Osteoarthritis - When your knee starts hurting

You get 40 and suddenly your knee hurts , damn you were meant to windsurf, snow board, run marathons til your 60ies. Osteoarthritis is inflammation as a result of wear and tear affecting cartilage, bone , tendon’s and muscles making up the joint. Symptoms are pain, swelling and stiffness of the joint. If the swelling is red and hot see your doctor immediately, as this could be a sign of more severe and urgent forms of arthritis. Luckily Arthritis is a phasic illness and short bad swells are followed by long symptom free periods. Half the population over 65 has some arthritis but 1 in 10 in this age group might have severe enough arthritis to cause some disability. Factors affecting likelihood of arthritis apart from aging are genetic , gender (more likely in women), previous injuries , deformities of joints , occupational risks (knee in athletes, elbows in use of powerdrills…) Factors you can do things about, are obesity and lack of right regular exercise. Simple painkillers like paracetamol and anti-inflammatories like ibubrufen( nurofen) are still Ist line treatment , you only need to take them intermittently , as they help to relieve the acute pain and inflammation . You should definitely discuss any long term medications with your doctor, especially if you have other medical problems or take medication ( High blood pressure , diabetes, stomach ulcers…) Topical preparations like anti inflammation creams or capsicaine work , are weaker than oral medicines but have lower side effects. We have so far not got medical treatment that changes disease progress. Don’t decide on a surgical intervention during time of acute flare up. If you worry about taking medicine remember that during anaesthetic for a knee replacement and the following wardstay you propably would take 100 times the doses of simple painkillers .Cortisone injections have a definite role during flare ups and up to 3monthly injections can be given if needed, which might safe you on side effects and cost, to the boxes of panadol and brufen you would otherwise need to swallow. Lubricant injections are offered by some, are very expensive (500$ the injection alone) and have only been around short time to judge their effectiveness and safety. A good physiotherapist can do loads for you, hydrotheraphy, taping, topical treatments, TENS machines, advice on right exercise (for instance Quadriceps for knee arthritis), fitting of and much more. Bracing particularly if fitted by orthotists can be worthwhile, modern braces are lightweight and are very supportive. Omega 3 fatty acids ( fishoil)may have a natural anti-inflammatory effect, Glucoseamine is more controversial but very popular. Magnets , Bracelets have no evidence. Between flare ups of arthritis it is time to focus on weight loss and low impact exercises, the only 2 interventions which have been shown to make a long term difference in flare ups and severity of arthritis. Nearly everyone is able to do lane walking in the pool, or cycling for knee arthritis per example.

Helko Schenk
Geraldton Medical Group 30 5 2010

Sources:
- Patient.co.uk
- “Aything but a knee replacement!” DR David Colvin, Medicine Today 5/2010