Arthritis
Arthritis is an inflammation of the joints that can cause debilitating joint pain. There are more than 100 different kinds of arthritis and related conditions. The two most common types of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA).
Osteoarthritis. Sometimes called degenerative arthritis, osteoarthritis is the most common type of arthritis. It's a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age.
Rheumatoid arthritis. The most debilitating form of arthritis, rheumatoid arthritis is an autoimmune condition that can affect almost any joint in your body, including your knees. Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go.
The symptoms of arthritis usually develop over time, but they may also appear suddenly. Common arthritis joint symptoms include swelling, pain, stiffness and decreased range of motion. Arthritis is most commonly seen in adults over the age of 65, but it can also develop in children, teens, and younger adults, particularly those who are physically active. Arthritis is more common in women than men and in those who are overweight.
Diagnosis
Accurate diagnosis of your arthritis will require a comprehensive physical examination. In the physical examination, your doctor will likely:
Inspect your affected body part for swelling, pain, tenderness, and decreased range of motion
Check to see how far you can move your affected limb in different directions
Push on or pull the affected joint to evaluate the integrity of the structures
IMAGING TESTS
In some cases, your doctor might suggest tests such as:
X-ray. X-ray is used to help detect bone fractures and degenerative joint disease.
Computerized tomography (CT) scan. CT scanners combine X-rays taken from many different angles, to create cross-sectional images of the inside of your body. CT scans can help diagnose bone problems and subtle fractures. A special kind of CT scan can accurately identify gout even when the joint is not inflamed.
Ultrasound. This technology uses sound waves to produce real-time images of the soft tissue structures within and around your knee. Your doctor may want to move your affected limb into different positions during the ultrasound to check for specific problems.
Magnetic resonance imaging (MRI). An MRI uses radio waves and a powerful magnet to create 3D images of the inside of your knee. This test is particularly useful in revealing injuries to soft tissues such as ligaments, tendons, cartilage and muscles.
LAB TESTS
If your doctor suspects an infection or inflammation, you're likely to have blood tests and sometimes a procedure called arthrocentesis, in which a small amount of fluid is removed from within your affected joint with a needle and sent to a laboratory for analysis.
Treatments for Arthritis
Treatments will vary, depending upon the location of your arthritis and the type of arthritis with which you are diagnosed.
MEDICATIONS
Your doctor may prescribe medications to help relieve pain and to treat underlying conditions, such as rheumatoid arthritis or gout. Some types of medications used to treat arthritis are listed below:
Acetaminophen. Acetaminophen (Tylenol, others) has been shown to help some people with osteoarthritis who have mild to moderate pain. Taking more than the recommended dose of acetaminophen can cause liver damage.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, others), taken at the recommended doses, typically relieve osteoarthritis pain. Stronger NSAIDs are available by prescription.
NSAIDs can cause stomach upset, cardiovascular problems, bleeding problems, and liver and kidney damage. NSAIDs as gels, applied to the skin over the affected joint, have fewer side effects and may relieve pain just as well.
Duloxetine (Cymbalta). Normally used as an antidepressant, this medication is also approved to treat chronic pain, including osteoarthritis pain.
PHYSICAL Therapy
Physical therapy. A physical therapist can show you exercises to strengthen the muscles around your joint, increase your flexibility and reduce pain. Regular gentle exercise that you do on your own, such as swimming or walking, can be equally effective.
INJECTION THERAPY
In some cases, your doctor may suggest injecting medications or other substances directly into your joint. Examples include:
Corticosteroids. Injections of a corticosteroid drug into your knee joint may help reduce the symptoms of an arthritis flare and provide pain relief that may last a few months. These injections aren't effective in all cases.
Hyaluronic acid. A thick fluid, similar to the fluid that naturally lubricates joints, hyaluronic acid can be injected into your knee to improve mobility and ease pain. Although study results have been mixed about the effectiveness of this treatment, relief from one or a series of shots may last as long as six months.
Platelet-rich plasma (PRP). PRP contains a concentration of many different growth factors that appear to reduce inflammation and promote healing. These types of injections tend to work better in people whose knee pain is caused by tendon tears, sprains or injury.
Stem cell injections. The cartilage covering the ends of the bones enables the bones to glide smoothly against one another with only slight friction. Osteoarthritis causes damage to the cartilage and leads to increased friction — resulting in pain, inflammation, and ultimately, a loss of mobility and function. The goal of stem cell therapy is to use the body’s own healing mechanisms to help repair and slow the deterioration of body tissues, such as cartilage.
Stem cell therapy for arthritis aims to:
slow and repair damaged cartilage
decrease inflammation and reduce pain
possibly delay or prevent the need for total joint replacement surgery
In simple terms, treatment involves:
taking a small amount of blood, usually from the arm
concentrating the stem cells together
injecting the stem cells back into the knee
ORTHOVISC® injections. ORTHOVISC® is a viscous (thick) sterile mixture made from highly purified hyaluronan from rooster combs. Hyaluronan is a natural chemical found in the body. High amounts of hyaluronan are found in the joint tissues and in the fluid that fills the joints. The body's own hyaluronan acts like a lubricant and a shock absorber in the joint. It is needed for the joint to work properly. When you have osteoarthritis, there may not be enough natural hyaluronan in the joint, and the quality of that hyaluronan may be poorer than normal. ORTHOVISC® is given in a shot (injection) directly into the knee joint. ORTHOVISC® is used to relieve knee pain due to osteoarthritis. It is used for patients who do not get adequate pain relief from simple pain relievers like acetaminophen or from exercise and physical therapy.
surgery
Arthroscopy - involves small incisions, specialized instruments and a tiny camera – to fix tears in soft tissues around the knee, hip, shoulder and other joints; repair damaged cartilage and ligaments; and remove broken, free-floating cartilage pieces.
Best candidates: Active people younger than 40 years.
Joint Resurfacing - unlike total joint replacement, this procedure replaces just part of the knee or hip joint. In the knee, surgeons replace only one of the knee’s three compartments with an implant, usually on the inside (medial) or outside (lateral) part. In the hip, the socket is replaced with a metal cup, and the damaged hip ball is reshaped and capped with a metal, dome-shaped prosthesis, like a crown on a tooth.
Best candidates: For the knee, older, less active patients with arthritis in only one knee compartment. For hips, men younger than 50 with a large build, especially athletes or those with physically demanding jobs
Osteotomy - involves cutting and removing bone or adding a wedge of bone near a damaged joint. In the knee, an osteotomy shifts weight from an area damaged by arthritis to an undamaged area. In the hip, it is often used to correct misalignment (hip dysplasia) that occurs early in life.
Best candidates: Patients in their 30s and younger or who are younger than generally recommended for total joint replacement.
Synovectomy - in people with inflammatory arthritis, the lining of the joints – the synovium – can become inflamed or grow too much, damaging surrounding cartilage and joints. In this procedure surgeons remove most or all of the affected synovium, either in a traditional, open surgery or using arthroscopy.
Best candidates: People with limited cartilage damage in the affected area who have tried anti-inflammatory medications but continue to have inflammation or overgrowth of the synovium around the knee, elbow, wrist, fingers or hips.
Arthrodesis, or Fusion - in this procedure, surgeons use pins, plates, rods or other hardware to join two or more bones in an ankle, wrist, thumb, finger or the spine, making one continuous joint. Over time the bones grow together and lock the joint in place.
Best candidates: People with severe joint damage from OA or inflammatory arthritis.
Total Joint Replacement (TJR), or Total Joint Arthroplasty - in this procedure the damaged joint is replaced with an implant that mimics the motion of the natural joint. Implants are made from combinations of metal, plastic and/or ceramic components.
Best candidates: People with severe joint pain who haven’t been helped by other treatments. Improvement in implant durability means that TJR is more common in younger people than in the past.
Minimally Invasive Total Joint Replacement - this technique replaces a damaged joint but uses shorter incisions than in a traditional TJR. Less muscle is cut and reattached.
Best candidates: Active, normal-weight people younger than 50 years.
Joint Revision - this surgery is to remove a failed, infected or worn-out implant and replace it with a new one.
Best candidates: People with a damaged artificial joint. Implants can last 15 to 20 years, but those who get them as young adults may eventually need one or more revisions.