse over time, much of which is not reversible. So, once you've had that damage, you can't turn the clock back. 

In those cases, medications, like biologics, are a game changer. Because they stop that progression. They're not just helping your symptoms; they're stopping the disease process. So that, you know, five, 10, 20 years down the road, you don't have joint damage that you wish you could have intervened earlier and stopped. 

When I talked to my orthopedic colleagues who do the joint replacements, they no longer do them for rheumatoid arthritis. Thirty years ago, a huge percentage of the joint replacements they had to do were for people who had rheumatoid arthritis that got to the point at which it damages the joint. Now, virtually all of their joint replacements are for osteoarthritis. Because that's the stuff that we can't stop. Rheumatoid arthritis: We've got good treatments now that keep you from getting to that point. 

Bailey Cook: 
Last one on the medication side of things. What would you say about the people that say that over-the-counter medications are safe? Because a lot of people just say, "Oh, just take some Tylenol and you'll be fine." 

Eric M. Ruderman, MD: 
Potentially safer because anything that's over the counter has gone through review by the FDA that has said, at the doses that you can get them over the counter, they're safe enough to make a decision on your own. Whether or not you're going to take it, you don't necessarily need medical advice and a prescription to take it. On the other hand, not completely safe. Tylenol is a perfect example. One of the most dangerous overdoses is Tylenol. If you take too much Tylenol, you can end up knocking out your liver, and it can be fatal. And so, there are limits to what you can take. 

A lot of the nonsteroidal anti-inflammatories, like ibuprofen or naproxen, things like Advil or Aleve, can be very helpful. But they're effectively just lower doses of some things that we use as a prescription. And if you push the dose and take more than what's on the label, you can get into trouble. Over-the-counter drugs are generally pretty safe when taken as their label indicates, but not 100% safe. Because you can potentially get into trouble with those as well. 

Bailey Cook: 
Before we jump into the listener segment, where some of our listeners have told us their most common myths that they hear, are there any other myths that you've heard in your almost 30 years of practice? 

Eric M. Ruderman, MD: 
When you take medicine, you're going to have side effects and problems with the medicine, and you just have to live with that and deal with that. And that's not true. I mean, I think that the answer there is to work with your doctor. Because if there's a medication that works for your arthritis but causes a lot of side effects, then you find something else. There may be ways of avoiding those side effects, even with the same medication. But more importantly, maybe that's not the right medicine for you. 

Bailey Cook: 
And this goes right back to: Have that good relationship with your provider and be willing to ask the questions. 

Eric M. Ruderman, MD: 
I want people to ask questions. Unfortunately, even in this day and age, we don't have a cure; we don't have a treatment that makes arthritis go away. We control it, we can often control it very well, sometimes to the point that you don't even know you have it. But it's ongoing. And so, that's a really important partnership. 

I have people I've taken care of for 20 or 30 years and, you know, they may have a primary care physician. But when they have a medical question, I'm the one they call, because they've been seeing me far longer than their PCP. And that's OK. That kind of partnership is really important. And what's also important is: If you don't feel you have that partnership, then look for somebody else. It doesn't mean they're not a good doc. It just sometimes means it's not a good fit. And you need to find a fit that works for you. Because that's the only way you're going to be able to manage your disease over time. 

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Bailey Cook: 
The question that we asked on social media, we said: What is the most surprising myth or misconception about arthritis that you've heard? And as you can imagine, almost all of them were everything we've talked about earlier: that you're too young, only old people have it. But there were a couple that I wanted to bring up that were really interesting that I haven't even heard of. One of them says that eating cherries will cure arthritis. It goes back to the diet, but… 

Eric M. Ruderman, MD: 
The cherry issue actually is more gout. There's been over the years this idea that tart cherry juice helps gout. And honestly, there is a little bit of evidence it can be helpful, but it's not going to cure it, it doesn't fix it. It's been a while, but copper bracelets used to be a thing; they were going to cure your arthritis. There's all sorts of stuff like that. And the reality is, not so much. And there's no single food that you're going to eat that's going to make your arthritis better. It all comes back to, you know, a good healthy diet. 

Bailey Cook: 
Yeah. Another one that I hadn't heard: "My favorite myth was probably the bee sting therapy." Have you ever heard of that? 

Eric M. Ruderman, MD: 
Oh, yes, I have. That's pretty old school. And it's honestly kind of barbaric. The idea was that if let a bunch of bees sting you, you'd feel better. I think where that probably came from is: When you get stung by a bee, it kicks your adrenal glands into high gear. We all make sort of steroids internally. And that may make you feel better for a little while, but it's not a good way to do it. I haven't heard much of that in a while. Not a good idea.  

Bailey Cook: 
The last one that I'll bring up from our listeners was: that by having arthritis, you can't have kids. 

Eric M. Ruderman, MD: 
Oh, absolutely not true. For many of the things that we see, they happen to women more than men. And so, that's a big issue. And happen in women in their 20s and 30s, when that's really a big issue. And the answer is: not true that you can't have kids. But you need to plan about it. So, it does require a lot more thinking and planning. 

I'm like, "Look, if you're planning a family, the worst way to do it is just see what happens." If you have arthritis, you need to think it through. You need to think about the medications that you're taking. Because it is true that some of the medications we use are not safe in pregnancy or while trying to get pregnant. You need to be aware of that. And you need to also think about how active your disease is. The single worst thing for pregnancy is if you go into it with really active disease, because that's just not good for you, and it's not good for the baby. 

Bailey Cook:  
Well, we always end our episodes with our top three takeaways. So, what would be the top three things that you would want a listener to take away from this episode? 

Eric M. Ruderman, MD: 
I think that number one is partnership with your doctor. And if you have arthritis, that means, in most cases, a rheumatologist, because that's the way you address all these myths. If you've heard something, ask those questions. Because a lot of these myths actually come from people's experiences. And so, they're not completely crazy, but you talk to somebody about it. And make sure that you understand. And that you make your treatment decisions in partnership. 

I think the second thing I would stress is physical activity, exercise if you're up to it and feel that you want to do it, it’s going to be good for you, not harmful, if you have arthritis. And the last, I suppose, would be: Think about your medications as part of your overall plan. And that, while the side effects can be a bit scary potentially, the disease itself can be scarier. Think about that as you consider your management. Think about your medicines. We talked about natural therapies. Think about where they fit in, as an adjunct to your medicines, but not as a replacement for medications that we know can really control your disease and help you live a longer, healthier life. 

Bailey Cook: 
I think those were absolutely perfect. And that would have been exactly what I wanted listeners to take away as well. So, Dr. Ruderman, thank you so much for taking the time and for debunking some of these myths with us. We really appreciate it. 

Eric M. Ruderman, MD: 
Well, thank you for having me. And thank you to the Arthritis Foundation for leading this over so many years, at the forefront of this, to really help us understand these diseases and to help people find the resources they need to take care of themselves. 

Bailey Cook: 
Thank you so much. 

PODCAST CLOSE: 
The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation. This podcast aims to help people living with arthritis and chronic pain live their best life. People like you. For a transcript and show notes, go to arthritis.org/podcast. Subscribe and rate us wherever you get your podcasts. And stay in touch!