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Osteoarthritis - Pain in knee


Osteoarthritis is quite a common condition that affects any joint within the body. Most commonly, it affects the joints that bear most of our weight, such as the knees and feet.  It happens once the protecting cartilage that cushions the ends of the bones wears down over time.

Risk factors associated with osteoarthritis include older age, smoking, obesity, and repetitive stress on the joints. Signs and symptoms include joint pain and stiffness as well as enlarged joints.

Osteoarthritis – Treatment

Osteoarthritis will involve nonpharmacological approaches like losing weight or moderate exercise. pharmacological treatments target reducing pain and inflammation. If these ways aren’t productive then patients would surgery to remove joint stiffness and pain.

Osteoarthritis – Advance Explanation

Osteoarthritis, not surprisingly, is referred to as the “wear and tear” type of arthritis since it will affect all of us at some stage of life especially those who have had repeated injuries or stresses on their joints. This layman’s definition also helps to conceptually distinguish osteoarthritis from inflammatory types of arthritis such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and lupus arthritis, only to mention a few. Cartilage is a substance (you must have seen the pearly smooth material on the ends of chicken bones) that protects our bones where they connect to make a movable joint. As the structure of cartilage fails, stresses are transferred directly to the bone. The silky smooth joint interface is then lost. The bone responds to more direct stress by thickening and at some point, the joint begins to hurt.

Although the concept is useful, it is a bit of an oversimplification, since there is a strong genetic component to osteoarthritis that has revealed big differences among individuals and families in the rate of degeneration of protective cartilage in our joints over the years. While there is no question that obesity is a risk factor for advancing osteoarthritis, particularly in the hips, knees, and lower back, we sometimes see lightweight, dainty ladies who have probably never broken a real sweat come in with end-stage osteoarthritis requiring joint replacement to maintain the ability to walk. There is a familial type of osteoarthritis that occurs commonly in the small joints of the fingers that are genetically programmed to progress regardless of hand activity.

Medical science understands a lot about the mechanism of cartilage metabolism and degeneration but hasn’t yet discovered a way to stop the degenerative process or to make us re-grow new “original equipment” cartilage. Despite the genetic observations, management of osteoarthritis begins with prevention, or as we call it, joint protection. Wearing proper supportive footwear as well as all the available protective gear for sports and work, using proper body mechanics with lifting, maintaining normal body weight, and avoiding carelessness that results in joint injury, all make a difference.

Many modalities are in medical use to help people deal with the symptoms of osteoarthritis and to remain active. These include exercise and strength maintenance, pain medications, joint injections of corticosteroids or biological lubricants, supportive devices for joints, and walking aids. Health care providers at Regional Arthritis and Rheumatology Associates take pride in providing individualized care for our osteoarthritis patients.

Disease-modifying anti-rheumatic drugs (DMARDs) can drive the disease to a low activity state. The gold standard methotrexate at 15-25 mg per week, Arava, sulfasalazine, and the less potent Plaquenil are examples. But they often fail to induce remission. Newer biologic agents especially when used with methotrexate can produce good clinical outcomes. They include Enbrel, Remicade, Humira, Orencia, Rituxan, Cimzia, Simponi, and Actemra (listed in the order of approval by the FDA). However, most patients do not achieve remission from the disease even with these agents. These biologic agents may cause mild and serious side effects which limit their use. More research is needed to devise better combination treatments with these agents and to identify more effective, safe, and less expensive drugs to help patients with RA. Better therapies can be discovered only when RA patients volunteer for clinical research trials.

The health care providers in practice at Regional Arthritis and Rheumatology Associates are dedicated to taking care of patients with RA. They constantly learning about the new rheumatology drugs that are on the horizon.

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