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By Brian Mahaffey, MD
“Exercise is the best medicine.” Everyone has heard this and it is very true. However, as we get older, this may be more difficult due to knee arthritis. At Mercy Sports Medicine, we feel maintaining your activity level, no matter which activity you choose or how old you are, is key to good health and well-being.
Arthritis, by definition, is an inflammation of a joint. This leads to break-down, or degeneration, of the joint. About 50 million Americans have arthritis and it is the number one cause of disability. A common myth is that people with arthritis should avoid exercise; this is far from the truth. Multiple studies have shown that improved endurance, weight loss, and resistance exercise are very beneficial for patients with arthritis. The most common type is osteoarthritis, which may occur at any age, but is more common above age 65.
Symptoms of knee osteoarthritis include pain and stiffness of the joint, mainly in the morning. Many people will note swelling of the joint and may have locking and catching of the joint. Patients usually will also note a loss of motion and function. Usually, there is not a specific cause, but multiple issues. These include family history, obesity, previous injuries and overall muscle weakness. Standing plain X-rays are the best test to diagnose osteoarthritis. Occasionally, an MRI needs to be done but should be ordered by an expert in arthritis.
Treatment of knee osteoarthritis should be conservative. A “step-wise” approach to maximize activity level and minimize discomfort can be very effective. Also, treating locally (addressing the joint directly rather than through oral medication) is the best option. Even though oral medications may be very effective, there may be risks with systemic treatment.
Physical therapy and exercise is key for treatment at any severity of osteoarthritis. Water aerobics may be particularly helpful but weight-bearing activity to toleration is also recommended. Strengthening around the knee and hips is very helpful. Maintaining core stability is always important.
Oral medications should start with the safest available for each individual patient. Acetaminophen and Ibuprofen are very helpful, but both have side effects and risks for certain patients. Herbal medications and topical medications, both over-the-counter (OTC) and prescription strengths, have the same concerns. Care should be given in using medications stronger than this, such as narcotics. All of these medication types can be used initially, but long-term it is best to minimize their use.
Local medications are very effective, but need to be injected by a physician who has experience with this procedure. Corticosteroids are an effective, short-term treatment with patients who are having increasing pain. However, if used repetitively, they can lead to further degeneration of the knee joint. Viscosupplementation comes as multiple products. All are related to a protein found in rooster combs. This protein is found in joint fluid and is usually helpful with minimal side effects for degenerative osteoarthritis. Also, these injections tend to last for 6-12 months and can be repeated with minimal risk.Some people do not respond to this treatment. If the degeneration is severe, viscosupplementation is less likely to help.
If a “step-wise” approach fails, then surgery may be the right approach. Most people will require a knee replacement, which in the correct patient is very effective. Patients may have issues after surgery; we feel trying conservative measures prior to surgery is best.
Overall, no matter how severe your knee arthritis is, staying active is the best treatment. At Mercy Sports Medicine, we believe this is the key for good health and well-being.
Dr. Mahaffey, MD, MSPH, FAAFP, is director of Mercy Sports Medicine and a team physician with the St. Louis Cardinals.
You can reach Dr. Mahaffey at 636-893-1360.