This issue in Questions & Answers we interviewed rheumatologists Anne Regier, M.D., and Perri Ginder, M.D., who recently joined the staff of Rockhill Orthopaedics. Doctors Ginder and Regier will help assist patients with arthritis-related back pain.

How is rheumatologist different from other specialist?
REGIER: We are trained in the diagnosis and management of connective tissue problems. In other words, we are concerned with pain in muscles, joints, ligaments, and tendons. We see lots of patients who complain of low back pain, for example, which is often due to arthritis. There are, of course, quite a few different types of arthritis from degenerative, which is fairly common, to less recognized forms.

Can in injury to a worker cause arthritis in the back?
GINDER: Probably not, though physical trauma can sometimes trigger a flare-up of underlying arthritis, which the worker might have not known he or she had before the injury. So it can seem like the injury brought it on, when it didn't.

If injuries rarely cause arthritis of the back, how are you involved in the treatment of injured workers?
REGIER: Several ways. First, injured workers' test or x-rays might reveal arthritis and we're asked to diagnose what kind it is and prescribe treatment. Another way is, injured workers might not be responding to conventional therapy and their doctors will notice increased joint swelling or more systemic symptoms and ask us to check it out. So, we can assist in getting people back to work sooner by treating arthritis conditions that are preventing their full recovery.
GINDER: We also become involved if it's necessary to know if a back problem is a result of the work injury or whether it was a pre-existing condition. It can be very difficult to tell. However, if identified on x-ray, arthritis is almost always a pre-existing condition, especially in the back.

When you diagnose arthritis in the back, what treatment do you prescribe?
REGIER: Most people will respond very well to physical therapy, nonsterodial prescriptions, physical conditioning, and weight loss, or a combination of these. They can also learn to cope with what they can't change.

Can people avoid getting arthritis?
GINDER: Usually not, because there's a strong genetic component. In elderly populations, majority of people- up to 80 percent-will have some form of ostearthritis, from mild to severe.
REGIER: But even though you probably can't prevent getting arthritis, you can optimize your chances of coping well with it by following an overall conditioning programs and maintaining your ideal body weight.

Are any new methods of diagnosis or treatment for arthritis on the horizon?
GINDER: New nonsteroidal drugs are coming out all the time. There's a helpful drug for almost everyone with arthritis, though it may take a period of trail and error to find the right medication for a patient.
REGIER: Ongoing genetic research may eventually be able to predict who will get arthritis. That knowledge would be wonderful because it would allow the person to prepare and to do those things that we know can minimize the symptoms.