Treatment Of Arthritis In Knees

Deformities Of The Knee

The appearance of the knee can change during a flare and as damage progresses.

In RA, swelling and redness are common during a flare. In the long term, persistent inflammation can result in permanent damage to the cartilage and the tendons. This can affect the shape and appearance of the knee.

With OA, the muscles around the knee can weaken, resulting in a sunken appearance. The knees can start to point toward each other or bend outward.

Knee deformities range from barely noticeable to severe and debilitating.

Treatment will depend on the type of arthritis a person has.

Treatment Innovations & Future Directions

Approximately 15% of the worlds population has OA.19 With a staggering 630 million suffering from OA it is increasingly becoming a burden on healthcare systems. Consequently, many scientists and engineers have been hard at work developing cost-effective alternatives to knee replacement surgeries. Recently two promising innovative approaches have been gaining popularity for the treatment of severe knee OA

Nsaids Worsen Knee Arthritis Pain

Physicians in San Francisco used data from OAI to observe 273 patients with moderate to severe knee arthritis who took NSAIDs for four years versus 793 control patients who didnt take NSAIDs . Joint inflammation and cartilage quality worsened at the four-year follow-up for patients taking NSAIDs versus those who did not take these drugs.

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How Can I Manage The Symptoms Of Post

The best way to manage your post-traumatic arthritis symptoms is to move and exercise your joints. Arthritis can get worse over time if its not treated. Follow the instructions your provider or physical therapist give you. Talk to your provider about any changes in your symptoms, especially if they get worse.

How Is Osteoarthritis Of The Knee Diagnosed

The diagnosis of knee osteoarthritis will begin with a physical exam by your doctor. Your doctor will also take your medical history and note any symptoms. Make sure to note what makes the pain worse or better to help your doctor determine if osteoarthritis, or something else, may be causing your pain. Also find out if anyone else in your family has arthritis. Your doctor may order additional testing, including:

• X-rays, which can show bone and cartilage damage as well as the presence of bone spurs
• magnetic resonance imaging scans

MRI scans may be ordered when X-rays do not give a clear reason for joint pain or when the X-rays suggest that other types of joint tissue could be damaged. Doctors may use blood tests to rule out other conditions that could be causing the pain, such as rheumatoid arthritis, a different type of arthritis caused by a disorder in the immune system.

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What Causes Osteoarthritis Of The Knee

Osteoarthritis of the knee happens when your knee joint cartilage wears out or is damaged. Articular cartilage is tough, rubbery tissue on the ends of your bones that lets you bend and move. Meniscal cartilage absorbs shock from pressure on your knee.

Your cartilage is like your cars shock absorber, protecting your car from bumps and jolts. Drive on lots of rough roads, your shocks wear out fast. Drive on easy streets, your shocks last longer. You can wear out or damage your knee joint cartilage if:

• Youre overweight. If your body mass index is 30 or more, youre seven times more likely to develop osteoarthritis in your knee than someone with a lower BMI.
• You injure your knee or have an old knee injury.
• You frequently put stress on your knee at your job or playing sports.
• You inherited a tendency to develop osteoarthritis of the knee.
• You have crooked bones or joints, such as having knocked knees.

The Rsna Conference Studies

The RSNA is the Radiological Society of North America which held its annual conference in Chicago this year. Data from several new studies were presented at the conference that use the NIH-funded OAI dataset . OAI describes itself as:

The Osteoarthritis Initiative is a multicenter, longitudinal, prospective observational study of knee osteoarthritis , currently in its 14th year of follow up. This Initiative is a public-private partnership between the NIH and private industry that seeks to develop a public-domain research resource to facilitate the scientific evaluation of biomarkers for osteoarthritis as potential surrogate endpoints for disease onset and progression.

Lets quickly review each study.

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Reducing The Strain On Your Knees

Apart from keeping an eye on your weight, there are a number of other ways you can reduce the strain on your knees.

• Pace your activities dont tackle all your physical jobs at once. Break the harder jobs up into chunks and do something gentler in between. Keep using your knee even if its slightly uncomfortable, but rest it before it becomes too painful.
• Wear shoes with thick soles and enough room for your toes. Wearing the right shoes can reduce the shock through your knees as you walk and prevent any changes to your feet.
• If you need extra support for your feet or knees when you walk, speak to your physiotherapist, occupational therapist or doctor about getting insoles made for your shoes.
• Use a walking stick if needed to reduce the weight and stress on a painful knee. An occupational therapist can advise on the correct length and the best way to use the stick.
• Use a handrail for support when going up or down stairs. Go upstairs one at a time with your good leg first.
• Think about making changes to your home, car or workplace to reduce unnecessary strain. An occupational therapist can advise you on special equipment that will make things you do every day easier.

Using a heat pack or something similar on a painful knee might help to relieve the pain and stiffness of osteoarthritis. An ice pack can also help but be careful not to put ice or heat packs or hot water bottles directly on your skin wrap them with a tea towel or cover.

Home Remedies And Medical Options

Options include:

Experts say that people who play an active role in managing their OA, for example, are likely to see a more positive outcome. You can do so by learning about arthritis, becoming aware of what makes symptoms better or worse, and making decisions with your doctor.

Discover exercises to strengthen the knee muscles.

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What Are The Risks Of Platelet

As with any type of injection, there are small risks of bleeding, pain and infection. When the platelets are from the patient who will be using them, the product is not expected to create allergies or have risks of cross infection. One of the main limitations with PRP products is that every preparation in every patient can be different. No two preparations are the same. Understanding the composition of these therapies required measuring numerous complex and different factors. This variation limits our understanding of when and how these therapies may succeed and fail, and the matter of current research endeavors.

What Are The Most Frequent Treatments For Knee Oa

NSAID drugs like Motrin, Advil, Aleve, Celebrex, and others are one of the main ways that the traditional medical care system treats arthritis pain. Another mainstay treatment for knee arthritis in particular is a corticosteroid injection. However, what if we had research with evidence that both of these treatments make arthritis worse?

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Transcutaneous Electrical Nerve Stimulation 1

Transcutaneous Electrical Nerve Stimulation is the use of electric currents produced by a medical device to stimulate nerves for therapeutic purposes.Electrodes are placed on the skin in the affected region then slow electrical pulses cause muscles to contract and relax, essentially mimicking passive exercise.While TENS ranks quite low on the recommendations list, some people with advanced knee arthritis have had success when combining TENS into their treatment plan for temporary pain relief.

How Knee Arthritis Is Treated

• Complementary and Alternative Medicine

Knee arthritis is extremely common, especially as you age, and can prevent you from participating in your daily activities. While there are many different types of arthritis, the most frequently seen variety in the knee is osteoarthritis , which typically causes pain and stiffness as you bend or straighten the knee.

Fortunately, there are a wide variety of treatment options available for osteoarthritis, which are detailed in the sections below.

RealPeopleGroup / Getty Images

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Highly Recommend This Treatment

I have had the knee injections over three, six-month periods of time. I was skeptical when I first began treatments but the results were simply amazing for me!!! My knees feel like time has rolled back 20 years, as I can exercise and snowboard with no pain to my knees!!!

My first consultation have been with Andrea, a very knowledgeable, professional and personable PA, who takes the client experience at their office to a highly credible level!!! The doctor and office support team are all friendly and easy to work with.

Heads Up: This Topic Makes Some Physicians Testy

I posted the press release from RSNA about the two new knee steroid injection studies on Linkedin. I had several physicians who were clearly upset about this information. Why that happened is worth exploring.

Many physicians have been using NSAIDs and knee steroid injections for their whole careers. Because both seem to help their patients function and they are covered by insurance, they have become the standard of care. However, as the research on harm has increased, in particular with steroid knee injections, some physicians have begun to question their use and have begun offering alternatives like HA and PRP. However, on the other end of that spectrum, there is a group of physicians who dont like being told that what they have been doing is likely causing harm and that they should do something else. Call it institutional momentum.

However, when it comes to injecting steroids into joints, the data has been evolving toward harm for quite some time. Any physician who was following the literature could easily see that there were problems brewing. In fact, its this data that caused me to ban high-dose steroid injections from my practice years ago. If you read this blog regularly, you know that Ive been highlighting research studies that show steroid injections are bad news for at least 15 years.

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Chris Centeno, MD

If you have questions or comments about this blog post, please email us at

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Physical Agents Including Electrotherapeutic Modalities

These include transcutaneous electrical nerve stimulation shortwave diathermy inferential current therapeutic application of a musically modulated electromagnetic field and ultrasound. Of these, ultrasound has the most evidence showing it can be effective, but overall there’s too little conclusive research to fully judge any of these treatments, according to the AAOS guidelines.

How Can I Reduce My Risk For Post

Follow these general safety tips to reduce your risk of an injury:

• Always wear your seatbelt.
• Wear the right protective equipment for all activities and sports.
• Make sure your home and workspace are free from clutter that could trip you or others.
• Always use the proper tools or equipment at home to reach things. Never stand on chairs, tables or countertops.

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What Can I Expect During The Procedure

Blood is removed from the arm using a needle into the vein. Then the blood is processed in a centrifuge, equipment that separates blood components into different parts according to their density. The platelets are separated into blood serum , while some of the white and red blood cells may be removed. Therefore, by spinning the blood, the equipment concentrates the platelets and produces what is called platelet-rich plasma .

However, depending on the protocol used to prepare PRP, there are multiple different products that can result from putting blood into the centrifuge. Therefore, different PRP preparations have different number on platelets, white blood cells, and red blood cells. For example, a product called platelet-poor plasma can be formed when most of the platelets are removed from the serum. The serum that is left contains cytokines, proteins and growth factors. Cytokines are emitted by immune system cells.

If the platelet cell membranes have been lysed, or destroyed, a product called platelet lysate , or human platelet lysate can be formed. PL often is made by freezing and thawing the plasma. PL has a higher number of some growth factors and cytokines than PPP.

What Happens During Arthroplasty

You may have your surgery in an outpatient clinic or at a hospital. The technique your surgeon uses varies depending on the type of surgery and the joint you need replaced. Right before your procedure, you will receive anesthesia. This ensures you wont feel pain during arthroplasty.

Your surgeon makes incisions and removes the damaged joint. Then they replace it with an artificial joint. They use stitches, staples or surgical glue to close the incisions. Your provider wraps the joint in a bandage. You may also need a brace or sling.

Surgeons can do some joint replacement procedures using minimally invasive techniques. These techniques use fewer incisions and special tools. The recovery time for minimally invasive procedures can be less than it is for traditional procedures. Your surgeon will recommend the most appropriate procedure for you.

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Complementary And Alternative Medicine

Many complementary and alternative medicine treatments have been used to treat knee osteoarthritis, with variable success. Glucosamine and chondroitin supplements have been marketed since the 1990s as disease-modifying options. A double-blind RCT showed little benefit from the use of glucosamine combined with chondroitin in participants with mild knee osteoarthritis.15 However, a greater benefit was noted in persons with moderate to severe pain. Glucosamine is safe, but the benefit is variable. Chondroitin does not decrease pain from osteoarthritis of the knee or hip.15

The benefit of acupuncture is not clear. A meta-analysis did not demonstrate any clinically relevant improvement in pain or function scores with acupuncture compared with sham acupuncture.16 However, in the short term and in the long term , patients who received either acupuncture or sham acupuncture felt better than those who received usual care. Another study showed that six months of treatment with traditional Chinese acupuncture decreased pain scores and increased functionality an average of 40 percent compared with sham acupuncture or no treatment.17

Is Any Of This New Information

While the data showing that NSAID drugs may make knee arthritis worse is newer, the idea that steroid injections are really bad for knee cartilage is not new at all. For example, weve had experimental data from the lab and animal studies for decades that show that corticosteroids harm cartilage cells . We even have a randomized controlled trial from the New England Journal of Medicine showing the same in actual knee arthritis patients .

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Are There Any Complications

Osteoarthritis can develop over just a year or two, but more often its a slow process over many years that only causes fairly small changes in just part of the knee.

But in some cases, the cartilage can become so thin that it no longer covers the ends of the bones. This causes them to rub against each other and eventually wear away.

The loss of cartilage, the wearing of the bones, and the bony spurs can change the shape of the joint. This forces the bones out of their normal positions, making your knee feel unstable and painful.

Some people with osteoarthritis find a lump appears at the back of their knee. This is called a Bakers cyst or popliteal cyst.

A Bakers cyst is fluid-filled swelling at the back of the knee that happens when part of the joint lining bulges through a small tear in the joint capsule. This can then cause joint fluid to be trapped in the bulge.

It can happen on its own, but is more likely in a knee thats already affected by arthritis. A Bakers cyst doesnt always cause pain, but sometimes they can burst so the fluid leaks down into your calf, causing sharp pain, swelling and redness in the calf.

Osteoarthritis in the knee might change the way you walk or carry your weight, and this could cause you to develop the condition in other joints, such as your hips.