Knee arthritis 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
Osteoarthritis is the most common type of knee arthritis.
Also called wear-and-tear arthritis or degenerative joint disease, osteoarthritis is characterized by progressive wearing away of the cartilage of the joint. As the cartilage is worn away by knee arthritis, bone is exposed.
Knee arthritis typically affects patients past the age of 50 years but it can occur as early as the teens. It is more common in patients who are overweight, and weight loss tends to reduce the symptoms associated with knee arthritis. There is also a genetic predisposition of this condition, meaning knee arthritis tends to run in families. Other factors that can contribute to developing knee arthritis include trauma to the knee, meniscus tears or ligament damage, and fractures to the bone around the joint.
Knee arthritis symptoms tend to progress as the condition worsens.
The most common symptoms of knee arthritis are:
• Pain with activities
• Limited range of motion
• Stiffness of the knee
• Swelling of the joint
• Tenderness along the joint
• A feeling the joint may "give out"
• Deformity of the joint (knock-knees or bow-legs)
Probably one of the most important, yet least commonly performed treatments is weight loss. The less weight the joint has to carry, the less painful activities will be.
Use of a cane or a single crutch is the hand opposite the affected knee will help decrease the demand placed on the arthritic joint.
Stretching is vital to maintain good range of motion around a joint.
Strengthening exercises are performed to help the patient improve the function of their muscles. The goal is to improve strength, increase endurance, and maintain or improve range of motion. Common types of strength training include:
Ice and heat are useful to warm up and cool off muscles. In addition, these modalities can stimulate blood flow and decrease swelling. These can be important aspects of the therapeutic process.
Non-steroidal anti-inflammatory pain medications (NSAIDs) are some of the most commonly prescribed medications, especially for patients with orthopedic problems such as arthritis, bursitis, and tendinitis. These medications are available over-the-counter (e.g. Ibuprofen, Motrin, Aleve) or as a prescription (e.g. Celebrex). NSAIDs are effective at pain relief (analgesia), and to reduce swelling (anti-inflammatory).
Medications that work to reduce inflammation come in two major categories: Steroids (e.g. cortisone), and non-steroidal anti-inflammatory medications (NSAIDs). Steroid drugs are a derivative of a natural hormone produced by the body. These medications can be given orally, systemically, or as a localized injections.
NSAIDs work to block the effect of an enzyme called cyclooxygenase. This enzyme is critical for production of prostaglandins. It is prostaglandins that cause swelling and pain in a condition such as arthritis or bursitis. Therefore by interfering with cyclooxygenase, there is a decrease in the production of prostaglandins, and also a decrease in pain and swelling.
Prostaglandins also have other important functions in the body. One type of prostaglandin (there are many varities) helps line the stomach with a protective fluid (called gastric mucosa). NSAIDS have the potential to cause stomach ulcers and kidney damage and therefore should be used cautiously. COX-2 drugs may be safer for the stomach. All NSAIDS including Cox-2 drugs elevate the risk of cardiovascular events such as heart attack and stroke.
NSAIDs should NOT be used if:
You are pregnant
You are breastfeeding
You have a history of stomach ulcers
You are taking blood thinning medication
NSAIDs should be used only under CLOSE physician supervision if:
You have asthma
You have liver problems
You have heart problems
You have kidney problems
As mentioned eralier, all NSAIDS, regardless of class, are associated with a slight but definite increase in cardiovascular events.
Cortisone treats the inflammation.
The shot should be administered using ultrasound guidance to en sure proper positioning. Numbing medication, such as Lidocaine or Marcaine, is often injected with the cortisone to provide temporary relief of the affected area. Also, topical anesthetics can numb the skin before injection.
It is imperative that any kind of shot into a joint be made using ultrasound guidance!
Probably the most common side-effect is a 'cortisone flare,' a condition where the injected cortisone crystalizes and can cause a brief period of pain worse than before the shot. This usually lasts a day or two and is best treated by icing the injected area. Another common side-effect is whitening of the skin where the injection is given. This is only a concern in people with darker skin, and is not harmful, but patients should be aware of this.
Other side-effects of cortisone injections, although rare, can be quite serious. The most concerning is infection, especially if the injection is given into a joint. The best prevention is careful injection technique, with sterilization of the skin. Also, patients with diabetes may have a transient increase in their blood sugar which they should watch for closely.
Because cortisone is a naturally occurring substance, true allergic responses to the injected substance do not occur. However, it is possible to be allergic to other aspects of the injection, most commonly the betadine many physicians use to sterilize the skin.
If a cortisone injection wears off quickly or does not help the problem, then repeating it may not be worthwhile. No more than 2-3 injections into the same joint should be given within a calendar year.
Animal studies have shown effects of weakening of tendons and softening of cartilage with cortisone injections. Repeated cortisone injections multiply these effects and increase the risk of potential problems. This is the reason many physicians limit the number of injections they offer to a patient.
Another method for treating osteoarthritis of the knee has been with an injectable lubricants containing hyaluronan. Hyaluronan is one of the major molecular components of joint fluid, and it gives the joint fluid its viscous quality. The high viscosity of synovial fluid allows for the cartilage surfaces of joints to glide upon each other in a smooth fashion.
By injecting these materials into a knee, some people consider this joint lubrication. This is why you may hear of hyaluronans as a 'motor oil' for the knee joint.
Numerous studies have been performed in the past decade to assess the effectiveness of hyaluronan as a treatment for osteoarthritis.
The theory behind using the glucosamine and chondroitin joint supplements is that more of the cartilage building blocks will be available.
Glucosamine is a precursor to a molecule called a glycosaminoglycan. This molecule is used in the formation and repair of cartilage. Chondroitin is the most abundant glycosaminoglycan in cartilage and is responsible for the resiliency of cartilage. Treatment with these joint supplements is based on the theory that oral consumption of glucosamine and chondroitin may increase the rate of formation of new cartilage by providing more of the necessary building blocks.
There have been numerous studies to examine the treatment effects of glucosamine and chondroitin over short periods of time. Most of these studies last only one to two months; however, they have indicated that patients experienced more pain reduction when taking the joint supplements than patients receiving a placebo. The improvement experienced by these patients was similar to improvements experienced by patients taking non-steroidal anti-inflammatory medications (NSAIDs) which have been a mainstay of non-operative arthritis treatment. The NIH funded GAIT trial was widely considered a negative study but there was indication that moderate to severe knee OA benefited from this preparation.
Bottom line: Glucosamine appears to be safe and might be effective for treatment of knee arthritis, but research into these supplements has been limited.
Knee Osteotomy is a procedure where a wedge of bone is removed from one side of the knee to help reduce the deformity that comes from the knee wearing away on the other side.
While most patients are not good candidates for this alternative to knee replacement, it can be effective for young patients with limited arthritis.
Total Knee Replacement Surgery is another procedure used for patients with severe arthritis.
In this procedure the cartilage is removed and a metal & plastic implant is placed in the knee.
Partial Knee Replacement Surgery is also called a unicompartmental knee replacement, this is replacement of one part of the knee. It is a surgical option for the treatment of limited knee arthritis.
The newest form of treatment for osteoarthritis of the knee uses autologous stem cells (stem cells obtained from the patient) along with platelet rich plasma which contains multiple growth factors to heal and regrow cartilage. Stem cells are harvested from the bone marrow of the iliac crest (hip bone) and from subcutaneous fat. Platelet rich plasma is obtained from the patient's whole blood. Using ultrasound and arthroscopic guidance, the physician induces a specific injury at the site of the osteoarthritis ("bare bone") and places the stem cells and the platelet rich plasma into the area of the knee joint that needs repair. Preliminary data is very encouraging.
For more information about whether stem cell therapy may be right for you, contact the Arthritis Treatment Center of Maryland at (301) 694-5800 or contact them at www.arthritistreatmentcenter.com
You can also check out this link:
Stem Cells for Osteoarthritis
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