Dr. Paul Waytz
speaker
98 appearances
1 recordings
1 series
first heard Jun 2024
last heard Jun 2024
Dr. Paul Waytz’s voice in public audio — every appearance, attributed to the second.
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Um, whereas your rheumatologist is, you know, when you say you're a rheumatologist at a party, it's usually a, you know, a showstopper there, you know, people go, okay, fine. Right. Um, but I, I think. Mercifully, I think people are getting more knowledgeable these days and they have friends who have rheumatic problems and they'll say, you know, my knee hurts.
And maybe that friend or somebody with some knowledge, including their primary care doctor will say, do any other joints hurt? And that's the next step. Orthopedists, and I love orthopedists, I have some good friends, you know, you go in with your knee, they're focusing on the knee. And a good orthopedist will say, do you have any other joint problems?
And once they say, yeah, my wrist and my ankle, they said, well, maybe you ought to see a rheumatologist because it might be more than one joint. It's multiple joints that are giving you the problem. But rheumatology is the relatively new field where people were doing orthopedic procedures a century or more ago.
Yeah, you know, I'd like to, I'll just interrupt. It is, but again, with the development of new medications over the last, let's say, 50 years and increasing numbers of new medications, our ability to change the course of people with various kinds of arthritis has improved significantly, especially rheumatoid arthritis, which for years was known as the great crippler.
And it still can be that way, but we've got some amazing medications and amazing insights into how we treat and approach. And I will say this for our listeners, especially, there's a window. There's a window that of a couple of years, that if you can start appropriate treatment within that window, you can do, you know, a light year's worth of work to prevent joint damage.
Once the cartilage is damaged, you can't repair that. You know, it's gone. And it may lead to a process of progressive problems. But if you can get in there before at the very early stages, that changes lives.
Good point.
Sure. That's, again, a great question. Well, when I started out in private practice, say 1980, we, so up until, for a long time, people said, oh, all you can do is remove the inflammation or treat the inflammation that's there and you're treating the pain. And then some bright people said, well, we should try and do more. So they developed, so medications came to be that would reduce
not just remove inflammation like you would get with ibuprofen and naproxen and drugs like that. So it does more than just remove the inflammation. It tries to prevent the inflammation getting to the joint. Because that was an aha moment. And one of the first medications was elemental gold. You must remember using gold for rheumatoid arthritis.
And the great story there is that people thought that TB caused rheumatoid arthritis. And they knew that gold treated the tubercle bacteria. So they said, so we'll give that. Well, in fact, it does treat the tubercle bacillus. But it also reduces inflammation or prevents a certain amount of inflammation from getting there.
People thought the same thing with hydroxychloroquine or Plaquenil, which is a drug that's used to treat malaria because people said, well, you know, TB is kind of like malaria. And in fact, Plaquenil is still a great drug for rheumatoid arthritis. And then people realized that there were a lot of side effects with gold and a lot of people were escaping, even if they benefited from it.
And people said, well, one way to really treat inflammation is to give them a cancer drug. which is when the drug methotrexate began being used for rheumatoid arthritis, which, you know, once again, like many medicines, changed our lives because low doses of methotrexate, as opposed to cancer treating dosages, reduce inflammation. It works in a different way than treating cancers.
And then all of a sudden, after a couple of decades of methotrexate, people were again escaping. And that's when the development of all the MAB drugs, infliximab and adalimumab and all these drugs that end in MAB, the monoclonal drugs that you see advertised. And they
are once again changing how we look at things because they do a really, really good job of preventing inflammation from getting to the joint and other areas. So I don't know if that's kind of the long answer to the question, but we've evolved and we've continued to evolve so that when I retired 10 years ago, I think there were four biologics, which is the big group named
And now there's probably 10 and more in the pipeline that work on different aspects of inflammation that produce the cells, the angry cells that chew up the joint.
You know, I will send you a check in the mail for answering that question because gout is caused by an excess of uric acid. And we all make uric acid. Some people make more uric acid than others. And some of that's genetic or familial. Some it's because they eat too much of the wrong food, especially fatty foods, which helps the buildup of uric acid.
Alcohol can increase the production of uric acid and slow down the ability for kidneys to get rid of uric acid such that uric acid will build up in a joint and uric acid becomes a needle-like crystal in the joint. And at some point, those needles, those crystals incite an inflammatory response. It's a different kind of inflammation than with rheumatoid arthritis, but it's very...
It's a terrible situation where people have severe pain, redness, warmth, and swelling. Now you can treat that, or it will go away on its own after two weeks. But the uric acid stays there. And with time, the uric acid, if it left untreated, will affect multiple joints and can cause as much damage as rheumatoid arthritis. And nodules, just like some people get with rheumatoid arthritis.
So it basically starts with uric acid. And the reason I thank you for asking that is gout is a treatable condition. We have wonderful medications, low risk, low side effect profile, that will lower the uric acid. And if you can get to people, again, before the damage, you can prevent problems with gout. Now, I'll tell you a story. You have to take those medications lifelong.
There was a lineman for the Vikings who I saw as a patient who had gout. And he had it in a couple of joints. We made the diagnosis. I put him on the medication. He took it. He felt great, you know, and this was a tough guy, really tough guy. He felt so great. Like many people do. He said, I don't need this medication.
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