Arthritis treatment for 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 knee pain can be treated with a variety of measures.

The key to proper treatment is to make a correct diagnosis. There are more than 100 different types of arthritis and almost all of them can affect the knee.

The most common type of arthritis that causes arthritis knee pain is osteoarthritis.

It is the most common form of arthritis and affects. It affects between 20 and 30 million Americans. Osteoarthritis is a condition that adversely affects hyaline articular cartilage, the tough gristle that caps the ends of long bones.

Hyaline cartilage is made up of a matrix consisting of a combination of proteoglycans (complexes of proteins and sugars) and chondrocytes. Chondrocytes are located within the matrix… picture a gelatin mold with grapes. The gelatin is the matrix and the grapes are the chondrocytes. Chondrocytes are cartilage cells that manufacture matrix under normal healthy circumstances. They are responsible for nourishing the matrix as well.

However, when OA develops, a distinct change in the joint environment occurs. Chondrocytes begin to elaborate destructive enzymes causing cracks in the cartilage. These are called “fibrillations.”

One of the most common joints affected by osteoarthritis is the knee. This is not a surprise since OA preferentially attacks weight-bearing joints.

The treatment of OA of the knee is primarily symptomatic. Weight loss, exercise, physical therapy, assistive devices (such as canes, braces, and walkers), analgesics (pain-relieving medicines), non-steroidal anti-inflammatory drugs (NSAIDS) which also reduce inflammation and pain, as well as thermal modalities such as heat and ice can all be employed.

Weight loss is important from two perspectives. The first is the mechanical one. Weight-bearing joints "see" five extra pounds of load for every extra pound a patient carries around. The second is that recent research has shown that adipocytes- fat cells- manufacture pro-inflammatory cytokines, proteins that aggravate inflammation.

Recent clinical trials with an anti-nerve growth factor look very promising for reducing the pain of knee osteoarthritis. These trials were temporarily halted by the FDA because of "joint failure" in some patients. This may have resulted because the drug worked too well!

However, once those resources are exhausted and the patient has undergone injections with glucocorticoids (“cortisone”) and viscosupplements (hyaluronic acid…” rooster comb shots”), there is a large void that is present because until recently the only remaining option was knee replacement surgery.

Despite the improvement in technology, knee replacement surgery is still surgery with all the attendant risks of a major invasive procedure in a hospital setting. And the specter of having to have a revision procedure (a replacement of the replacement) done maybe three times in one’s lifetime is an unhappy picture.

Recent work using autologous stem cells, sometimes referred to as mesenchymal stem cells looks very promising. (Wei N, Beard S, Delauter S, Bitner C, Gillis R, Rau L, Miller C, Clark T. Guided Mesenchymal Stem Cell Layering Technique for Treatment of Osteoarthritis of the Knee. J Applied Res. 2011; 11: 44-48).

For more information, go to: Stem Cells Arthritis Treatment A website devoted to the new technology of using stem cells to potentially help in arthritis treatment.

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