Arthritis knee pain treatment
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
The most common type of arthritis is osteoarthritis (OA). This article discusses the diagnosis and management of this common problem.
Osteoarthritis (OA) of the knee is one of the most common causes of knee pain in people past the age of 30. It is now suspected that OA of the knee begins much earlier, perhaps as early as the teen years, in some instances. The cause is progressive wearing away of the cartilage cushion that covers the ends of the long bones that make up the knee joint. The inflammation that accompanies this process leads to swelling and pain.
Major risk factors for OA of the knee include family history of osteoarthritis, trauma, and obesity. Initially the discomfort is described as stiffness in the knees with inactivity. Shortly, daily activities such as going up and down stairs as well as getting into and out of a car may be difficult.
OA of the knee can cause locking, clicking, and a “give-way” sensation in the knee.
Pain at night is also a symptom of OA.
The diagnosis is established by careful history and physical examination. Physical findings include tenderness along the joint line, malalignment of the knee (either bow-legs or knock knees), and the presence of joint swelling due to either inflammation of the capsule or the presence of an effusion (fluid). The hip should also be examined because hip arthritis can cause referred knee pain.
Laboratory blood tests will often be ordered to rule out other causes of arthritis. In addition, the physician will often draw fluid from the knee to analyze it.
While x-rays may be ordered to determine the extent of cartilage wear, they may be normal early on in OA. Magnetic resonance imaging (MRI) is a much more sensitive method for detecting OA of the knee.
Treatment of OA of the knee depends on the extent of symptoms. For mild pain, analgesics such as acetaminophen (Tylenol) may be sufficient. Stronger analgesics such as tramadol (Ultram) or Vicodin may be more effective.
However, for those people who do not respond to acetaminophen or tramadol, the next option are non-steroidal anti-inflammatory drugs (NSAIDS). A note of caution: all NSAIDS have been associated with a slight increase in risk for cardiovascular events (heart attack and stroke). They should be used with caution in patients who have a history of underlying heart disease. They should be used with great caution in patients who have a history of gastrointestinal ulcers or significant liver and kidney disease.
Patients should be started on ice (ice packs) applied to the knee for 20 minutes twice a day. They should also start quadriceps setting (thigh muscle strengthening) exercises. These are exercises designed to strengthen the quadriceps muscles. The stronger these muscles are, the less pain a patient will experience.
Dietary supplements such as good quality forms of glucosamine and chondroitin may be helpful.
Injections of glucocorticoids (steroids) into the knee can be quite useful for symptomatic patients. Another type of injection- hyaluronic acid (Hyalgan, Supartz, Euflexxa, Orthovisc, Synvisc) may be indicated. Hyaluronic acid mimics the effects of the normal synovial fluid produced by the healthy knee. These injections reduce pain, provide lubrication, and may slow down the rate of cartilage deterioration.
Inserts in shoes (wedges) may help with knee alignment issues and therefore can lead to pain relief.
Weight loss for patients who are obese is important. Low impact aerobic exercise (swimming, a stationary cycle, walking) accompanied by thigh strengthening and stretching are also effective for reducing pain. Weight aggravates knee pain through two mechanisms. The first is the mechanical stress; the second is that adipocytes (fat cells) secrete pro-inflammatory cytokines, proteins that aggravate inflammation.
Braces and sleeves worn over the knee can also reduce pain that occurs with weight-bearing. Special types of braces that “unload” the part of the knee that is narrowed from arthritis can relieve symptoms in many patients.
Arthroscopy, which is a procedure where a small telescope is inserted into the knee and used to remove damaged or diseased tissue, is another potential option.
Autologous stem cells appear to show promise in relieving pain and restoring articular cartilage. At our center we have had excellent results using a guided mesenchymal layering technique.
Finally, patients who have pain that is associated with severe loss of cartilage from the knee may be candidates for knee replacement.
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