Arthritis of the Knee Education

Arthritis is inflammation of at least one of your joints. Pain, swelling, and stiffness are the principal symptoms of arthritis. Any joint in the body might be affected by the disease, but it is especially common in the knee.

Knee arthritis can make it tough to do many day to day activities, like walking or climbing stairs. It is a major cause of lost work time and a significant disability for a lot of people.

The most frequent kinds of arthritis are osteoarthritis and rheumatoid arthritis, but there are more than one hundred different forms. In 2012, more than fifty-one million individuals stated that they'd been diagnosed with some form of arthritis, according to the National Health Interview Survey. While arthritis is chiefly an adult disease, some forms affect children.

Though there isn't any cure for arthritis, there are numerous treatment options available to help deal with pain and keep people staying active.

Anatomy

The knee is the biggest and strongest joint in your body. It's made up of the lower end of the femur (thighbone), the upper end of the tibia (shinbone), and the patella (kneecap). The ends of the three bones where they contact are covered with articular cartilage, a smooth, slippery substance that protects and cushions the bones as you bend and unbend your knee.

Two wedge-shaped pieces of cartilage known as meniscus act as "shock absorbers" between your thighbone and shinbone. They're tough and rubbery to help cushion the joint and keep it stable.

The knee joint is encompassed by a thin lining called the synovial membrane. This membrane produces a fluid that lubricates the cartilage and decreases friction.

Description

The major types of arthritis which affect the knee are osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis.

Osteoarthritis

Osteoarthritis is the most frequent form of arthritis in the knee. It's a degenerative,"wear-and-tear" type of arthritis that occurs most often in people fifty years and older, but may occur in younger people, too.

In osteoarthritis, the cartilage in the knee joint slowly wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones lessens. This can result in bone rubbing on bone, and make painful bone spurs.

Osteoarthritis develops slowly and the pain it causes gets worse with time.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease that attacks several joints throughout the body, including the knee joint. It is symmetric, which means that it generally affects the same joint on both sides of the body.

In rheumatoid arthritis the synovial membrane that covers the knee joint starts to swell, This results in knee pain and stiffness.

Rheumatoid arthritis is an autoimmune disease. This means the immune system attacks its own tissues. The immune system harms normal tissue (such as cartilage and ligaments) and softens the bone.

Posttraumatic Arthritis

Posttraumatic arthritis is a type of arthritis that develops after an injury to the knee. For instance, a broken bone may damage the joint surface and lead to arthritis years after the injury. Meniscal tears and ligament injuries may cause instability and additional wear on the knee joint, which with time may lead to arthritis.

Symptoms

A knee joint suffering from arthritis may be painful and inflamed. Usually, the pain develops slowly over time, though sudden onset is also possible. There are other symptoms, as well:

•   The joint might become stiff and swollen, making it hard to bend and unbend the knee.

•   Pain and swelling might be worse in the morning, or after sitting or resting.

•   Energetic activity could cause pain to flare up.

•   Loose fragments of cartilage and other tissue can interfere with the smooth motion of joints. The knee might "lock" or "stick" during movement. It can creak, click, snap or make a grinding noise (crepitus).

•   Pain can result in a sense of weakness or buckling in the knee.

•   Many individuals with arthritis observe increased joint pain with rainy weather.

Doctor Examination

Throughout your visit, your physician will talk with you about your symptoms and medical history, perform a physical examination, and potentially order diagnostic tests, like x-rays or blood tests.

Physical Examination

During the course of the physical assessment, your physician will look for:

•   Joint swelling, warmth, or redness

•   Tenderness around the knee

•   Range of passive (assisted) and active (self directed) motion

•   Instability of the joint

•   Crepitus (a grating sensation within the joint) with movement

•   Pain when weight is put on the knee

•   Issues with your gait (the way you walk)

•   Any symptoms of injury to the muscles, tendons, and ligaments around the knee

•   Involvement of other joints (an indicator of rheumatoid arthritis)

Imaging Tests

•   X-rays. These imaging tests make detailed pictures of dense frameworks, like bone. They are able to help distinguish among the different types of arthritis. X-rays of an arthritic knee might show a narrowing of the joint space, alterations in the bone and the formation of bone spurs (osteophytes).

•   Other tests. Sometimes, a magnetic resonance imaging (MRI) scan, a computed tomography (CT) scan, or a bone scan might be necessary to determine the condition of the bone and soft tissues of your knee.

Laboratory Tests

Your physician may also suggest blood tests to figure out which type of arthritis you have. With certain types of arthritis, like rheumatoid arthritis, blood tests will help with a correct diagnosis.

Treatment

There's no cure for arthritis but there are a number of treatments that might help alleviate the pain and disability it can cause.

Nonsurgical Treatment

As with other arthritic conditions, initial treatment of arthritis of the knee is nonsurgical. Your doctor might suggest a variety of treatments.

Lifestyle modifications. Some alterations in your daily routine can protect your knee joint and slow down the progress of arthritis.

•   Lessen activities that exacerbate the condition, such as climbing stairs.

•   Switching from high impact activities (such as jogging or tennis) to lower impact activities (like swimming or cycling) will place less stress on your knee.

•   Losing weight can decrease strain on the knee joint, resulting in less pain and increased function.

Physical therapy. Specific exercise can help increase range of motion and flexibility, as well as help strengthen the muscles in your leg. Your physician or a physical therapist can help develop a personalized exercise program that meets your needs and lifestyle.

Assistive devices. Using equipment like a cane, wearing shock-absorbing shoes or inserts, or wearing a brace or knee sleeve can be helpful. A brace assists with stability and function, and could be particularly helpful if the arthritis is centered on one side of the knee. There are two types of braces that are often used for knee arthritis: An "unloader" brace shifts weight away from the affected portion of the knee, while a "support" brace helps support the whole knee load.

Other remedies. Applying heat or ice, using pain-relieving ointments or creams, or wearing elastic bandages to offer support to the knee may provide some relief from pain.

Medications. Several types of drugs are helpful in treating arthritis of the knee. Because people respond differently to medications, your doctor will work carefully with you to determine the medications and dosages that are safe and effective for you.

•   Over-the-counter, non-narcotic pain relievers and anti-inflammatory medications are usually the first choice of therapy for arthritis of the knee. Acetaminophen is an easy, over-the-counter pain reliever that may be effective in reducing arthritis pain.

Like all medications, over-the-counter pain relievers can result in side effects and interact with other medications you're taking. Be sure to discuss potential side effects with your doctor.

•   Another kind of pain reliever is a nonsteroidal anti-inflammatory drug, or NSAID (pronounced "en-said"). NSAIDs, like ibuprofen and naproxen, are available both over-the-counter and by prescription.

•   A COX-2 inhibitor is a specialized kind of NSAID that may cause fewer gastrointestinal side effects. Common brand names of COX-2 inhibitors include Celebrex (celecoxib) and Mobic (meloxicam, that is a partial COX-2 inhibitor). A COX-2 inhibitor reduces pain and inflammation so that you can function better. If you're taking a COX-2 inhibitor, you should avoid using a traditional NSAID (prescription or over-the-counter). Be sure to tell your physician if you have had a heart attack, stroke, angina, blood clot, hypertension, or if you're sensitive to aspirin, sulfa drugs or other NSAIDs.

•   Corticosteroids (also called cortisone) are powerful anti-inflammatory agents that can be injected into the joint These injections offer pain relief and reduce inflammation; however, the effects don't last forever. Your doctor may recommend limiting the number of injections to three to four per year, per joint, because of possible side effects.

In many cases, pain and swelling may "flare" right after the injection, and the potential exists for long-term joint damage or infection. With frequent repeated injections, or injections over an extended period of time, joint damage may actually increase rather than decrease.

•   Disease-modifying anti-rheumatic drugs (DMARDs) are used to slow down the progression of rheumatoid arthritis. Drugs like methotrexate, sulfasalazine, and hydroxychloroquine are oftentimes prescribed.

Additionally, biologic DMARDs like etanercept (Embril) and adalimumab (Humira) may decrease the body's overactive immune response. Because there are many different drugs today for rheumatoid arthritis, a rheumatology specialist is commonly required to effectively manage medications.

•   Viscosupplementation requires injecting substances into the joint to improve the quality of the joint fluid. For more important information:

•   Glucosamine and chondroitin sulfate, substances found organically in joint cartilage, can be taken as dietary supplements. Although patient reports indicate that these supplements may relieve pain, there's no evidence to support the use of glucosamine and chondroitin sulfate to decrease or reverse the progression of arthritis.

Additionally, the U.S. Food and Drug Administration does not test dietary supplements before they are sold to consumers. These compounds may result in side effects, as well as negative interactions with other medications. Always consult your physician before taking dietary supplements.

Alternative therapies. Many alternative forms of therapy are unproved, but may be helpful to try, provided you find a qualified practitioner and keep your doctor informed of your decision. Alternative therapies to treat pain include the usage of acupuncture and magnetic pulse therapy.

Acupuncture uses fine needles to stimulate specific body areas to alleviate pain or temporarily numb an area. Although it is used in many parts of the world and evidence indicates that it can help ease the pain of arthritis, there are few scientific studies of its effectiveness. Be certain your acupuncturist is certified, and don't hesitate to ask about his or her sterilization practices.

Magnetic pulse therapy is painless and works by putting on a pulsed signal to the knee, which is placed in an electromagnetic field. Like many alternative therapies, magnetic pulse therapy has yet to be verified.

Surgical Treatment

Your physician may recommend surgery if your pain from arthritis causes disability and isn't relieved with nonsurgical treatment. As with all surgeries, there are some risks and potential complications with different knee procedures. Your doctor will discuss the possible complications with you prior to your operation.

Arthroscopy. During arthroscopy, doctors use little incisions and thin instruments to diagnose and treat joint issues.

Arthroscopic surgery isn't often used to treat arthritis of the knee. In cases where osteoarthritis is accompanied by a degenerative meniscal tear, arthroscopic surgery can be suggested to treat the torn meniscus.

Cartilage grafting. Normal, healthy cartilage tissue could be taken from another part of the knee or from a tissue bank to fill a hole in the articular cartilage. This process is typically considered only for younger patients who've small areas of cartilage damage.

Synovectomy. The joint lining damaged by rheumatoid arthritis is gotten rid of to lessen pain and swelling.

Osteotomy. In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and reshaped to alleviate stress on the knee joint. Knee osteotomy is utilized if you have early-stage osteoarthritis that has damaged just one side of the knee joint. By transferring your weight off of the damaged side of the joint, an osteotomy can alleviate pain and significantly improve function in your arthritic knee.

Total or partial knee replacement (arthroplasty). Your doctor will remove the damaged cartilage and bone, and then place new metal or plastic joint surfaces to regain the function of your knee.

Recovery

After any kind of surgery for arthritis of the knee, there's a period of recovery. Recovery time and rehabilitation depends on the type of surgery performed.

Your doctor may suggest physical therapy to help you regain strength in your knee and to restore range of motion. Depending on your procedure, you may need to wear a knee brace, or use crutches or a cane for a while.

Normally, surgery relieves pain and makes it possible to perform daily activities easier.

Provided by American Academy of Orthopaedic Surgery

Thank you for seeing me the day I walked into your office in such pain – I believe that there are angels among us & you were mine that day…

N.M age 59