I know we’re gonna talk about knee arthritis but where do we see a lot of your patients or where do you see where arthritis is most painful elbow I would say the most common presenting joints in our in our clinic are knees hips and shoulders correct yes but this kind of affect any joint in the body any joint in the body can be affected all right we have a 3d image of I believe the knee and this is a serious knee arthritis why don’t we take that real quick and doctor tell us what we’re seeing here and who that looks painful what we’re seeing here is a knee joint so the area that you have where the joints where the bones meet that’s actually where the cartilage is and let me see if I can edit the image here a little bit to show you where you would see some of that where enterin is exactly in this area right here where I’m drawing that arrow where you start to see some cartilage breakdown so the cartilage breaks down you start seeing the bone under it get exposed and and that’s what triggers or what is believed to trigger that inflammatory response and changes the environment inside the joint it’s important to remember this joint is also covered by a capsule and that capsule contains or retains that they joint fluid or what we call the synovial fluid so inflammatory markers in that synovial fluid are usually altered or increased in you know for some of them as well when you have arthritis so it’s not just about wear and tear it’s also about an inflammatory environment inside action you