Knee arthritis: A fresh look at treatment optionsPrintEmailDetailsWritten by Tyrone M. Reyes, M.D.Category: Library Health NewsPublished: 02 December 2014Created: 02 December 2014Hits: 217There is a 50-50 chance that, at some point in your life, youll develop osteoarthritis (OA).Not great odds, considering how much this joint condition can be disabling to you afecting ambulation and many activities of daily living.The pain and limited mobility in OA occur as the cartilage that cushions the space between bones wears away with age and overuse.Left bare of their padding, bones rub painfully against each other particularly in the hands, spine, knees, and hips.There are many options for managing the symptoms of knee OA, such as pain, swelling, and stifness.But which options truly work?The American Academy of Orthopedic Surgeons (AAOS) last year updated its clinical practice guidelines for the treatment of knee OA after reviewing the scientifc literature and assessing the benefts and harms of care options.Heres a look at what they found.Diet and exerciseWhen you have aching knees, getting up to exercise may be the last thing on your mind.But no therapy has a bigger, more consistent payof than exercise, according to the analysis of the evidence-based literature.And you dont necessarily need fancy equipment or gym membership.One study found that people with OA in one or both knees who simply participated in an organized walking program for eight weeks experienced an overall 39-percent improvement on a scale that measured their activity level, pain, and medication use.Meanwhile, similar patients in a comparison group who didnt exercise experienced worsening symptoms.A good exercise program for knee OA features low-impact aerobic training (such as walking or swimming) and exercises to improve balance and strength.Exercise can improve fexibility, range of motion, and muscle strength in the legs in addition to relieving pain and improving function.Combining exercise with a proper diet will help you maintain a healthy weight, too, which is another sound recommendation for people with knee OA.Lightening your load can relieve stress on the knees.Meanwhile, some research suggests that losing fab reduces blood levels of infammatory factors that may worsen arthritis.While more study is needed, a modest amount of research shows that overweight people with knee OA who shed a few pounds at least fve percent of their body weight have less pain and stifness, as well as fewer limitations on daily activities.Drug treatment for pain reliefNonsteroidal anti-infammatory drugs (NSAIDs) are the medications with the best track record for treating knee OA, with at least 19 studies confrming their value for soothing joint pain.NSAIDs are available over the counter and by prescription, and come in pills or topical form thats applied to the skin. Your doctor will prescribe the optimal choice for you.If oral NSAIDs upset your stomach, your doctor may prescribe a pain reliever called tramadol; most studies suggest it provides at least some relief from pain and stifness from arthritic knees.Meanwhile, if you take acetaminophen (Tylenol) to manage knee OA symptoms, you may need to rethink your regimen. The AAOS said acetaminophen was a reasonable choice for treating knee OA in its 2008 guidelines, but that recommendation was based on a maximum dose of 4,000 milligram (mg) a day.However, in 2011, the US Food and Drug Administration cautioned against taking more than 3,000mg daily because of concerns that the drug can cause liver damage at higher doses. Whats more, the limited research thats been conducted on acetaminophen for knee OA has failed tofnd a signifcant beneft.The AAOS is now unable to say whether acetaminophen is a good choice for people with knee OA.If you take acetaminophen for pain, check to be sure your daily dose is safe.Corticosteroidal injections are sometimes used for short-term pain relief, but AAOS couldnt fnd conclusive evidence that theyre more efective than a placebo and cant recommend either for or against the injections. Furthermore, regular injections can actually cause additional damage to the joint, and patients should have no more than four injections a year.Similarly, the AAOS says too little good-quality research is available to recommend for or against the following therapies sometimes prescribed to treat OA of the knee and other joints: Most opioid drugs such as oxycodone and hydrococlone. Pain medications administered via skin patch.Injections of growth factors or platelet-rich plasma. Chiropractic and other forms of manual therapy. Unloader knee braces, which are supposed to unload stress on the knee joint.Treatments to avoidAccording to the AAOS, the weight of scientifc evidence suggests that the following popular therapies are not efective for treating osteoarthritis of the knee: Hyaluronic acid.The AAOS formerly called scientifc support for injections of this lubricant into the joint inconclusive, but now strongly recommends against its use for knee OA because of its lack of efectiveness. Acupuncture.Any reduction in symptoms from pinprick therapy is too small to make a diference, studies show. Glucosamine and Chondroitin.Extensive research indicates that these popular supplements are no more efective than sugar pills for knee OA. Lateral wedge insoles.TheAAOS says it cannot suggest the use of custommade shoe inserts because of lack of evidence that they ofer any relief from knee OA.Surgery: Not always the best optionThe AAOS recommends against undergoing an arthroscopy, or arthroscopic debridement, a surgical technique that uses a thin tube with a light and tiny video camera at one end to view the inside of thejoint and remove damaged cartilage or bone.It also recommends against arthroscopy with lavage inwhich a surgeon washes out debris such as loose pieces of bone and cartilage from a knee joint.No reviews or studies showed that either procedure signifcantly improved OA symptoms compared with noninvasive therapies.The AAOS concluded that the risk of surgery and lack of efectiveness were sufcient reasons to advise against arthroscopy, with or without lavage, for people with OA.Likewise, the AAOS failed to fnd adequate evidence to recommend or discourage a form of surgery routinely performed on patients with knee OA called arthroscopic partial menisectomy.However, a study in the New England Journal of Medicine published in May 2013 raised questions about the value of this procedure, which is performed to repair tears in the meniscus, the rubbery layer of cartilage that keeps the thighbone (tibia) and shinbone (femur) from crashing into one another.A torn meniscus can produce pain and stifness and may also cause a knee to lock or give way now and then.Meniscal tears are common in people who have knee OA and occur in about 35 percent of men and women over 65.However, for reasons that arent clear, these tears dont cause symptoms in about two-thirds of people who have them.Nonetheless, when a meniscal tear is discovered in a person who has knee OA, doctors recommend a partial menisectomy to remove the torn portion of the cartilage.In the US, about 465,000 Americans undergo this procedure each year.The study found that OA patients who had their torn cartilage surgically repaired and then underwent physical therapyshowed no diference in pain level, stifness or limitations on daily activities compared with OA patients who had physical therapy and no surgery.Going under the knife may be appropriate for some forms of joint pain, such as when damage caused by osteoarthritis is so severe the only remaining option is a total knee replacement, or arthroplasty, during which the disease or damaged joint is removed and replaced with an artifcial one. But people with knee OA should consider surgery only after theyve exhausted all other possiblepain-relief treatments. More conservative methods may be just as likely to ease your pain and get you back up on your feet.The bottom lineThe truth is, theres more than one approach to reducing the pain of knee osteoarthritis and improving function. What works for one person wont necessarily work for another.Furthermore, just because a therapy isnt strongly recommended by the AAOS due to inconclusive scientifc evidence doesnt necessarily mean that it should never be tried.It may mean simply that not enough high quality studies have been done to determine its efectiveness and more research is needed.However, you should never try an alternative option without your doctors consent.Consult with your doctor to fnd the best course of treatment that works best for you.source: Philippine Starhttp://www.philstar.com/health-and-family/2014/12/02/1397943/knee-arthritis-fresh-look-treatment-options