Treating Arthritis Symptoms

By Dr. James McKoy
Interviewed by Melissa Moniz
Wednesday - April 21, 2010
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Dr. James McKoy
Rhematologist, pain medicine specialist

What’s your job description?

A rheumatologist is an internist or pediatrician who is qualified by additional training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones. I also have additional training as a pain specialist. I joined Kaiser in 1996 as a rheumatologist and was chief of rheumatology until 2008. Then I became chief of the division of pain medicine, which I am doing at the present time. These are two totally separate medical specialties, although arthritis is a disorder associated with pain.

Can you talk about arthritis and its different forms?

Arthritis is one of the most prevalent chronic health problems and the nation’s leading cause of disability among Americans.

The definition of arthritis is inflammation, which by definition, is pain, swelling, stiffness, warmth of a joint with associated decreased range of motion. It is just the body’s response to repair injury or damage. But it’s the ongoing response, the severity and location of the response that determines prognosis.

The most common form is osteoarthritis/degenerative joint disease. The next most-common form is rheumatoid arthritis, an autoimmune disease in which the joint lining becomes inflamed as part of the body’s immune system activity. Rheumatoid arthritis is one of the most serious and disabling types, and is more common in women.

Are the symptoms similar?

Most all forms of arthritis can be associated with pain, swelling, stiffness and deformities, but the pattern, joint involvement, disease course and treatments are markedly different. The first thing most patients will notice is pain or stiffness of the joint and sometimes some swelling of the joint. If symptoms have been present for a while, the inflammation can do significant damage to the joint, which might be irreversible. So if patients have swelling, pain or stiffness of the joint, they should see their doctor.


What are the most effective treatments right now?

We can focus on the two most common ones: osteoarthritis and rheumatoid arthritis.

When it comes to treatment of osteoarthritis, weight management and appropriate exercise is very important. And then medications for pain and inflammation. Anti-inflammatory drugs are usually prescribed to treat the symptoms. Cortisone injections can be used periodically for severe pain and swelling, and lubricants can be injected directly into the joints to alleviate pain and stiffness.

Rheumatoid arthritis treatments are different. The ones that are similar to osteoarthritis are weight management and activity modification.

But rheumatoid arthritis has a step treatment approach where, at the bottom, you have the anti-inflammatory drugs, and at the second tier you have drugs such as plaquenil, methotrexate and Arava. On the third tier you have medications that are called biologics, very strong effective medications. Low-dose prednisone and cortisone injections also can be used.

You are one of the honorees at the Arthritis Foundation’s annual walk taking place May 2. Can you talk about your work with the foundation?

I’ve been affiliated with the Arthritis Foundation since I first came to Hawaii in 1983. I’ve been a very active participant with the organization, including serving on the medical advisory panel of the national award-winning Arthritis Today magazine for 10 years. I’ve also been the primary educator for the Arthritis Foundation’s patient education programs around the state and medical spokesperson for the organization. And since 1986 I’ve been on the board of directors.

Are there any new treatments being developed that will further help patients?

Believe it or not, yes. There has been a new pathway identified in rheumatoid arthritis that could possibly revolutionize the way we’re treating arthritis. This new pathway affects or stops inflammation. If you stop inflammation, theoretically you should not get the damage in the joints because it is the inflammation causing the damage. If they tailor drugs to this pathway, it will tremendously affect the overall outcome of patients.

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