A United Front

Richard D. Kase is a self-proclaimed jock. Name just about any sport and he’s played it. He played football in high school and college before moving on to rugby, 10K runs, baseball and racquetball.

While such activities may have helped Kase, 53, lead a healthy lifestyle, the high-impact sports took a toll on his joints over the years. “I didn’t want to give up my athletic lifestyle, but I paid for it afterward,” says Kase, chairman and president of North Canton-based GDK & Co., a wealth management firm.

The abuse on Kase’s joints began with high school football. He had knee surgery in his junior year to repair a torn ligament and tendon, and then went on to play again his senior year. His senior year at Xavier University brought an injury to his other knee, and yet another
surgery.

Years later Kase knew he had severe osteoarthritis – a condition in which the cartilage surrounding the ends of the bone deteriorates. “By the time I was 30 years old, I’d had five knee surgeries and it was very difficult and painful to walk,” recalls Kase. “My legs became extremely bowed because of all of the cartilage they had removed over the years. I was taking 12 ibuprofens a day just to alleviate the pain.”

Kase is not alone. While his problems were caused in part by the amount of cartilage removed through surgery, the risks of developing osteoarthritis after a joint injury are great. A knee injury early in life can increase the risk of osteoarthritis by five times, according to the Arthritis Foundation.

“If you’ve had a significant injury you may go on to develop arthritis,” says Matthew Kraay, associate professor of orthopedic surgery at Case Western Reserve University in Cleveland and director of joint reconstruction and surgery at University Hospitals Health System.
Sixty-six million people, or nearly one in three, in the United States are affected by arthritis or joint problems. Of those, about 21 million have osteoarthritis. “There are over 100 different conditions that can cause arthritis,” says Abby Abelson, rheumatology education director for the Center for Osteoporosis and Metabolic Bone Disease at The Cleveland Clinic. “Joint pain is really a symptom, it’s not a diagnosis.”

Kase’s arthritis became so severe that even normal activities were excruciating. He would walk down inclines on the golf course backward to avoid the stress on his knees. “It was so bad my wife and I would go on vacation at Hilton Head and we’d try to go for walks on the beach and I couldn’t go 50 feet,” says Kase. “I thought only people in their 70s and 80s get arthritis, but I realized younger people get it, too.”

In December 2002, Kase opted to have bilateral knee replacement surgery. “ I decided to take control,” he says. “I wanted a better quality of life.”

While no one can turn the clock back and prevent a previous injury, there are things that can be done to prevent further injury or decrease the risk of developing osteoarthritis. Perhaps the best advice is to avoid activities that put stress on the joints, such as running or contact sports.

“Certain activities are riskier,” says Kraay. “High-impact activities are prone to arthritis. Take it easy on impact activities associated with ligament damage and arthritis.”

Kraay advises his patients to turn to low-impact exercise. “I recommend biking for a lot of people,” he says. “It’s almost as vigorous as running, it’s just less stress on your joints.”

Kase agrees that low-impact exercise can alleviate joint pain. “I’ve always done something to keep active,” he says. “The movements of the joints – the stretching and bending – really help the arthritis.”

Today, instead of running a marathon or crouching in the catcher’s position, Kase hits the gym. “I’m still in the weight room three or four times a week,” he says. “I lift weights, or go on the treadmill. I can’t run – no twisting or pounding of the knees. There are such wonderful machines now that are easy to use and don’t hurt your joints at all.”

Factors such as obesity and bone development problems can also contribute to osteoarthritis. “We do know that people who are overweight put a lot of stress on the joints, especially the knee,” says Kraay. “If you start to develop problems with your joints you may have to modify your lifestyle. If you’re overweight, lose the weight and that’s going to reverse that whole process.”

Hip dysplasia – a condition where the hip socket doesn’t develop correctly – can also lead to osteoarthritis. However, the condition can be reversed if caught early enough. “Correct it early before you get arthritis in that joint,” says Kraay. “We see young people in their teens, 20s or even 30s with mild dysplasia and we can correct that.”

While joint pain is a symptom of arthritis, it is not something that should be self-diagnosed. “The main thing about arthritis is the importance of getting an evaluation to determine what kind of arthritis it is,” says the Clinic’s Abelson. “If it’s inflammatory arthritis, that will have a different pattern than if it’s osteoarthritis.”

While osteoarthritis affects weight-bearing joints, rheumatoid or psoriatic arthritis affects hands, feet, knees, wrists, elbows and shoulders. “With osteoarthritis there’s more pain with use – typically they will have pain at the end of the day because of increased wear and tear on the joints,” explains Abelson. “In rheumatoid arthritis there’s stiffness in the joints in the morning. There may be swelling; there may be warmth.”

In either case, early diagnosis is critical. “A delay of even three to four months makes a difference in long-term joint damage,” says Abelson, referring to rheumatoid arthritis. Kraay offers the same advice in cases of osteoarthritis. “With traumatic problems, take care of it early on,” he advises. “It’s like when the oil light in your car flicks on. Get the oil checked sooner rather than later, when your whole engine blows.”

People often tend to disregard joint pain rather than consult a doctor. “Younger people sometimes avoid the pain,” says Kraay. Kase admits he ignored his symptoms before getting help. “Being a jock, I figured you could just work through it,” he says of the pain.

In fact, of the 66 million people with arthritis, 23 million have not been diagnosed. “Most of the time your joints don’t hurt,” says Kraay. “If your joints hurt, it might be something. If you have pain in your joints, whatever age, you should get it checked out.”

While the experts don’t necessarily recommend a specific diet to slow or prevent osteoarthritis, other than eating healthy, Kraay advocates glucosamine chondroitin, a nutritional supplement found at most drug stores, for healthy joints. “Some data show that glucosamine chondroitin may reverse or slow it,” he says. “I do recommend it for my patients. It’s certainly a reasonable thing to do.”

People with joint pain are often misled by the belief that nothing can be done for their conditions. The truth is new advancements have led to numerous treatment options. “There are recent advances that have really changed the prognosis,” says Abelson. “Immunosuppressives really [help], and there’s new ones all the time.”

Kase agrees there is relief. “First, acknowledge you have the arthritis, but there are things you can do about it,” he says. “There are medications you can take, procedures they can do. It’s amazing the advancements they have made. You don’t have to live with the pain.”
Advancements have been made in the case of osteoarthritis and joint replacement surgery, as well. “Twenty- five years ago if you tore cartilage in the knee we took out the whole cartilage,” says Kraay. “Now we try to save as much as we can. Modern joint replacement itself is an incredible operation. The materials, the techniques work incredibly well. It’s a very gratifying procedure.” 

Kase is now a big advocate of both joint replacement and joint health. “I’m totally pain free now and I take no medications whatsoever,” he says. “You’ve got [joints] for life and you’ve got to take care of them.”