Your knee is sore, although you don’t remember injuring it. Like thousands of Canadians do every year, you go to your family doctor to discuss your knee pain. Your doctor listens and does a physical exam before suggesting X-rays. The diagnosis is osteoarthritis (OA). Now what?
Osteoarthritis is a degenerative (wear and tear) condition affecting the joints. Soft tissue, called cartilage, covers and protects the surface of the bones like Teflon on a frying pan. In OA, this cartilage breaks down, leading to pain and swelling within the knee joint. Once damaged, this cartilage cannot be replaced and OA becomes a progressive and chronic condition.
Osteoarthritis is the most common form of arthritis. According to the Arthritis Society, more than three million Canadians (one in ten) have osteoarthritis. This number is expected to increase over the next 20 years as our population ages. OA can occur in any joint, and is very common in knees. It can affect young people, but occurs more often as people age.
Osteoarthritis causes stiffness and pain, especially with activity. It is often worse when doing stairs or high-impact activities like running or jumping. Pain can also occur at night. Many people find it difficult to find a comfortable sleeping position. Joints may be stiff in the morning, or after sitting for a time. Often, there is no history of injury before the symptoms appeared. Some people remember having a knee injury a decade or more in the past. This earlier trauma can mean arthritis appears earlier in life than normally expected.
Diagnosis begins with a visit to your doctor. Your knee will be examined, and you will be asked some questions. If osteoarthritis is suspected, X-rays can help confirm the diagnosis. Your doctor uses the X-rays and the severity of symptoms to classify your arthritis as mild, moderate, or severe. If your doctor is confident that you have osteoarthritis, an MRI is not required. It is an unnecessary test that will not change treatment.
While symptoms may come and go, over time osteoarthritis will slowly get worse. Although it cannot be cured, it can be effectively managed. Often, the best treatment involves using a variety of strategies to reduce pain and improve function. Many people are able to manage OA symptoms and continue living an active lifestyle.
Lifestyle changes - Your doctor will recommend a lifestyle that includes a healthy diet, weight loss if needed, and a low-impact exercise program. As the knee is a weight-bearing joint, maintaining a healthy body weight will slow the progression of osteoarthritis. Often, pain can be significantly reduced just by losing weight. Keep in mind that certain forms of exercises are better for knee OA. While any form of exercise is good for your overall health, high-impact exercise like running or jumping may make OA symptoms worse. Instead, try low-impact exercise like cycling or swimming. These activities strengthen muscles while limiting the amount of weight that the knee joint bears. Physiotherapy is often recommended to help guide a focused low-impact exercise program, and to ensure that you are doing strengthening exercises correctly.
Medication – In addition to lifestyle changes, you might consider trying over-the-counter supplements like glucosamine and chondroitin. These supplements aim to improve cartilage health. However, there is debate about how well they work. Pain from osteoarthritis can be managed with oral medications like Tylenol. Non-steroidal anti-inflammatory drugs (NSAIDs) can be used orally or topically, and are commonly prescribed. Stronger pain medications are occasionally required for pain management. Talk to your doctor about which pain medications are right for you.
Bracing - Depending on your pattern of osteoarthritis, a knee unloader brace might be useful. These braces are worn during activity to shift weight away from the painful side of the knee. A brace can significantly reduce pain in people who have unilateral (one-sided) osteoarthritis in either the inner or outer aspect of the knee.
Injections – Several injection therapies are available to control symptoms. Corticosteroid injections (cortisone) can quickly reduce inflammation and pain within the knee. This can give significant but often short-term relief from symptoms. Hyaluronic acid (HA) injections may be used alone or along with corticosteroids. These injections enhance the gel-like fluid (synovial fluid) that naturally lubricates the knee joint. This strategy has been shown to reduce pain and improve mobility in mild to moderate forms of OA. While a HA injection has a slower onset of action than cortisone, it may provide longer lasting relief from symptoms. Various forms of HA injections are available currently in Canada. Newer injection therapies, including platelet-rich plasma (PRP) and stem cell therapy, are currently being studied for treatment of OA. Injection therapies must be tailored to each person’s needs. Discuss the alternatives with your doctor.
Surgery – Options such as knee replacement are only considered once all other management options have failed, and osteoarthritis has become severe. If you are a potential candidate for surgery, your doctor will arrange a visit with an orthopedic surgeon.
Like most chronic conditions, osteoarthritis can be effectively managed in the early to moderate stages. If you have more questions about ways to manage osteoarthritis, your family doctor can provide guidance.