Medical treatment for Arthritis of the Knee :
Once a patient develops arthritis in the knee, during initial stages conservative treatment (without operation) can be attempted. In the early phase of arthritis this treatment may be beneficial. As arthritic process continues the efficacy of this treatment gradually becomes less which necessitates different surgical treatments.
Initially the pt. may be benefitted by :
a) Life Style Modification :
As widely understood osteoarthritis is a life style condition. It is common to sit on floor, sit cross legged, etc in many cultures for social or religious needs. Appropriate changes in the life style can help.
- To avoid squatting & sitting on floor
- To avoid high impact exercises like jogging, skipping ropes, racket sports etc… These would cause repeated stresses on already damaged cartilage and further damage the knee. Modifying this to low impact exercises would help the arthritic knee reduce the pain.
- Weight loss is extremely crucial in the treatment of knee pain due to arthritis. The ideal weight should be as per the height and age of the person. The excess body weight (obesity) increases the loading of the knee joints and increases the pain.
- Use of western type of commode or a chair is recommended.
b) Medications :
In osteoarthritis the pain is due to Inflammation of the soft tissues around the cartilage. Use of oral Anti inflammatory medicines can reduce the inflammation and hence pain. A short course of these tablets (supervised by the doctor) helps to alleviate pain.
Sometimes a Local injection of steroid helps. Steroid is a very good medication if used locally in the joint cavity.However the effect of these injections is temporary and at times not predictable.
Calcium and Vitamin D helps to improve overall bone metabolism. It strengthens bone structure.
Food supplement like Glucosamine and chondroitin are also used. It is supposed to reduce the speed with which arthritis is progressing. It works by repairing the damaged cartilage and improving its elasticity.
Patients suffering from Rheumatoid arthritis and the Rheumatoid associated knee pain are required to use Rheumatoid arthritis medications which control this disease affecting other joints. It is necessary that medical management of this condition is under supervision of a Rheumatologist.
c) Physiotherapy and Exercises :
Exercises improve strength and mobility. Strengthening and stretching are the main forms of the exercise. Stretching helps to improve mobility and flexibility. Strengthening is done by alternatively tightening and relaxing the muscles of thigh and calf. The overall strength improves with sustained exercises. The physiotherapy supervision is necessary to exactly titrate the therapy.
d) Bracing :
Brace is an external device applied on the knee. It is supposed to Stabilize the joint from outside which reduces inflammation and pain in the joint. It is made of cloth, foam or synthetic material.
e) Intra Articular Injections :
Hyaluronate is a lubricant found in the human synovial joint. In early cases of Osteoarthritis this material can be used to inject directly in the joint in between femur and Tibia bone. It is known to increase the lubrication of the arthritic joint and hence reduce the pain. Depending upon which injection is used either it is a single injection or a set of 3 or 5 injections given every weekly.
Its effect can be unpredictable. Sometimes it works for a short while and at times for as long as 10 to 12 months.
These various forms of treatment provide a temporary relief. For long term definitive treatment with predictable results, Knee surgery may be the best option.