The Curbsiders Internal Medicine Podcast #493: Joint Pain in Older Adults with Dr. Una Makris
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Jul 28, 2025 Dr. Una Makris, a Professor of Medicine at UT Southwestern, discusses effective strategies for managing joint pain in older adults. She emphasizes an age-friendly approach, focusing on diagnosing and treating osteoarthritis and rheumatoid arthritis. The conversation includes insights into non-pharmacological interventions and the importance of lifestyle changes. Dr. Makris highlights the need for comprehensive assessments to combat ageism and improve treatment outcomes, advocating for personalized care and timely referrals for joint replacements.
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Clinical Diagnosis Over Imaging
- Osteoarthritis diagnosis is primarily clinical; rely on history and physical exam rather than imaging.
- Image only if there's concern for alternate diagnosis, progression, or prior to referral for surgery.
Start OA with Education and Movement
- Begin osteoarthritis treatment with education, weight management, and tailored physical activity.
- Encourage accessible exercise options like walking or aquatic therapy based on patient's safety and preferences.
Use Topicals and Braces Wisely
- Recommend topical diclofenac for OA due to limited systemic absorption, especially in patients with CKD or on anticoagulants.
- Consider knee braces if patients feel instability; physical therapy can aid in proper brace selection.