Arthritis is a common source of pain and is caused by inflammation in the joints. Arthritis of the knee can be quite painful and make ordinary activities such as walking, climbing stairs, or working-out quite difficult. At this time there is no cure for arthritis but there are ways to effectively manage arthritis so you can continue to go about your daily and active routine pain free. Arthritis of the knee is one of the most common areas in the body affected. Osteoarthritis is the most common form of arthritis in the knee. It is a degenerative “wear and tear” type of arthritis that can affect people of all ages.
- consider exercise as treatment
- consider supplements like glucosamine, condroton, or curcumin
- consider newer autologous biologic treatments like Platelet Rich Plasma (PRP) and stem-cells
- control your weight
- get steroid shots
- get arthroscopic surgery
- rush into a knee replacement
- get too crazy about your MRI
Many studies show that light to moderate amount of exercise reduce arthritis symptoms. The jury is still out as to whether heavy exercise like running helps or hurts knee arthritis. Walking, cycling, and other light to moderate exercise are still recommended.
Glucosamine and condroton can be helpful in preserving cartilage based on MRI studies if you have mild knee arthritis. In other studies they are helpful for reducing pain or increasing function. Curcumin has recently been shown to be as effective as ibuprofen (Advil or Motrin) without the serious heart side effects that are common with NSAIDs. It’s a potent anti-inflammatory and is a natural spice used in Indian food. Make sure it’s paired with a bio-perrine (and extract of black pepper as this increases absorption in the gut).
A recent study showed that when compared head to head, PRP bested knee gel shots for pain relief and function in knee arthritis patients. Our extensive stem-cell clinical registry data shows good long term relief in many patients with more severe arthritis where PRP is of limited use. Both of these injections use the natural healing potential of your body to help control arthritis symptoms and improve the nasty chemical environment (which is caused by the arthritis and works to break down the cartilage) in the knee that comes with arthritis.
While it makes common sense that carrying around more pounds puts more mechanical pressure and wear and tear on knee cartilage, carrying extra weight also has chemical effects. In several studies, even after adjusting for being heavier, there were other things leading to arthritis. One of these is likely the excessive insulin release associated with a metabolic syndrome. Regrettably, this problem is rampant in the U.S. and elsewhere, and is also associated with high blood pressure, high triglycerides, and other problems caused by eating a diet too rich in carbohydrates and sugars.
Steroid shots are a common solution offered by family practice and orthopedic clinics. The most common anesthetic used with the shots (bupivacaine) has been shown to kill cartilage cells, and a American Academy of Orthopedic Surgeons suggests physicians avoid using this anesthetic.
The steroid will also reduce natural healing and can also act synergistically with the negative side effects of the anesthetic to hurt cartilage. Consider getting an insurance covered injection of hyaluronic acid (knee gel shots aka rooster comb shots). These injections provide good relief for 6-12 months and likely improve the overall health of the cartilage in the knee.
Several high level research studies published in the New England Journal of Medicine clearly show that arthroscopic surgeries are no better than a fake operation (placebo). Despite this, arthroscopic surgery is still commonly offered by orthopedic surgeons to “clean up” the knee. Consider getting a second, or even third opinion before undergoing any surgery
Consider a knee replacement very carefully. Surprisingly, a good number of patients still report knee pain after a knee replacement. The knee replacement device will also wear out much more quickly if you’re young and active. In addition, the surgery can cause a dramatic increase in heart attack and stroke risk due to the invasiveness of the procedure. Finally, all devices (artificial knees) cause wear particles. Wear particles are bits of the metal, plastic, or ceramic that wear off the surfaces and into the joint and bloodstream. These particles have been associated with everything from allergic reactions to metal toxicity. While a knee replacement may be where you end up, putting it off as long as possible while allowing the device technology to improve may be well worth the effort.
Many patients look at their MRI as if it were the oracle of Delphi. However, many many research studies show that knee MRI findings like meniscus tears and cartilage loss aren’t necessarily associated with being in pain. For example, a huge study published by the famous Framingham study group in the New England Journal of Medicine showed that meniscus tears were quite common in middle aged and elderly patients without knee pain. In addition, other studies have shown that cartilage loss in the knee is also not directly correlated to pain. The risk you take by getting too hung up about what’s on the picture is that you’re more likely to get unnecessary surgery on the supposed problem seen on your knee MRI, but one that has nothing to do with why your knee hurts. If this happens, you’ll have taken the risk and downtime of an invasive surgery for no gain.
If your mensicus tear or lost cartilage isn’t causing your pain, then what is? The chemical environment inside the knee can be rich in pain causing chemicals for many reasons, yet none of that will show up on an MRI. In addition, patients who have swelling in the bone (also known as a BML or bone marrow lesion) on their MRI are more likely to be in pain. This problem is likely being caused by failure of both the cartilage and the bone.
Arthritis in the knee can be extremely painful and debilitating. The good news is that there are many treatment options that allow those with knee arthritis to effectively manage their pain and resume their active lifestyle. Walking and climbing stairs does not have to be a painful experience. The best news of all is that the most effective treatments are non-surgical procedures, supplements, and exercise so you can lead a pain free life.