Arthritis knees

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

Arthritis involving the knees is one of the most common problems encountered by a rheumatologist in office practice...

Arthritis of the knees is most often due to osteoarthritis. In this disease, the cartilage in the joint gradually wears away. In rheumatoid arthritis, as well as with other types of inflammatory arthritis, which can also affect the knees, the joint becomes inflamed and cartilage may be destroyed. With inflammatory forms of arthritis, arthritis not only affects joints; it can also affect supporting structures such as muscles, tendons, and ligaments.

Osteoarthritis may be caused by excess stress on the joint from deformity, injury, or obesity. While it most often is associated with "getting older", it is felt that osteoarthritis may develop at a much younger age.

Regardless of type of arthritis, it is not uncommon for both knees to be affected. One is usually more symptomatic than the other.

As mentioned above, other types of inflammmatory arthritis such as psoriatic arthritis, Reiter’s disease, ankylosing spondylitis, gout, pseudogout, and Lyme disease may affect the knees.

Arthritis in the knees presents with stiffness, pain, occasionally locking or clicking, and sometimes joint swelling.

Diagnostically, laboratory tests tests may be useful for diagnosis. Analyzing fluid from the knee joint may be helpful in diagnosing some kinds of arthritis. Imaging techniques such as magnetic resonance imaging can offer insight. X-rays are useful for demonstrating extent of damage but are not useful, for early diagnosis.

Most often osteoarthritis of the knee is treated with non-steroidal anti-inflammatory medicines given either orally or topically.

Local measures such as ice packs alsoi help relieve pain and reduce inflammation.

Exercises to restore joint movement and strengthen the knee (quadriceps and hamstrings) are usually indicated. Losing excess weight can also help people with osteoarthritis. This is because of the mechanical load as well as the fact that fat cells produce leptins, cytokines that aggravate inflammation.

"End-stage" arthritis with total loss of cartilage will require knee replacement surgery.

On a brighter note, stem cells are being used now and the combination of autologous stem cells (stem cells obtained from the patient's own hip using a small needle) and platelet rich plasma (obtained from the patin's whole blood) has been demonstrated to rebuild cartilage. The growth factors in the platelet rich plasma help stimulate the stem cells to differentiate into cartilage cells. This is a minimally invasive procedure done entirely with local anesthetic. For more information on this technique, contact the Arthritis Treatment Center at (301) 694-5800.

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Extensive injuries and diseases of the knees are usually treated by an orthopaedic surgeon, a doctor who has been trained in the nonsurgical and surgical treatment of bones, joints, and soft tissues such as ligaments, tendons, and muscles. Patients seeking nonsurgical treatment of arthritis of the knee may also consult a rheumatologist (a doctor specializing in the diagnosis and treatment of arthritis and related disorders).

Some knee problems, such as those resulting from an accident, can't be foreseen or prevented. However, a person can prevent many knee problems by following these suggestions:

• Before exercising or participating in sports, warm up by walking or riding a stationary bicycle, then do stretches. Stretching the muscles in the front of the thigh (quadriceps) and back of the thigh (hamstrings) reduces tension on the tendons and relieves pressure on the knee during activity.
• Strengthen the leg muscles by doing specific exercises (for example, by walking up stairs or hills, or by riding a stationary bicycle). A supervised workout with weights is another way to strengthen the leg muscles that support the knee.
• Avoid sudden changes in the intensity of exercise. Increase the force or duration of activity gradually.
• Wear shoes that both fit properly and are in good condition to help maintain balance and leg alignment when walking or running. Knee problems can be caused by flat feet or overpronated feet (feet that roll inward). People can often reduce some of these problems by wearing special shoe inserts (orthotics). Maintain a healthy weight to reduce stress on the knee. Obesity increases the risk of degenerative (wearing) conditions such as osteoarthritis of the knee.

Three types of exercise are best for people with arthritis:

• Range-of-motion exercises help maintain normal joint movement and relieve stiffness. This type of exercise helps maintain or increase flexibility.
• Strengthening exercises help keep or increase muscle strength. Strong muscles help support and protect joints affected by arthritis.
• Aerobic or endurance exercises improve function of the heart and circulation and help control weight. Weight control can be important to people who have arthritis because extra weight puts pressure on many joints. Some studies show that aerobic exercise can reduce inflammation in some joints.

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