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Podcast, Provider Interviews

Managing Gout, Osteoporosis, and Arthritis: Insights from Dr. Arinola Dada

3 weeks ago
50 min read
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Summary:

Getting diagnosed with an autoimmune disease can feel overwhelming, but small, consistent steps can make a big difference. 

In this conversation, Cheryl and rheumatologist Dr. Arinola Dada explore myths versus facts for gout, osteoporosis and inflammatory arthritis. For example, Dr Dada explains that diet is only responsible for 15% of gout symptoms. She also delves into what people with rheumatoid arthritis need to know about osteoporosis. 

Additionally, Cheryl & Dr Dada also explore how strength training—not to “bulk up,” but to boost energy, focus, and joint stability—can be a game-changer for these diseases.

Dr. Dada reassures newly diagnosed individuals to avoid the anxiety of worst-case scenarios online and instead focus on reliable information and gradual, sustainable lifestyle changes. 

She emphasizes that managing arthritis is a marathon, not a sprint, and that even 1% improvement each day adds up. With the right knowledge, support, and habits, you can take control of your health and live well with arthritis.

Episode at a glance:

  • Myths vs Facts for gout and osteoporosis
  • Strength Training Benefits: Cheryl and Dr. Dada discuss how strength training improves joint stability, reduces fatigue, and enhances focus for arthritis, gout, and osteoporosis.
  • Managing Anxiety: Cheryl and Dr. Dada discuss navigating the anxiety that comes with a new arthritis diagnosis, emphasizing the importance of reliable information.
  • Patience & Progress: The value of taking a gradual approach—small daily improvements can lead to significant changes in quality of life.
  • Empowering Patients: Dr. Dada emphasizes patient education and how it empowers individuals to make informed decisions about their care.

Medical disclaimer: 

All content found on Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Episode Sponsors

Rheum to THRIVE, an online course and support program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. See all the details and join the program or waitlist now! 

Speaker Bios:

Dr. Dada is a board-certified rheumatologist with over 20 years of experience, leading Overlake Arthritis and Osteoporosis Center, which includes a specialized gout clinic and the “GotGout” Facebook support group. A TEDx speaker on “Rethinking Gout and Chronic Disease,” she is renowned for her expertise in managing rheumatoid arthritis, gout, inflammatory arthritis, and osteoporosis.

Cheryl Crow

Cheryl is an occupational therapist who has lived with rheumatoid arthritis for over twenty years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources.

Episode links:

Full Episode Transcript:

[00:00:00] Cheryl:
Yay! I’m so excited today to have Dr. Arinola Dada here to talk about gout and osteoporosis and rheumatoid arthritis. Welcome! 

[00:00:10] Dr Arinola:
Hi, Cheryl. Thank you so much for having me on your show. I’m excited to be here with your crew. So wonderful to be here. Thank you so much for having me. 

[00:00:20] Cheryl:
Thank you so much for taking the time to chat with me today. And if you could just let the audience know, first off, where do you live and what is your relationship to arthritis? 

[00:00:30] Dr Arinola:
Okay. thank you. So, yes, I live in the greater Seattle area. I work in Bellevue. We didn’t talk about this. I think you’re close by, right? 

[00:00:40] Cheryl:
Yeah. I live in Bellevue. 

[00:00:41] Dr Arinola:
Okay. Okay. Yeah. So, I work in Bellevue. I have a clinic Overlake Arthritis and Osteoporosis Center. And I’m a rheumatologist. So, I treat people with joint pain and my job is to help them become pain free and guide their immune system to get on track. Personally, you know, like everybody else, we’ve had bouts, we’ve had bouts of arthritis. For me, they’ve been things that have gotten better somewhat with physical therapy over time. There’ve been some things that I did like running like a crazy person on the treadmill, injured my patella, ended up having to do rehab, all that. 

So, and then develop some little bit of arthritis behind my kneecap to tell me not to do that kind of thing again. I do also have ski injuries and things like that. But, you know, been lucky that I’ve been able to walk through and follow some of my advice through physical therapy and being able to maybe not be as aggressive as I had been. But at least, you know, do what I — my goal for my patients, which is to get them pain free so that they can live a good quality of life.

[00:01:46] Cheryl:
That’s awesome. And why did you choose rheumatology as your specialty? 

[00:01:53] Dr Arinola:
Ah, history. So, it was, so it was interestingly, while I was on my path to becoming a cardiologist. So, I was lucky enough to have had a rheumatology rotation about some 30 odd years ago. I’m going to, I’m going to date myself. And that was, and at that time, I, the first thing that struck me about that rotation was that there was this very, this rapport that the patients and the rheumatologists had that I hadn’t seen anywhere else. My mentors, the rheumatologists, they were sharp as whips. And the patient — they really just had that loving relationship. And I don’t know if part of it — now, as a rheumatologist I know, part of it is due to the fact that there’s this long-term relationship. You’re the guide for the patient as they walk, and you walk hand-in-hand with the patient on that journey. 

And so, really being able to witness this kind of moved my mind away from cardiology. But I would say what really sealed the deal, to be candid, was that it was a breakthrough of all the biologic medications. And it was just like, O-M-G. What an impact this is making on the lives of patients. They had just gone past like gold shots and steroids and handholding to where they could really impact people and get them from being wheelchair-bound to where they could go and be part of their children’s lives. They could even sit in the bleachers for hours watching football games. So, that, for me, was kind of the turning point in, wow, we now have, we understand the conditions a little better. We have the medications that are impacting lives. And you have this amazing relationship between the doctors and their patients. 

So, after that, I was sold out. Just like, I’m out the room. Bye-bye everybody else. And so, that’s how I fell in love with rheumatology. But I would say without the mentors, I would say the mentors were the most important part of that part because they taught me how to be a good rheumatologist. And I just, I said, I want to be that kind of doctor. The kind of doctor that the patients remember years later that, “Oh, this was my doctor.” So, I think that, probably that the medications, the patients, that whole triad is really what drew me into rheumatology. And I would say, I don’t feel like I’ve worked a day since. 

[00:04:34] Cheryl:
Wow. That’s incredible. And, you know, that’s often what I hear. I just interviewed recently, Dr. Diana Girnita, and she said the same thing about the relationship. Yeah, I’m sure you know — yeah. 

[00:04:47] Dr Arinola:
Yeah. I know. She’s a good friend of mine. Fantastic. 

[00:04:51] Cheryl:
Yeah. It was, yeah, I can see you are two birds of a feather because she said the same thing. Like, she also was going to be in cardiology. She was in cardiology and then switched to rheumatology because of the relationship. And I totally, I feel very lucky personally, as a patient, I’ve often talked about my own rheumatologist, Dr. Gorman, and I’ve seen her for over 20 years and she is an important person in my life. I brought my son to the appointment when he was just weeks old to meet her. And she’s just been with me through so many ups and downs. 

So, I think that’s a beautiful thing. The only thing I would add, this is my occupational therapist brain, but when you said wheelchair-bound, nowadays most patients and wheelchair users are preferring just like wheelchair user, because the wheelchair is not necessarily something that binds you. It’s actually a source of freedom for many people who use wheelchairs. And there certainly are people I have interviewed on this podcast who are, you know, have a positive relationship to using their wheelchair for mobility and freedom. I know it’s a phrase that a lot of providers were used to saying, like, wheelchair-bound, but nowadays people prefer just like wheelchair user, you know?

[00:06:04] Dr Arinola:
Yeah. I totally see that because yes, because the alternative is being bed-bound, right? So, yeah, I can totally see how it gives them the freedom. And yeah, I think I’ll take that. I will actually add that to my vocabulary, actually. I think I totally see how that totally makes sense. But I think from a rheumatoid, as a rheumatologist, our goal is to try to really optimize, you know, how much people can do and make sure they’re thriving and just living as well as they can and optimizing, whether it’s medication, holistic, exercise, PT, occupational therapy. What can we do to make sure that we’re really optimizing your health? And it’s not going to be the same for everybody, but when we can get you up and at them, and actually just even feeling better, I feel like we know. “I’ve come a long way, doc,” that, that statement, right. That’s what we’re looking for.

[00:07:04] Cheryl:
And certainly with the advent of the biologics, like you mentioned, there are far less people in the rheumatology patient population that require a wheelchair for mobility. So, that’s, you know, an indicator of the advancements in how the technology can affect people’s quality of life. And I would, I’m wondering, what do you, what’s something that you wish patients knew about your job?

[00:07:34] Dr Arinola:
One of the things that I think I wish they knew about my job was that it’s not just me. Is that there is a team of people that are rooting for our patients. Everybody from the people that are making sure that we get the right medical records from your doctor, to the medical assistant that’s taking the message, to the physician assistants that kind of go through and feel like who is the most ideal patient for what holistic program, people doing priority. We have a monster. So, I know a lot of times people feel better, like, “Oh, thank you, Dr. Dada.” But it is a team. There’s just no way it’s one person. So, there is a team. There’s even the fact that we actually have specialists come in and give our team up-to-date information. Like, we had Dr. Ghali the other day teach the whole team about holistic and additional therapies. She actually gave some, have you read it? Have you read it? The Indian, old Indian treatment, and give us some ideas on how we can incorporate this kind of treatment for our patients. 

So, I guess I’m just saying that it takes a village. And I think that’s, I think, would probably be the most important thing that I’d want people to know. And that there are always options, right? That we always want to keep hope alive. That even when there may not be treatment today, in these days, I used to tell patients that — oh, they would ask, “Hey, am I going to have to be on this medicine for the rest of my life?” And honestly, five years ago, my answer was, “Yes. For the foreseeable future.” But now, there is so much coming. It’s so much coming down the pipeline with medication options and different things that we’re even aware of, like ideas about, hey, if you start treating rheumatoid early, you can create remission, right? So, there is so much coming now that I am now changing from an emphatic ‘No’ to ‘Very possibly’. 

We may get something that actually cures where you’re not on medications for the rest of your life because we just have so much coming down the pike and the speed at which it’s coming to you. So, it’s an exciting time, I think, within rheumatology and just being hopeful that yes, we’re going to find something, one, and make sure that we maintain the quality of life. And I tell patients, I’m like, “Hey, my job is to preserve your joints so that when that better thing comes along, we will be able to make sure that your joints are functioning at that time.” So, our job is let’s prevent joint damage today. 

[00:10:20] Cheryl:
Yeah, it’s so funny how different people respond to the same information because like when my doctors, you know, explained that I would have to be on medication the rest of my life — Dr. Gorman, of course, you know her — so, but she said it in a way that was very optimistic. She’s like, “But it’s gonna be most people, they respond well to the meds, and it really helps them.” To me, I was like, oh good, then I’ll just take it the rest of my life. Like, but I know I’m, at least on social media, I’m not in the norm. Because the majority of people are very, very scared. I think I was just a little more of an optimist, because I was like, and I’ve taken it for 20 years, I’m great. I just, I am grateful for the medications. I’m also lucky that I haven’t had like horrendous side effects of anything, except a couple of the ones I tried didn’t agree with me and I had to stop them, but the ones I’ve been able to take for years have really worked. 

So, it’s just — but you’re right. The overall point about things like CAR T-cell therapy or the other things that are coming down the line, even like vagus nerve stimulation, I’m excited about that. There’s just so many things. Or even the Benaroya Research Institute researchers, I don’t know if you ever talked to them, but I had one of them on the podcast and she’s like, “I think there’s going to be a cure in the next 15 years.” And I was like, really? That’s so exciting. 

[00:11:35] Dr Arinola:
That is, yeah, so you’re right. We actually work with, we actually do clinical trials in our clinic, too. And that is part of why we’re feeling very excited. So, it’s not just rheumatoid arthritis. We have two studies. We just did one study on rheumatoid arthritis. We have two studies on Sjögrens. We have studies on gout. Just looking at different options and trying to figure out how we move over and beyond what we have already and transcend into that possibility of, potentially can we get that cure? 

[00:12:12] Cheryl:
That’s so exciting. And I love, you know, what I was anticipating you might say when I said, “What do you wish patients knew about your job?” is maybe like the fact like sometimes patients don’t know that doctors have so many demands on their time and that you can’t always do exactly just what you would like to do in the ideal world because you’re constrained by insurance or anything like that. But I love that you were like, no, I want them to know that it’s, there’s a team. It’s not just me. And that’s such a beautiful, positive message. 

And the other thing I wanted to ask you about today is something that actually, I don’t think in a hundred — and this is going to be episode a hundred and sixty something. A hundred and sixty four, I believe. I don’t think we’ve covered gout at all on this podcast. So, that ends today because you are like an expert in gout. And I don’t even know if people — most people with rheumatoid arthritis and inflammatory arthritis don’t even really know what gout is. So, what, is gout? Let’s start there.

[00:13:13] Dr Arinola:
 Okay. Let me have at it. [Laughs] Okay. So, gout is one of the most painful arthritic conditions. And you know it because it feels like someone came at you with a sledgehammer in the middle of the night, smashed your toe, went away, and comes back a month or two later. That is typically the description that people with gout have. It’s the intensity of the pain and the fact that it’s so episodic. But what is gout? Well, gout is caused by the fact that our body, the body is making — made of protein and we eat protein. And this protein forms purines. And these purines eventually form uric acid. And typically, we should just be able to excrete it into the urine and it doesn’t cause you any problems. 

Over the centuries, as we have gotten bigger — so you can imagine 200 years ago compared to now, even the skinniest of people is taller and bigger — and so, we have a bigger body mass. But the truth is that 700 years ago, well, having high muscle mass and product and finding a lot of food to eat was not the problem. The problem was starvation, right. So, our body had evolved into, hey, how do I manage on very little food? Now we’ve got plenty and now we’re bigger. So, just metabolically we’re producing much more proteins and much more uric acid. And so, this uric acid forms dagger-shaped crystals that enters the joints. And when it gets into the joints, because for whatever reason we can’t pee it out, then it forms that uric acid crystal in the joint. And the process of that uric acid triggering inflammation is what is known as the gout attack.

[00:14:59] Cheryl:
And is it always in the big toe or is it other places? Okay, that’s what I thought. 

[00:15:05] Dr Arinola:
Oh, no, I haven’t even — I’m not — and so, the answer is it usually starts in the big toe because uric acid likes to rest in cold places. But over time, yeah, it likes to crystallize in cold places. So, it likes the big toe. It’s far away from the heart. The heart is nice and warm. And so, it crystallizes in small joints, but it’s almost like over time, when that uric acid supersaturates in the joint, it moves to the next joint and the next joint. And so, you can find it in your elbows, around your ears, around your knees. So, it can then start to affect other people. Other, sorry, other joints. Yeah. 

[00:15:46] Cheryl:
Other joints. Yeah. Wow. Okay. And what are some of the common myths that you hear about gout that you’d want to correct today on this podcast? 

[00:15:56] Dr Arinola:
Gout, you know, because gout is an old disease, right. It’s as old as the kings, right? It’s as old as the pyramids. And so, over the years, over the centuries, there has been lots of opportunity, because the science hadn’t caught up, but they did know this old king had gout, this other king had gout. And so, lots of opportunities for there to be lots of myths about the disease because the science hadn’t caught up. So, one of the myths about gout that I think needs to be dispelled now is that it’s all in your diet. Buck up, be more disciplined, and you’ll be fine. And that is something that I’m going to say even doctors still have that stigma associated in the brain, you know, ‘If you just had a better diet, you would be fine’. We now know that diet is actually only responsible for 15% of gout. 

A lot of gout has to do with the fact that in the kidneys, in the — so, in the kidney, each kidney has this little filter and attached to the filter is this thing that looks like a garden hose. And that garden hose basically has pumps. And we have found out that genetically there are some pumps on that garden hose that determine whether you, whether your body absorbs. So, let’s assume you’ve already filtered the uric acid through the filter and it’s through the tube and everything through that tube should go into the bladder and get peed out. There are pumps on the sides of that garden hose that pull the uric acid back in. It’s like, we want more uric acid! 

And so, that is genetically determined. So, that’s not has does not have anything to do with whether or not you are on a good, you know, a good diet or not, because that’s genetically determined. The other thing that people should know is that women tend not to get as much gout as men. And the reason is when they’re having their menstrual periods, we flush out uric acid every month. So, we don’t have the, we don’t accumulate that much uric acid until we get older, until we’re in menopause years. And so, because women tend not to get gout when they’re younger, sometimes when they’re older after menopause, the diagnosis can be missed because people are thinking women don’t get gout. 

Well, they will after menopause because estrogen is low. They’re no longer having those periods. When they had oestrogen, oestrogen was actually helping them pee out the uric acid. But once they hit menopause, the rate starts to rise as much as men. So, when women, women tend to be misdiagnosed a lot because when women were younger, they didn’t have gout and people just have it in their minds that women tend not to get gout, but older or postmenopausal women do. 

[00:18:50] Cheryl:
Wow, that’s really helpful to know. Yeah, I could totally see how those misconceptions would happen. And I even just, even though I’m really involved in the inflammatory arthritis, I didn’t know as much about gout and I thought it was a lot more to do with diet, you know, until you said that. So, that’s really, really helpful to know that, there’s just going to be a genetic component. And sometimes even if you did all the right things, you can still get it. Yeah. And so, how is it treated? 

[00:19:24] Dr Arinola:
Yeah. So, I still, even though, yes, I did just say that diet is a small part of it, we still want you to at least follow certain recommendations. And so, we tell patients, avoid the things that we know are going to spike your uric acid. So, we avoid beer. That’s never good for people with gout. We tell people to avoid high fructose corn syrup, which everybody now knows is pro-inflammatory and so most people shouldn’t be eating that anyway. Avoid shellfish, avoid organ meats. And keeping well hydrated. So, that’s forms the pillar of let’s start with that. And then there are other things. So, if your body’s making too much uric acid, we have medications to stop your body from making any more of this uric acid. So, things like allopurinol and uloric. Talking to doctors about those options, because sometimes patients, you know, you have to, you have a doctor who has to decide what’s best for you. 

And so, and then the second part of it is, well, how do you treat the acute attack? So, somebody comes to you with the acute pain. And then, your doctor has to go through, you know, what’s the best option for you. So, there are medications like colchicine and prednisone, those kinds of things. But again, your doctor really has to look at the whole picture. If you have diabetes, we don’t want to give you too much steroids. Should we give you a shot? That kind of thing. And your doctor may order some X-rays or do something called a dual energy CT scan to figure out the severity of your gout, right, and go from there. So, that’s typically, hopefully that’s helpful in terms of there’s the long-term play, which is don’t make any more uric acid. Then there’s a short-term, how do we treat the acute attack? 

A lot of people take anti-inflammatory medications. They’ve been taking NSAIDs and Ibuprofen for years. And so, when they’re doing that, that can affect their kidneys. And so, I have seen a number of patients who had gout self-managed their gout, were just popping ibuprofen, and damaged their kidneys. And what happens when you have damaged kidneys, in addition to everything else, it makes gout worse. So, so that is not — so a lot of people say, when you have gout, take an anti-inflammatory medication. I say no, because people already know how to, and they’ve been doing it for years. So, by the time they’re seeing me, we’re no longer going that route. We’re using steroids, colchicine. There’s an injection of one newer medication called Ilaris. Expensive medicine, but for people who’ve had this repeated recurrent attacks, they just get one shot, and it’s usually covered by insurance in the United States. But that’s also an option for people to really break that cycle of the attack. 

[00:22:07] Cheryl:
That’s super helpful. And the majority of people who listen are people with lived experience of conditions like rheumatoid arthritis or similar inflammatory arthritis. What do we need to know, people like me, about gout? Are we more prone to gout, or no? 

[00:22:25] Dr Arinola:
So, I would say that, I don’t know that people with rheumatoid arthritis are necessarily more prone than the average person, but the average person is prone to gout. And I think the problem with people with rheumatoid arthritis also developing gout is that when it presents, it could look like I’m having an RA flare. And then, you’re having an RA flare that’s not getting better with your current medications. And maybe your doctor is giving you steroids intermittently to treat the RA flare. It’s going to respond. But at some point, either you or your doctor says, this feels different because the RA pain is really not as intense and, like, you don’t walk into the office with your shoe in your hand. Yes, you’re uncomfortable. 

And there’s something about rheumatoid arthritis patients that I’m just going to give them kudos for. They are just the people, I think, I don’t know if it’s the — they have a very high pain — I don’t want to say high pain tolerance. I just want to say it is just that there’s a certain level of like Zen that they’re in, you know, that you almost have to prod from them. They’re like, “Oh, it’s fine. It’s fine.” I’m like, no, it’s not fine because I’m looking at this swollen joint right here, you know? And so, they are, I’ve noticed that, of all my patients, they just are not complainers. I want them to share. Share, let me know how it’s going, and sometimes actually have to go and look like, no, that is swollen. 

This would be different. I think the gout patients, the pain is just so intense that there is no hiding in that, right. So, I would say that the patients with rheumatoid arthritis will feel that the intensity of their pain will be different. The joint, the acute, you know, usually in the first, year or two with gout, it would be one joint or the other, right? It wouldn’t be multiple joints like people with rheumatoid arthritis have. And then, the what makes it difficult to diagnose is one, during the attack, the doctor may say, or the both of you may decide, hey, I’m going to check the uric acid level. So, uric acid level in the blood can be high in people with gout, but sometimes during the attack, it can be low. 

So, you almost have to come back after the attack is gone and then get a uric acid level that truly reflects the stable level of the uric acid. So, most people with gout are going to have a high uric acid in the blood, usually greater than six. And when they have the high uric acid level in the blood is usually an indicator for the doctor to look into it. But if the blood test is done during an attack, about 15% to 20% of people may have a low uric acid, and so it can be confusing to say, oh, your uric acid is fine, so it’s not gout, and then you move on, but should really be rechecked when things are quiet.

[00:25:30] Cheryl:
Yeah, that’s really, that’s really helpful to know. And I just found a page on the Arthritis Foundation, I’m going to put it in the show notes. They said there was a study in 2020 that had involved 2000 patients with RA and found that 17% of those also had gout. So, but they say in the article, it used to be thought that gout and RA were mutually exclusive. So, maybe you might run into a doctor that thinks that you can’t have gout if you have RA, but you certainly can. So, that’s good, that’s important information to know. 

Yeah, typically for me, my, flare ups are pretty symmetrical. Typically, it’s noticeably worse on the right side than the left, but if one side’s hurting, the other side’s hurting. And if I suddenly had, and it doesn’t feel like a stabbing pain, to me at least, it’s more like it’s, it can be just like, it’s like an ache, like a really, really sore ache, but not like someone stabbing me, like you said, like a hammer smashing my joints. I think that would be pretty noticeable. 

I never knew how bad crystals were. My husband had his first ever kidney stone. We actually went to Overlake ER and had a really, really good experience there. ‘Cause they were really quick to diagnose it. And yeah, he had no, we had no idea what it was other than he’s like sharp, stabbing pain in his back on one side. And I was like, okay, this is a kidney stone, just ’cause I heard of it, but it just sounds like it. Yeah. I’m like, ’cause it was a crystal thing too. I’m like, what are these crystals doing to us? 

[00:26:56] Dr Arinola:
No, they’re not. And they’re not — they’re very painful . 

[00:27:00] Cheryl:
Oh, yeah. He, it was such a role reversal. ‘Cause usually I’m the one that has pain historically and all of a sudden he was, I was the one in the comforting, you know — 

[00:27:10] Dr Arinola:
Oh, I hope he’s doing better. 

[00:27:12] Cheryl:
He did. Yeah. It was, that was another thing that was so shocking. It went from so bad to so fine once it passed, like, completely fine. It was surreal.

[00:27:20] Dr Arinola:
I’m glad. I’m glad you tell him to keep hydrated. 

[00:27:23] Cheryl:
Every morning. Yeah. No, I’m like water, water, water, water, water. 

[00:27:28] Dr Arinola:
And we tell people with gout to also keep hydrated, but yes.

[00:27:32] Cheryl:
I mean, when in doubt, drink more water. It’s one of the few simple things we can do that really helps all these conditions. And is there anything else you would like to share about gout before we move on to osteoporosis? 

[00:27:47] Dr Arinola:
You know, I, once the diagnosis of gout has been made, people may still have intermittent episode of attacks. Sometimes those attacks are happening because the uric acid in the blood is lowering. As the body’s uric acid level drops, for instance, let’s say somebody’s on, has changed their diet from drinking beer every day to not drinking any more beer, right? That’s a huge difference, for instance. And when one has lowered the — and so that process means that the body’s uric acid, the blood uric acid will start to drop. And during that time, uric acid crystals can be moving in, can be moving out of the joint because the blood uric acid is low and then all the concentrated uric acid in the joint is moving out, which is great. That’s what we want. 

But that process of uric acid moving either out of the joint, because you’ve been good, you’ve stopped drinking beer every day, or because — like when I worked at the VA, our Vets liked to go fish. And so, when they fish, they would get some shellfish. And so, they would wash it down with beer and Monday morning was gout clinic. So, if you’ve had a Vet Day at the lake fishing, or you’ve been good, you’ve been listening to your doctor, you’re not drinking any more beer, or you’re on allopurinol or something. Either way, you’ve altered the uric acid in the blood. So, either it went down because you were good, or it went up because you were not so good. Either way, it causes an influx or efflux of uric acid in or out of the joint. 

And it is the movement of uric acid in or out of a joint that actually precipitates the attack because that movement tells the white blood cells that something foreign is in that joint that doesn’t belong there. And that is what triggers the inferno. And that inferno is the white blood cell. That’s your body’s military coming to figure out what is going on. And so, the — so now that you understand that, oh, it’s the white cells that are there. And so, all the medications that are used to treat acute gout are usually just trying to get rid of the white cells there. The crystals are still there. We’re just trying to get rid of the white cells that are causing the inflammation. 

So, the tip is when you start to even begin to think that you’re having a gout attack, treat quickly. So, you could have, compare it to a tiny little kitchen fire where you’re just trying to put out the fire with a tiny little extinguisher, to now the whole building is on fire and now you need to call for reinforcement. So, you can treat it. I tell my patients, even when you start to even begin to think that perhaps this could be an attack in your toe, start taking the colchicine. I usually give my patients some prednisone to keep on hand. That’s the time to take those emergency medicines. If you have gout and you don’t have an emergency medicine, talk to your doctor, say, “Hey, can you give me some emergency medicines?” Your doctor will give you something. So, that Friday night when you can’t get hold of your doctor, you’re not left alone to suffer until Monday morning. So, I would say don’t wait to treat gout. Early intervention can help prevent it. Even though I said that it is not all because of what you eat, still taking those reasonable steps that we mentioned is important. 

And finally, one final, because I have a lot of tips about gout, but one final tip is that in general — and that’s something with rheumatoid arthritis patients too — the anti-inflammatory diet, the plant-based diet is still a better option, rather than trying to nitpick, I’m going to eat this, I’m not going to eat that. If you have a plant-based diet, even though they are purines from plants, your body can actually process purines from plants better than it can the purines from animal products. So, sometimes my patients say, “Oh, I had a meal yesterday and I think that’s what triggered my attack.” And I said, “What did you have?” He said, “It’s the asparagus!” I said, “What else was on that plate?” “Oh, a little bit of steak.” I’m like, yeah. Yeah. Mm-hmm. It’s not the asparagus, my dear. “Just too many asparaguses!” No. 

Yes, theoretically the asparagus can cause uric acid to be high theoretically, but in the body, our body like processes it like that. So, that actually does not cause it because we’re looking at what are the foods that will cause the uric acid to rise in your blood, not when you look at it under the microscope, and your body can process it so well that it doesn’t cost your uric acid levels to be high. But when we’re talking about the shellfish, the organ meats, and the delicious steak that you had. Yeah. That is, my patients love to blame the asparagus. Like, no, it’s not the asparagus. So, those are my tips. 

[00:32:31] Cheryl:
That’s amazing. That’s so funny. You’re like trying to be honest with the doctor, but you’re like, I’ll start with the good thing I did, and then I’ll tell you the confession. And I always, and I do tend to think of shellfish as kind of healthy or just fish in general. So, again, that word ‘healthy’ is like a loaded word, but yeah, in this case, it’s not going to be the best choice. Yeah. 

[00:32:52] Dr Arinola:
In this case, right. In this case. But otherwise, you’re right, because it has the good fats and those, yeah, and those are very helpful. And so, other than this situation where we’re just trying to watch for concentrated proteins, we try to avoid shellfish. But otherwise, yes, for other people, if that’s not — if you’re not trying to avoid high purines, then yes, for other conditions, then we really, you know, we love the Mediterranean diet, right. And so, and we love the fish. Even patients with gout should have fish. We just don’t want them indulging the shellfish part of it. 

[00:33:31] Cheryl:
Yeah, that’s so — it’s just another reminder of how individualized everything has to be, right. And like the other example, a lot of the dieticians I know uses, like, dairy. Some people are sensitive to dairy. It’s inflammatory for them. But if you’re not sensitive to dairy, then that can be a great source of protein and calcium. So, just, you got to know your body. But, oh, speaking of calcium and bones and everything, yes. Osteoporosis. This is another thing that I really am excited to talk to you about because I haven’t covered it a lot in the podcast yet. You know, what is osteoporosis, just to start off? 

[00:34:08] Dr Arinola:
So, osteoporosis is the condition where the bones are fragile. And so, it’s like a condition where your bones are slowly losing their strength. And the reason we care is that it’s silent. It’s one of those silent conditions. And you may not know until something snaps and you fracture a bone. And so, a lot of times, and so that’s a lot of times, you know, unlike other forms of like — unlike arthritis, for instance, you know, and you seek help. A lot of times people just get screened for something else and then they find out they have osteoporosis. 

And then, the question is, why should I treat something that’s not bothering me? Yet, yet is the operative term, right? It’s not bothering you yet. And so, basically it’s a condition where people with usually asymptomatic, zero symptoms, but those bones are fragile. And we’re concerned that, you know, once we make that diagnosis, we want to try to treat it or improve the situation as soon as possible, because we feel that it is a race against time.

[00:35:18] Cheryl:
Yeah, that’s so important. And how do you diagnose it? 

[00:35:24] Dr Arinola:
So, we have in our office a bone density scan. In places that they don’t have bone density scans, X-rays could potentially be helpful, but they are not the real, they’re not the way to test it. A lot of times somebody gets an X-ray and they say, your bones are looking thin on X-rays. Let’s confirm on a bone density test. So, this scan is basically like an exam bed is what it looks like, examination bed in your doctor’s office. And then, this scan goes over you. And right there within a few minutes, it spits up the analysis. And what it does is that it looks at the density in your spine. 

Usually it goes, looks at the density in the lumbar spine, and it looks at the density in the hips. And if, for instance, there’s maybe a person has had surgery in the spine and hips, then sometimes we look at the non-dominant forearm to try to figure out what the average bone density is. But we do not look at every single bone in the body. For instance, we perhaps do not care very much if the pinky gets broken, but we do care if there’s a compression fracture in the spine and if there’s a hip fracture. So, that’s why we typically check for those bones. 

[00:36:41] Cheryl:
Yeah, and I wish I had like taken more notes. But I got one done, you know, 5 or 10 years ago due to having rheumatoid arthritis and I remember they said, I don’t have any osteoporosis and they said that, that they thought my bones actually looked really strong. It was probably because I used to be a runner. I used to run a lot and I’ve also done a lot of swing dancing. And so, those, like, load bearing activities might’ve been what helped. But what, in general, what do people with rheumatoid arthritis or other inflammatory arthritis, these arthritic conditions, need to know about osteoporosis? Why is it important for us to be aware of it? 

[00:37:22] Dr Arinola:
It’s so important, right, because having an uncontrolled inflammation can cause the bone density to be low. It can almost leach out some calcium from the bones. Two, when you’re having joints that are inflamed and painful, perhaps you’re not running and walking as much. So, perhaps you’re more sedentary. And being active and weight bearing protects your bones. And being more sedentary makes you more prone to low bone density. So, right off the bat, just having the condition and just having symptoms from the condition can make you more prone to osteoporosis. 

But then, comes in your doctor with our handy dandy medications, prednisone being the most notorious of it. And prednisone can cause you to have osteoporosis. So, that’s one of the reasons why anytime you walk into your rheumatologist’s office, for instance, if they put you on prednisone, the next thought in their head is, how do I get you off the prednisone that I put you on? Because of things like osteoporosis.

 And some autoimmune diseases like lupus may even have a higher risk. And even something like ankylosing spondylitis may also have even a much higher risk of people having osteoporosis. So, people with autoimmune or inflammatory arthritis like rheumatoid arthritis, probably just like your doctor did, should get a baseline so that they even know where they are to begin with. And then, based on the baseline bone density can determine whether or not they need to have a follow up or how quickly that should happen. 

[00:39:06] Cheryl:
Yeah. That’s so helpful. Yeah. I don’t know if there’s guidelines on like how many, how often — I was just thinking to myself, maybe I should get one, like, every set number of years. Yeah. 

[00:39:16] Dr Arinola:
So, any woman over 50 should get a baseline bone density. And then, and there are so many organizations, I think there are 20 different organizations that have different ideas on what to do. But the baseline bottom line is that it’s not — and a lot of places, it may be based on the costs and some of those, some of those recommendations were based on when the bone density scan was very expensive. But now it’s an inexpensive test. So, now, I think it’s like $50, $75, unless you’re getting it in some kind of major facility where they charge a facility fee. Otherwise it’s a pretty relatively inexpensive test to do. 

Because especially because when we think about the repercussions of not getting it done, it’s much cheaper than getting a hip replacement done because one has fractured a bone. So I would say that getting a bone density scan now, should probably now just be at the age of 54 baseline, and then going forward, your doctor can determine, here you are at low risk. We can check you up 3, 4, 5 years. If you’re high risk, then we’re like, oh, we should be checking this every year,

[00:40:23] Cheryl:  
Yeah. And so, the big thing to know for people listening is that you want to know if you have osteoporosis, because you’re going to be much more likely to break a bone, right? 

[00:40:32] Dr Arinola:
Yes. You want to know because, you know, and maybe that mean itself can galvanize you into, hey, 30 minutes of walking every day, remembering to take your calcium and vitamin D, you know, doing strengthening, exercising. If you were smoking, that you stop smoking. One more reason not to smoke that kind of thing.

[00:40:50] Cheryl:
So, yeah, you anticipated my next question, which is like, what can we do to prevent it or reverse it? 

[00:40:58] Dr Arinola:
Yeah, 30 minutes of walking every day is what we recommend to our patients. But also, flexibility exercises. I try to explain to my patients that they, you know, so when we think of that older lady that walks out of the grocery store, all she has is maybe her little bag, one item that she purchased. The ground is unsteady. She falls. A bunch of teenagers came in. They’re listening to their music, they’re chit chatting, they’re pushing each other. They don’t fall. And part of it is that as we get older or more mature, we lose proprioception, right, which is a sense of where your joints are when you’re not looking at them. And so, one of the ways we can improve proprioception is to strengthen the muscles, ligaments, and tendons that surround a joint and muscles. So, if we do that, then our sense and stability improve, and so we’re less likely to fall. 

And if we’re less likely to fall, then it’s less likely that we even break that said fragile bone. So, part of it is, yes, we want to strengthen the bones, but we want to minimize the likelihood that we fall. And so, the strengthening exercises kind of keeps the muscles, tendons, and ligament taut. And as well, as you know, all the kinds of exercises, you know, some people do like Tai Chi exercises, you know, stretching, because we start to get stiff. So, I started doing yoga too, you know, yoga exercises too, because I found that, you know, I’m not as limber as I used to be, right? So, I started to do yoga exercises too, to just kind of keep things from getting too stiff. Because when it’s too stiff, again, you can’t really respond as quickly when, you know, your joints are kind of in a precarious position.

[00:39:06] Cheryl:
No, that’s, I’m so glad you mentioned all of that. And oops, sorry, just moved my head now that my camera’s adjusting. Proprioception is one of the things I was most fascinated by when I was in occupational therapy school. So, we talked about it when you learn about just sensory receptors in general. And I was like, because they were saying, this is just what I remember that, you know, you think about, we have these five senses; sight, sound, smell, taste, touch. 

And then, but there’s like these three hidden senses, like the proprioception, vestibular, which works with proprioception, your sense of balance, like in your inner ear, that’s vestibular. And then, proprioception, your body awareness sense. And then, and which is located, those sensors, those proprioceptive receptors, are in your muscles, tendons, ligaments. And it’s literally like you can think about drawing a line from, like, your joints to your brain. And it’s, like, have you ever seen those videos where it’s somebody that’s like, they’re doing a green screen video for, like, a movie, like a superhero movie, and the guy has all those little dots on his arm.

[00:43:58] Dr Arinola:
Oh, yes, yes, yes. Yeah. 

[00:44:00] Cheryl:
It’s almost like your brain’s mapping of where all your joints are as you move. And you can see when babies are born, they don’t have a good proprioception sense, and they’re, like, trying to reach something, and they’ll reach, like, over, under, and it’s just fascinating to watch it develop. So, I think I’m so glad you mentioned that, because when people get older and they fall or even if they’re they’re young, and they have inflammatory arthritis, and let’s say one — a lot of the people I talk with in my support group say, I drop things all the time. Why am I dropping things? It must because my hands are weak. 

And it could be true that you have lack of strength, but it’s possible, or maybe even more probable, that you’re lacking proprioception. Like, your brain isn’t remembering where your body is in space, and so you’re not — it has to do with not only, like, your aim when you’re aiming for something, like aiming to pick up that, you know, that pen or that cup that you’re about to drop, it’s also your awareness of how much pressure to put on the object. It’s really — anyway, but it’s so interesting. And you, of course, it would make sense that something that affects your joints or your ligaments and tendons is gonna affect. 

[00:45:09] Dr Arinola:
Affect that. Yes, exactly, yeah. 

[00:45:11] Cheryl:
So, you’re so right that strengthening is gonna help a lot.

[00:45:16] Dr Arinola:
Yes. Yeah, and thats, yeah, so yeah. A lot of people you know don’t, you know, and especially as women, you know, and then you’d be surprised, you know. Some women are like, “Well, I don’t want to bulk up.”

[00:39:06] Cheryl: 
Oh, really. Oh, no, I mean, I don’t, I can’t — I think people are annoyed to probably hear me talk about how much I — I didn’t start strength, how much strength training has helped me, like, I didn’t start a real strength training routine until about a year and a half ago. So, like September of 2023, and it has changed my life. Actually biggest benefit of strength training, this is just twice a week, going for personal training sessions for 50 minutes each. But my fatigue is so much better. And my brain fog, my ability to focus is noticeably better.

[00:45:59] Dr Arinola:
Definitely, definitely. And I tell people I’m like, but you know what? I was also one of those people that was, like, “I don’t know if I want to bulk up,” but yeah, we’re not going to, as women, and we do need that strength and actually helps your metabolism, right? And like you, what you’re noticing is that you’re just much clearer, right? You’re processing things better, you’re improving the blood flow. So, multiple, multiple benefits of strength training for women. But what I do recommend, because you know how some people are, my lovely patients are like, “Dr. Dada told me to walk, so I’m just going to go and I’m going to go lift!” No, we are going to pace ourselves, right? It is a marathon, not a sprint, right. We’re going to start with low weights, and then we’re going to gradually increase over time with guidance as tolerated. 

You know, if you already have osteoporosis, we actually do want to be careful. The last thing I need is you trying to do some kind of overhead stress, and then you now have a compression fracture, right? That will be the opposite of what we’re trying to achieve, right. So, I tell my patients, let’s start slow. It’s a marathon, not a sprint. And let’s gradually walk our way. Because even the small reps, I’m like, you don’t have to be trying to lift kind of Hulk Hogan kind of weights. Even the small reps makes a difference, because part of it is toning the ligaments and tendons. So, we’re not going for you trying to lift 300 pounds. We’re going for you just trying to do, start small reps and start to gradually walk your way, especially if you’re dealing with arthritis, especially if you have osteoporosis. 

And I love the idea of getting a trainer, getting some guidance, getting a physical therapist involved, just so that you don’t go and hurt yourself, because that sets you back so far, because we have some very enthusiastic, you know, weekend warriors, right? So, we’re like, let’s pace ourselves, knowing that we’re trying to walk our way gradually through this process so that we can get the quality of life we deserve. 

[00:48:02] Cheryl:
That’s so, so well said. Well, this is so great. We’re gonna have to do another session sometime, but for now, yeah, I gotta move on to the rapid-fire questions. So, what are some of your best words of wisdom for someone newly diagnosed, you know, with rheumatoid arthritis, let’s say?

[00:48:21] Dr Arinola:
You know, I like to tell on my patients — a lot of times when people come in, they’ve been busy on the Internet, and they’ve read the worst horror stories. They’ve kept themselves up at night for the last few weeks waiting till they were going to see me so that I could confirm their worst fears. And I’m going to say that understand that when you are reading things online, you’re reading extremes, right? You’re reading either kind of the best outcomes, or a lot of times it’s more the worst outcomes that you’re reading right? And so, creating that sense of anxiety, just put it on pause. I would rather — I enjoy people, you know, when we’ve had the conversations, they do the research, they come in, they talk to me about it, we walk through what makes sense and what doesn’t make sense. Know that I’m your partner through this, right? 

So, don’t try to minimize self-induced anxiety by reading things online that are just people statements. If you do need to, you know, because I can understand, “Hey, it’s going to take me a few weeks to go find that, Dr. Dada. What do I do while I’m waiting?” Then just go to the reliable sites, right? So, go to places like Arthritis Foundation. Go to places like Mayo Clinic, you know, come to Cheryl’s site, you know. Listen to, you know, I have a Healthy Joints Healthy Life show. Listen to people. We have patients that give testimonials on there that kind of talk to you in your own words. So, really having the patience to make sure that you’re not kind of being swept up in people’s lives that may not necessarily reflect the reality, and trying to make sure you align yourself with places that are more reliable will, in the end, minimize the stress that is put on you with this new diagnosis or new possible diagnosis. 

So, that’s what I would say. It’s not a word, but it’s more of kind of, you know, just make sure that you’re protecting yourself from unnecessary trauma by making sure, if you’re online looking for, especially before the diagnosis is made, just go to those reliable sites, knowing that you’re not going to get swayed with people who’ve had, like, extreme kind of results. So, “I took methotrexate. You know, I almost died from liver cirrhosis.” That’s not the experience of most people. So, just trying to make sure that people are aware of the places they should go to, and maybe a little more cognizant of the fact that not everybody online is going to have the same experience as you will have.

[00:51:05] Cheryl:
A hundred percent. I could not, could not agree more. Second one, do you have a favorite, like inspirational saying or something for tough days?

[00:51:17] Dr Arinola:
I, like, I think I kind of already said it when I said that it’s a marathon, not a sprint, right. We’re gonna pace ourselves. One of the books I read recently is Atomic Habits, and that is basically about trying to get 1% better every day. 

[00:51:36] Cheryl:
Yeah, I love that. 

[00:51:37] Dr Arinola:
And that is, that is, I think that is, that is something that I’m living by in different aspects of my life too, because we all want instant everything. I want this done now, but really just trying to do 1%. If I have less 1% less pain every day, doesn’t mean PT is not working, right. It just means that I have to kind of persevere through it and just make sure that we’re getting 1% better every day. I didn’t eat shellfish today, but I still had a gout attack. Well, we haven’t tried it for long enough.

[00:52:08] Cheryl:
Yeah, yeah. And do you have a favorite arthritis like gadget or tool in your toolbox? It’s okay if you don’t.

[00:52:18] Dr Arinola:
I think my favorite tool, honestly, is patient education.

[00:52:23] Cheryl:
Oh, speaking my language. Yeah.

[00:52:24] Dr Arinola:
Yes, yes. And that’s why I came on your show. That’s why I have my show. I want to empower patients so that they are empowered to have, to make the choices that are important for them so that they can get the best health outcomes possible. So, you and I want to be their guides. You know, they are the superhero in this story. They just need a guide to help them to get to where they have the best quality of life ever.

[00:52:56] Cheryl:
That’s such a perfect note to end on, and I’ll be including all the links to your, you know, your YouTube channel, and your site. But can you let them know again the name of your channel, just to make sure?

[00:53:09] Dr Arinola:
So, it’s Healthy Joints Healthy Life with Dr. Dada.  And then, podcast with the same name. But yes, thank you. And then, I think you can find my TEDx talk on gout, also by Dr. Dada.

[00:53:23] Cheryl:
Yay! Thank you so much for taking the time to chat today. I really learned a lot about gout and osteoporosis, and I just appreciate your dedication to patient education and patient empowerment so much, so.

[00:53:38] Dr Arinola:
I love your show. Thank you for the energy you bring. Just thank you for really, I fully admire you, give you full kudos because you’ve been doing this for much longer than most of us had even thought about, and you were inspiring me even back in the Creaky Joint days. So, really, just give you full kudos for sharing your journey, right, and also just being an inspiration to people. Because I was telling someone the other day was like, you can talk to the cows come home, but patients really identify with somebody else who’s worked in their shoes. They’re like, now you’re talking to me, right? So, having you out there as just an inspiration to patients and just encouraging them that, you know, this is a 1% improvement every day and that it can get better, and they’re seeing you living your life and just watching that is inspiring to a lot of patients. So, kudos to you, and thank you for all you do.

[00:54:32] Cheryl:
You’re so kind. Thank you so much. We’ll talk to you later. Bye-bye for now. 

[00:54:36] Dr Arinola:
Thank you so much. You take good care. Bye-bye. 

[00:54:38] Cheryl:
You too.

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