The Joint Effort Podcast

From Stiff Mornings To Strong Steps: Understanding Early Arthritis

• Dr. Noelle DiGioia Guthrie & Tiffany Belculfine, PA • Episode 3

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What Does Early Arthritis Feel Like—And Why Does It Matter?

Your knees shouldn’t sound like snack time, and that stiff first step out of bed isn’t “just getting older.” We unpack the clear signs of early osteoarthritis, how a simple x-ray reveals what’s changing inside your joints, and why the choices you make now can slow progression and keep you moving with less pain. With orthopedic surgeon Dr. Noelle DiGioia Guthrie and physician assistant Tiffany Belculfine, we trace the path from subtle twinges to “bone on bone,” separating osteoarthritis from autoimmune forms like rheumatoid and psoriatic arthritis.

We start with the real-life clues: predictable pain after load, morning stiffness that eases with motion, swelling after runs or long days, and the crackle that makes you hesitate on stairs. Then we map the diagnostic basics—what joint space narrowing means, why knees often speak first under four to five times your body weight, and how hip and spine arthritis shape posture and daily function. From there, we offer a practical toolkit: NSAIDs and acetaminophen for flares, topical diclofenac gel, ice, activity tweaks, and targeted strength work for quads and hips to reduce joint stress.

When simple steps aren’t enough, we explain office-based options in plain language. Steroid shots for short-term relief, viscosupplementation for lubrication in the right candidates, PRP to modulate inflammation, and cryoneurolysis that cools specific knee nerves to cut pain. Finally, we set clear expectations around timing a knee or hip replacement—what signals “end-stage,” how to weigh pain, function, and imaging, and why the best surgery is the one you need no sooner and no later than necessary.

If your joints are talking, this conversation helps you listen—and act. Subscribe, share this episode with a friend who’s avoiding stairs, and leave a review telling us the one activity you want to get back without pain.

To learn more about The Bone and Joint Center at Magee-Womens Hospital visit: https://www.pghbjc.com
Dr. Noelle DiGioia Guthrie
300 Halket St.
Pittsburgh, PA, 15213
412-683-7272

To learn more about The Wellness Center for Bone and Joint Health visit: https://www.boneandjointhealth.org
Tiffany Belculfine
300 Halket St., Suite 1601
Pittsburgh, PA, 15213
412-641-8594

SPEAKER_00:

Welcome to the Joint Effort Podcast, where mobility meets reality and your future self says thank you. Your hosts, Dr. Noel DeJoya Guthrie of the Bone and Joint Center at McGee Women's Hospital, and Tiffany Belkafai, Physician Assistant at the Wellness Center for Bone and Joint Health, serving adults across western Pennsylvania. If your knees sound like bubble wrap, your hips argue with putting on socks, or your side-eyeing stares, you're in the right place. From arthritis and osteoporosis to everyday aches, they'll break it down and build you back up with a personalized plan for real life. The show is informational and not a substitute for talking to the clinician. Now, let's get you moving. Here are Dr. Noelle and Tiffany.

SPEAKER_02:

It's not just getting older. Early arthritis has a voice, and listening to it can change your future. Welcome everyone, Julie Schwenzer, co-host and producer in the studio with Tiffany Belcofine, Physician Assistant at the Wellness Center for Bone and Joint Health, and Dr. Noelle DeJoya Guthrie of the Bone and Joint Center at McGee Women's Hospital. So, Tiffany and Dr. Noel, it's great again to be with you. Thanks for your time. Thank you for having us. So let's get into it. We'll start with Dr. Noel. What does early arthritis feel like and why does it matter?

SPEAKER_03:

Yeah, very good question. Maybe let's take a step back first and maybe just define osteoarthritis because I think that's important. I know we've discussed osteoporosis and osteopenia in our previous episode, but um same family of diseases, but a little bit different. So osteoarthritis is basically the wear and tear of your joints. Um it can be your hips, your knees, your back, your spine, your shoulders, hands. Um, but just over time, as as we use our joints more, um, we get older, there's more repetition in the load that we wear in our joints, your cartilage, which coats the end of your bones essentially, particularly like talk about your knees and your hips on your femur, your cup side, and then your tibia, it starts to wear down. Um, and this just happens, it happens to everybody as we get older and as you are more active, as you grow older in your life. Um, some people it happens um more quickly, some people it's more common in as that happens. And I think an important um thing to point out is it is a progression. So, you know, the good question from you is what are some early uh symptoms or stages of arthritis? And um I think early, early stage of arthritis, things that you might feel. Um, you could be, you know, you're a runner, you run five miles a day, and by mile three, you kind of feel a tweak in your knee. Maybe you go home after that, you're feeling a little more swollen, a little more sore, particularly when you're bearing weight. Um, that's important. Um, say you go to sleep that night and you get up in the morning and you're like, oh my gosh, I'm really stiff and I'm sore. That could be kind of, you know, signs that should signify in your head, oh, maybe, you know, maybe something's going on. Maybe I just tweaked it on my run that was a little bit longer than normal. Um, maybe there's something underlying going on. Um, I think it's at that point, it's important for people to, you know, I think there is a a uh role for just, you know, icing it, taking anti-inflammatory medications, seeing if it goes away. But say it lasts for like a few months and you're concerned about what's going on. I think that's a perfect point to come to your local orthopedist, go to your primary care doctor. And the first step that we would do is to get an x-ray. Um, really easy to do, uh, get x-rays of your knees, hips, shoulders, spine. Um, and x-rays are our the best way that we can see the progression of arthritis. Um, so you can't necessarily see cartilage, um, meniscus or ACL, PCL on X-ray, but you can see the bones. And if the bones are looking to be closer together, that could be, you know, that you're having early stages of arthritis. Um so that that's what I would tell people that have symptoms like that that last a little bit longer, um, maybe in your like 50s or so. That's kind of the range where people start to to notice things, can be earlier, can be later, but that's kind of the median of when people start to notice things like that.

SPEAKER_02:

Are there different types of early arthritis? Like, are there like how much can is it a different body area? Like how do you think that?

SPEAKER_03:

Yeah, so good question. There's different types of arthritis. So there's osteoarthritis, which is what we're talking about, kind of just the mechanical wear and tear of your cartilage. There is also rheumatoid arthritis, psoriatic arthritis, different types of arthritis that are more immune modulated. So they're they're modulated by your um inflammatory, not inflammatory, I'm sorry, um, your autoimmune reaction in your body. Um kind of a di so we do treat those, but um, and those can lead to the point where you would need a knee or a hip replacement, but different um progression and and reason for having it. Um, I wouldn't say there's a difference between um early osteoarthritis. Well, there is a difference between early osteoarthritis and end stage osteoarthritis, meaning that your cartilage basically is gone when you're at your end stage arthritis. But when you're on the earlier stages, you still have some preserved.

SPEAKER_02:

And are there specific joints that tend to signal arthritis first that you've seen in your patients?

SPEAKER_03:

Yeah, I think the load-bearing joints of a patient's body tend to um wear out quicker and earlier. So, meaning your knees, so your knees actually sustain four to five times your body weight. Um, so you know, using in just they sustain a lot of force, hips as well, um, not as much as the knees, but that's also a load-bearing joint. Um, you can see arthritis in your spine too. Obviously, think about your spine, that's what holds your body up every single day of your life. Um, but you can also see arthritis less commonly, shoulders, elbows, wrists, hands, feet, um, but a little less common than your big joints, like knee, hip, shoulder, I'd say, and spine.

SPEAKER_02:

Let's see, what other like doctors or nurse practitioners in other fields, who most likely is to refer their patients to you because they're complaining of certain symptoms?

SPEAKER_03:

I think primary care doctors are, you know, definitely the the uh forefront of seeing patients who just have joint complaints. Um, and and it's totally a great reason for them to get x-rays and then to see what those results are and send them to an orthopedis. Um, that's usually probably I'd say the the first um person who sees them is your primary care doctor.

SPEAKER_01:

Um there's a lot of patients who, you know, come to an orthopedis because they know how they have arthritis or whatnot, but and sometimes people may not call it arthritis, they might call it something like bone on bone, isn't that right? Yeah, yeah, yeah. So we like people to know that that's the same thing.

SPEAKER_03:

Yeah. It's more of a colloquial term, you know, when people get their x-rays and shows that their bones are touching, you know, that they call bone on bone. And I think that's that's kind of synonymous with end stage arthritis, meaning that you really have no cartilage left on the ends of your bones that can um make your joints supple.

SPEAKER_02:

Yeah, that sounds painful. Yeah. Um, so what do patients do if they suspect they have early arthritis um but they haven't been diagnosed? Do they need to go to their GP first? Can they come to you guys?

SPEAKER_03:

Yeah, I mean, I think going to your primary care doctor, like we said, is a very reasonable first step. They usually get x-rays, and then usually they're really good about referring to an orthopedis. Even if you have early um degenerative changes, that's a very good reason to come to an orthopedic surgeon. Um, we do a lot of um preventative measures as well as treating um arthritis conservatively, particularly in the early stages, that can help um prevent the progression and also modulate your pain. Because that's pain is really what drives a lot of these, a lot of um people with osteoarthritis symptoms. You know, you're having pain from your cartilage wearing out. So there's a lot of things that we can do if we know that you have it, that we can do to help modulate your pain and prevent the progression. Conservative means there's, you know, we kind of start very easy things, oral anti-inflammatory medications, advil, there's a medication called maloxicam that we use a lot, tylenol. Um, those are kind of the first for there's a lot of topical gels, Volterin gel, things like that, ice rest, activity modifications. That's kind of the first line of things that we do. Um, secondarily, we can do injections. So we can do steroid injections. There's visco supplementation injections, commonly known as euflexor or Synvisc, are the brand names. Um we've been doing uh PRP injections, which stands for protein-rich plasma. Um that's a type of injection too. And then next line, uh there's also another procedure that uses cold therapy to kind of numb some of the nerves in your knee to prevent pain. Um, so those are the more conservative means. And then, you know, say someone fails all those means, but also has arthritis that's bone on bone, like we talked about, the kind of end-all be all that we have right now is a total knee replacement or a total hip replacement, so surgical interventions.

SPEAKER_02:

Sure. And then can these treatments all be done um at the regular uh center at the McGee's Woman Hospital or at the wellness center?

SPEAKER_03:

Yeah, yeah, no, good question. I mean, so some primary care doctors do injections, some the some of them will do steroid injections, which is great. Rheumatologists do injections as well. But we so at the bone and joint center where I practice, um, it would be our office do injections, you know, consults for osteoarthritis, um, and also do the eye of air procedure, which is the the using cold to numb the nerves procedure. That's the name of it. Um that would be at our practice, which is the bone and joint center, but the wellness center doesn't do those, you know, inner interventional things, but they would refer patients to us if that was the case.

SPEAKER_02:

And I'd love to throw in a question too for Tiffany. I had a question. What are some of the most common complaints you hear from patients? Like what's the most common thing they come in for finally? Okay, I need to do something about this because the pain's too much in one area, or you know, they're having trouble sitting down, standing up, picking up things.

SPEAKER_01:

Really, any of those. Um, people notice lots of things that are different in their day-to-day life. They used to be able to get up out of the chair, and then all of a sudden it's much harder for them to do so. So then when it's much harder for them to do that, they're more likely to sit still longer. And then when they need to get up, they get stuck in this vicious cycle of, well, it really hurts when I move, but I also can't move, and now I need to move, and it's really hard. So people just lose some of their mobility. They find it harder to go up and down the stairs, they find they need to hold on to things for better balance. Um, they might hear, you know, creaking noises or snap, crackle, pop rice crispy noises, and that worries them. Um, you know, in in some regards, not knee and hip, but other joints, you know, maybe they can't open a jar anymore. They can't hold things. So they they really start to notice changes in their everyday life.

SPEAKER_02:

Okay, well, I want to thank you both because this was really helpful. And like, you know, you guys said in the last podcast, it's in the in the initial podcast, too, is that we don't hear enough about this, and you guys are generating a lot of awareness, and hopefully this can prevent you know, a lot of people from having issues and having to do something extreme later on for their health because their quality of life is so impacted. So we appreciate you. We're glad to be here. Yes, yeah. Thank you. Okay, thank you, thank you, Tiffany. Thank you, Dr. Noel. Really helpful info today, and we'll catch you next time on the Joint Effort Podcast.

SPEAKER_00:

That's today's dose of strength, balance, and better movement from the Joint Effort Podcast. Ready for care that fits your life and gets you moving? To schedule an appointment with Dr. Noel for your surgical and injection needs, call 412-683-7272. Or visit pghbjc.com. Or if you are looking for lifestyle changes that are non-surgical, contact Tiffany Belkefine. Call 412-641-8594 or visit boneandjointhealth.org. Healthy bones and happy joints make every day better. Until next time, keep moving, stay steady, and take care of yourself.