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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 over
the age of 30. 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.
Risk factors include family history
of osteoarthritis, trauma, misalignment of the knee (leg not
being straight), and obesity. Initially the discomfort is described
as stiffness in the knees after lying down or sitting. Going
up and down stairs as well as getting into and out of a car may
be difficult.
OA of the knee can also cause locking,
clicking, and a "give-way" sensation in the knee.
Pain at night is also a sign of
OA.
The diagnosis is established by
careful history and physical examination. Physical findings include
tenderness along the joint line, misalignment of the knee (either
bow-legs or knock knees), and the presence of joint swelling.
The hip should also be examined because hip arthritis can also
cause knee pain.
Laboratory blood tests will often
be ordered to rule out other causes of arthritis. In addition,
the physician will often draw fluid off 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 but is expensive.
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 propoxyphene (Darvon) may be more
effective.
However, for those people who do
not respond to acetaminophen or tramadol, the next option is
low doses of non-steroidal anti-inflammatory drugs (NSAIDS).
Examples of these drugs include ibuprofen (Advil), ketoprofen
(Orudis) and naproxen (Aleve). These drugs may be purchased over
the counter. More severe or persistent pain may require a prescription
NSAID such as etodolac (Lodine), nabumetone (Relafen), dicloflenac
(Voltaren), meloxicam (Mobic), and celecoxib (Celebrex). A note
of caution: all NSAIDS have been associated with a slight increase
in risk as far as cardiovascular events (heart attack and stroke)
are concerned. They should be used with caution in patients who
have a history of underlying heart disease. Also because of other
reasons, they should be used with great caution in patients who
have a history of ulcers or significant liver and kidney disease.
At the same time as medicines are
introduced, a patient 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 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.
Finally, 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.
Finally, patients who have pain that is associated with severe
loss of cartilage from the knee may be candidates for knee replacement.
DISCLAIMER:
This article is NOT intended for medical advice. Always
check with your doctor for diagnosis and treatment of any illness.
About the author: Nathan Wei, MD FACP FACR is a rheumatologist
and Director of the Arthritis and Osteoporosis Center of Maryland.
He is a Clinical Assistant Professor of Medicine at the University
of Maryland School of Medicine. For more info: http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html
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