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Treatment options for Osteoarthritis of the Knee

published on 07-30-2007

kneeThe term “arthritis” refers to a condition of inflammation within a joint. It is the body’s reaction to disease or injury and includes swelling, pain, and stiffness. There are over 100 types of arthritis: the most common are osteoarthritis, rheumatoid arthritis, and gouty arthritis. In the US an estimated 70 million Americans or one in three are affected with a type of arthritis. It may surprise you, but the exact causes of many types of arthritis are still unknown. We do have good understanding of some of the mechanisms involved but ultimately genetics or lifestyles may predispose people to these diseases.

Osteoarthritis is by far the most common type of arthritis we see. It is often described as a gradual wearing away of the cartilage that causes bone on bone contact in a joint causing pain and swelling. The unique design of our joints allow friction and heat to be dissipated through the slick tissue coverings of the bone ends (cartilage) and a lubricating fluid bathing the joint called synovial fluid. With age and repetitive trauma as well as chronic inflammation, cartilage wears and synovial fluid becomes less viscous resulting in the typical morning stiffness, pain, swelling, and tenderness of osteoarthritis. OA (osteoarthritis) typically affects hands and weight bearing joints such as the knees, hips, ankles and the spine.

With the above discussion, how do we halt cartilage degeneration or repair damaged cartilage? The real answer aside from weight reduction and avoiding activities that cause excessive stress on the joint is we can’t! Treatment is rather aimed at reducing pain, inflammation, and maintaining joint function. Treatment options for OA include lifestyle modifications, supplements, medications, viscosupplementaton, and surgical replacement.

Exercise does not necessarily aggravate OA and in fact helps maintain supportive musculature and reduces joint stiffness. Aquatic activities are especially well suited for people with OA secondary to reducing impact on the joints. Local heat on an affected joint before the activity and ice after an activity is also helpful. Nutritional supplements such as glucosamine, chondroitin, and flak seed oil can also be beneficial. Traditionally, the mainstay of treatment to reduce much of the pain of OA is a group of medicines we call NSAIDS which include medications such as ibuprofen, Relafen, Motrin, and Aleve to name a few. These medications have the advantage of reducing pain, inflammation, and swelling, but at what cost? Recently this group of medications has come into question with an apparent increase risk of heart attack.

If you do not want to consider joint replacement and previous medications have failed you may want to consider hyaluronan injections. Hyaluron is a natural chemical found in many tissues throughout the body and gives synovial fluid its slippery viscous properties that reduce joint friction. The first hyaluronan injectable was FDA approved for the US market in 1997. Currently there are five brands of injectable hyaluronans on the market and are FDA approved for relief of OA of the knee. These injections have the advantage of longer symptom relief over steroid injections of a joint and are not harmful with repeated injections of surrounding ligament and tendon structures. Many of my patients have enjoyed six months or more of pain relief. The treatment consists of a series of anywhere from three to five injections given over a three to five week period of time.
If OA is significantly altering your lifestyle and hampering your activities of daily living then schedule an appointment to see if these injections may be right for you.

Christopher Carpenter MD
Plum Creek Medical

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