I'm Dr. John Esdaile, a rheumatologist - aka arthritis doctor - and it's Arthritis Awareness Month. AMA!

How much of an impact can adding turmeric to your diet or turmeric supplements make with rheumatoid arthritis? Asking for a family member who was just diagnosed.

Thanks for being available and sharing your insights.

Thank you for your comment, turmeric is an anti-inflammatory like Aleve or Motrin. Like those drugs, turmeric can cause stomach ulcers. It does not alter outcomes like joint damage, but it does alter symptoms like pain and stiffness.

I have ankylosing spondylitis and currently have only biologic treatments left to try. I'm very scared to try these meds because if the side effects, are there any new treatments? What's your opinion on stem cell treatment?

For people who have failed the older treatments, the new biologic drugs can be dramatically effective. More than half say they are back to normal after taking them. One usually knows if they are going to work within 3-4 months so the risk of taking them is not high. Also, many of the side effects we feared early on are much less common and some are non-existent. I would consider trying them.

There is no evidence that stem cell treatment is beneficial at this time.

How quickly does arthritis typically progress? I have lupus and feel like I need to squeeze in as much now as I can because so many people end up on disability (and then the extra activity of squeezing everything in causes more joint pain from overdoing it - I’m struggling to find a balance.)

Lupus varies from mild to severe. However, it is generally treatable. The majority of people can keep working. For severe cases, it takes a team - including arthritis, skin and kidney doctors, physios, etc. - but the outlook is getting better and better for people. You have to cut yourself some slack as lupus is a serious inflammatory disease.

What drew you to rheumatology vs other disciplines?

I was told little could be done for people with arthritis. I thought I could change that.

I am a gymnastics coach and one of my gymnasts is a 14 year old girl with psoratic arthritis in her wrists and two fingers. She's been cleared to train by her doctors but is really struggling with her grip strength and I'm hesitant to just throw exercises at her because her functionality is obviously different to the average person, and gripping a lot causes her pain. Do you have any ideas for grip strength or wrist exercises that could help? Thanks!

Inflammatory pain will cause weakness. So if the wrist and finger pain is due to inflammation, her medical team needs to tackle that. Once the inflammation is controlled, there are physiotherapists who focus on hand weakness and they can help. I was a gymnast and the pressure across the hand joints can be very high so progress may be slow.

How can weightlifting help my bones? Thanks in advance, Doctor.

All weight bearing exercise - like weight lifting - strengthen the bones and prevent osteoporosis and hip fracture. Aerobic exercises like running increase the heart rate and reduce inflammation in individuals who have some arthritis.

There are several ways! Weight lifting is a weight bearing exercise and strengthens the bones. Aerobic activities like running - which increase a person's heart rate - reduce inflammation and help prevent disability for those with arthritis.

As someone diagnosed with juvenile arthritis four to five years ago when i was 15, what sports can I do that aren’t that rough on my joints? Also I have stopped eating pork because that seems to trigger my symptoms. Why could that happen?

The best sport is probably swimming as, if you are able to do it, there is not much pressure on the joints compared to higher impact sports. However, all exercise is great for juvenile arthritis as it maintains muscle and is anti-inflammatory itself. As for eating pork, I'm not sure.

Can I prevent arthritis?

Yes definitely! Smoking doubles your risk of rheumatoid arthritis. Becoming obese increases your risk of knee osteoarthritis by 400-700%. Weight bearing activities like walking reduce the likelihood of osteoporosis and hip fracture. Many researchers are currently looking into arthritis prevention.

Has there been any correlation shown between gut biome health and inflammatory arthritis disorders?

We have known for a long time that inflammation in the bowels is associated with arthritis. It has been suggested that very low grade bowel inflammation could be involved in some cases of ankylosing spondylitis. Research on the gut microbiome is a hot research topic. I think we have to stay tuned to know how it can help diagnosis and, most importantly, treatment of arthritis.

How effective is marijuana at treating arthritis? Shout out to 'ole musky.

There is near complete lack of research. Because it was illegal, one could not get funds to study it. We did one study on side effects that found no serious side effects on the heart and lungs with short-term use. Given what we do know, marijuana could perhaps help with the nausea that sometimes occurs due to methotrexate - a commonly used drug for rheumatoid arthritis, psoriatic arthritis and lupus.

Are there any studies that correlate weather changes with flare-ups?

The research is conflicting. There are studies saying that weather does and does not lead to flare ups. However, lots of patients tell me they can predict when a storm is coming.

Have you noticed more autoimmune cases occurring linked to EBV in recent years?

For many years, there was a lot of research into whether EBV could cause autoimmune diseases like rheumatoid arthritis. By the mid twenties, more than 90% of us had EBV. Most didn't know they had it. Despite ongoing interest, researchers have not been able to prove that EBV causes diseases like rheumatoid arthritis, in part because almost everyone has had it.

I have arthritis in my left hip due to EDS, and when it gets bad I get pain shooting down my left from my hip. I always thought arthritis only affected the joint and not surrounding tissue; can you tell me what’s up?

Generally, hip arthritis leads to pain in the front of the groin. I cannot be certain the cause of the pain going down your left side. If the pain went past your left knee, one might suspect it came from the back. But I'd recommend you tell your doctor about the pain going down your left side.

I’m a 37 year old female. I have intermittent joint pain especially in my wrists, fingers, elbows & shoulders. Sometimes in my hips, ankles and knees too. Have been tested for gout & arthritis but no positive results. What else could it be? Thanks!

Unfortunately, blood tests are not that helpful in diagnosing arthritis. For example, in early rheumatoid arthritis, 50% lack rheumatoid factor and anti-CCP, which are blood markers for the disease. However, if one talks to the patient, and examines their joints, it is usually very obvious what they have. For someone with joint pain, an expert history and physical examination will be much more rewarding than blood tests.

Just so you know, women before menopause almost never get gout.

What can I change and do within my daily routine to prevent early onset arthritis?

There are many things you can do: 1. Stay slim 2. Stay fit 3. Don't smoke 4. Consider vitamin D supplementation (800 IU per day) if you're not getting sun (most of us are using sunblock). 5. Especially for women, if you are not getting 1,200mg of calcium per day, consider a supplement. Calcium via the diet is best.

As for foods, the problem appears to be excess quantity more than anything else. Everything in moderation. Follow the diet your mother told you.

My knees are creaking quite a bit when I go up the stairs. They don't hurt but it worries me. If I put my hand on my knees and slowly bend them I can feel grinding inside. Should I be worried?

37 years old, flat feet but wearing orthotics.

We know the following from a study across Vancouver: 1. When a person has had pain, aching or stiffness in the knee for one month at any time in the past and 2. Pain, aching or stiffness in or about the knee for any time in the past year and 3. Over age 40 they have an 85% chance of having very early knee osteoarthritis. A normal weight and improved quad muscles can reduce the symptoms and the progression. This applies to the population of British Columbia. Grinding can be from the knee cap alone and generally improves with improved thigh muscles. I encourage you to see your doctor if you are concerned.

How serious is the connection between weight and arthritis? If you're 50 lbs overweight and 50 years old how much of that ache is arthritis and how much is just being old and fat?

Obesity (BMI greater than 30) dramatically increases your risk of knee and hand osteoarthritis. Other aching may not be due to arthritis but could be due to weaker muscles.

Obesity (BMI greater than 30) dramatically increases your risk of knee and hand osteoarthritis. Other aching may not be due to arthritis but could be due to weaker muscles.

Obesity (BMI greater than 30) dramatically increases your risk of knee and hand osteoarthritis. Other aching may not be due to arthritis but could be due to weaker muscles.

I have pain in one finger knuckle on each hand (not symmetrical) that is the worst in the morning or if I lightly bump either knuckle. This pain has persisted for several years but blood tests and an MRI show nothing. Neither was precipitated by any injury. I get the sense that my doctor thinks I'm crazy or is at the very least dismissive of it. I've only found anti-inflammatory cream to help. So, my question is: is there a chance it's arthritis but as of yet undetectable by tests due to the limited locations? I'm early 30s, female.

People can have arthritis with normal blood tests, x-rays, and even MRI. You probably aren't crazy. If you want a definitive opinion, I would ask your doctor to humour you and refer you to an arthritis specialist (rheumatologist).

Is the inflammation in osteoarthritis different from the inflammation in rheumatoid arthritis or psoriatic arthritis?

Yes. The inflammation in rheumatoid arthritis and psoriatic arthritis is driven by the immune system. The inflammation in osteoarthritis is very much less and, in part, may arise from inflammation caused by cartilage breakdown caused by the osteoarthritis.

If I have RA how likely is it I will develop osteoporosis?

Osteoporosis used to be twice as common in those with RA compared to those without it. The most recent evidence is that when we control the inflammation caused by the RA well, the increased risk of osteoporosis is dramatically reduced.

If I play with my fingers or do any weird kind of movements with them, could that cause arthritis in my finger joints?

No. People used to be told that pulling on their finger joints and cracking them would cause arthritis. That does not appear to be true.

Hello Dr Esdaile,

I have suffered with severe bouts of gout since I was 15. We believe it started as a result of chemotherepy through my younger years, along with radiation treatment.

For years I have followed a diet of no red meat, No spinach, Mushroom, fish, Alcohol, Organ meats etc. I wake up in the morning with Lingering uric acid crystals in my feet, and the pain lasting all day. I had been on 600mg of Allopurinol, Plus daily colchicine and weekly indomethicin due to flare ups. I did everything perfect, and nothing worked.

10 months ago, I started doing the 23/1 fasting plan, otherwise known as One Meal A Day. A month after I started I noticed I hadent had any flairs that month. 2 months later the foot pain in the morning was gone, 4 months in I thought it was to good to be true, so I tried eating some of the foods that cause gout.

Today, I survive on a Red Meat, Fish, Alcohol EXTREMELY high purine diet, and have stopped taking ALL of my medications. I have never been happier. All because I started fasting for 23.5 hours a day.

Can you explain what may have happened in my case?

Gout is due to an excess of uric acid as you noted. Your response sounds like a miracle. Did the diet lead to a normalization of your blood uric acid level?

When does inflammation generally become arthritis? I hurt my knee and tore my acl and damaged the padding in the joint. How proactive should I be in limiting inflammation in order to lower my risk of arthritis?

I'm 39 and the ortho who did my surgery on my acl said I will probably need a knee replacement in my 60's.

A torn ACL does put one at high risk of osteoarthritis of the knee. Staying fit and slim can delay the onset.

What's the best way to manage arthritis caused by having Crohns Disease?

Some people with Crohn's Disease have spondylitis and we treat them like ankylosing spondylitis.

Others can have an arthritis of the joints of the arms or legs that is more like rheumatoid arthritis. But it does not generally cause the extensive damage of rheumatoid arthritis. Control of the Crohn's Disease sometimes improves this type of arthritis. If that does not work, we would treat it somewhat like rheumatoid arthritis.

Are you gonna answer any questions?

I guess just one, he probably has arthritis and types real slow

Sorry, I forgot to mention that I would start answering questions at 1pm PDT.