Q: I’m 56 and I’ve been getting worsening pain in my left knee for the last year. An x-ray showed moderate osteoarthritis. What can I do to treat this?

Osteoarthritis is the most common form of arthritis, it is also known as degenerative joint disease. Any joint in the body can be affected, it most commonly affects the hands, feet, spine, hips, and knees. By age 80, most persons experience arthritis pain.

How a joint becomes osteoarthritic?
The protective tough gristly cartilage at the ends of the bones becomes damaged and eventually disintegrates. Because it is devoid of a blood supply, damaged cartilage cannot be spontaneously repaired by the body. Spurs (osteophytes) are often found in the affected joint. Detached flakes of cartilage irritate the joint capsule resulting in inflammation. This inflammation further breaks down the joint’s cartilage. A viscous cycle ensues. When the cartilage disappears, bone rubs against bone.

Reported symptoms

• Intermittent pain initially, but may become incessant as the disease progresses
• Swelling
• Joint tenderness
• Joint stiffness
• Pain on weight-bearing & movement
• Joint deformity
• Cracking sound or grating sensation with joint movement
• Reduced range of joint movement
• Muscles around joint become weak

Risk factors

• Being over 40 years in age
• Being overweight increases the chances of osteoarthritis in the hips, knees, and spine
• Previous joint injury
• Older women
• Family history
• High-impact sports or workouts
• Joint overuse
• Jobs that require lifting, kneeling, squatting, walking, stair climbing

Triggers of pain

• Inactivity
• Weather – damp, and cold
• Stress, depression, anxiety
• New joint injury
• High impact exercises
• Weight gain
• Current or recent infection
• Alcohol, sugar, processed foods, artificial flavorings, saturated and trans fats

Treatment Options

• Early treatment may stop, or at minimum slow the progression of osteoarthritis.
• Physiotherapy/ Exercises
• Strengthening the muscles which traverse the joint can slow the degenerative process.
• Topical

Topical creams, ointments, gels, balms, etc may provide relief for mild pain. Such products include:

• Diclofenac gel
• Nutmeg oil
• Counterirritant oils containing wintergreen, menthol, camphor, eucalyptus
• Capsaicin derived from chili peppers

Medications

•  Paracetamol/ Acetaminophen is effective in relieving mild-moderate pain. These medicines are most effective when taken on an empty stomach
• NSAIDs such as Ibuprofen, diclofenac, naproxen, and others are often prescribed for moderate-severe arthritis pain. These must be taken with food.
• COX 2 Selective Inhibitors such as Celebrex and Arcoxia are a type of NSAID but with fewer gastrointestinal side effects. These are costly.
• Cymbalta is an SNRI antidepressant that is prescribed for knee arthritis.
• NSAID intramuscular injections are often administered for acute flares.

Joint injections

Corticosteroid joint injections are given by the doctor at Family Care Clinic and other doctors here in SVG to persons whose pain is failing to respond to other forms of treatment.

Surgery

Reserved for persons not responding to non-surgical modalities of treatment. These include:

Arthroscopy, whereby a tube with a camera, is used to look into the joint, and rough areas of cartilage are smoothened and bone fragments and damaged cartilage removed.

The diseased joint is partially or completely replaced by a prosthesis (joint replacement)

Author’s Contact Information: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnosis, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided