So, what are we going to do about it?
  • Most treatments are aimed at symptoms, not a cure...The first step is limiting inflammation in a safe way. We have many options for this. In inflammatory arthritis, the treatments from your primary care doctor or rheumatologists will play a role.  Some of the tools we will employ include:

 

  • Maintain a healthy weight. This is the most important measure we can control. We place 3-4 times our body-weight across the knee joints with regular speed walking. Ascending stairs and getting out of a chair can increase to 6x body weight. Small decreases in body weight result in exponential decreases in force across the knee joint.

 

  • Non Steroidal Anti-Inflammatory Drugs. (NSAIDS). In mild to moderate stages, an over the counter anti-inflammatory like Motrin, Ibuprofen or Aleve are very effective. We recommend taking them for at least a week at a time during a flair of inflammation, up to a few weeks, as long as you are not experiencing the side-effects or complications listed on the package. Ensure you are taking them with food, and check with your doctor if you have any concerns whether NSAIDS are appropriate for you.  In moderate to Severe cases, we may employ a prescription NSAID such as Meloxicam(Mobic), Celebrex or Diclofenac(Voltaren) if this is safe for the patient.

 

  • Physical therapy. “Motion is lotion,” for arthritic joints. Strengthening the muscles around the joint help with stability and pain. Remember, you do not “graduate” from therapy once you are discharged, rather, the exercises need to be continued at home.

 

  • Activity modification. Avoiding or even eliminating impact exercises like running and jogging and transitioning to walking, cycling, swimming or elliptical will help decrease the day-to-day inflammation.

 

  • Corticosteroid injections. This allows us to place anti-inflammatory directly into the knee joint. Occasionally, patients have worsening, or “rebound” pain for a day or two. Give the steroid 3-5 days to set in before deciding on how effective it is for you. These can generally be given every 3-4 months, as long as they are remaining effective.

 

  • Viscusupplementation. This is the gel injection sometimes referred to as “Chicken Shots,” or “Chicken Grease”. The active medication in this is called Hyaluranic Acid, and was initially discovered in high concentrations in rooster comb. It is a thick, viscous fluid which is aimed at lubrication the joint and kick starting it back into producing its own lubrication. These can be given every 6 months, as long as they are remaining effective. Most insurance plans require pre-approval, and some will not pay for them at all.

    • *** One caveat to remember is that we cannot give and injection in the same joint within 3 months of planned surgery d/t the risk of infection. As such, if you think you may be progressing towards surgery, keep this timing constraint inline.​

 

  • Glucosamine/Chondroitin: This is an over the counter nutritional supplement in which the active ingredient is a substance naturally occurring in healthy cartilage. Studies have shown mixed results in its effectiveness, to the point where the American Academy of Orthopaedic Surgeons no longer recommends the routine use in OA treatment. Studies that did show benefit were in patients with mild-to-moderate x-ray changes in Glucosamine amounts of 1500mg per day.

    • If you are considering adding this to your treatment regimen, do so separate from any additional treatments, when you are at a stable, baseline level. Try it for 3-4 weeks steady. If you do not notice a benefit, then we would recommend discontinuing. The only considerable side-effect would be to your bank account (usually $10-$30 monthly)​

 

  • Knee braces and Heel wedges: We can employ a number of different bracing options, depending on your leg shape, as well as the primary type and location of your arthritis. Heel wedges can make small shifts in the mechanical axis of your leg and “unload” one part of the knee. We use a Lateral heel wedge for Medial sided knee arthritis, and a medial wedge for lateral compartment arthritis.