- What is Osteoarthritis (OA) And How Is It Diagnosed?
- The Four Stages Of Knee Pain
- Non-Surgical Treatments
- Surgical Treatments
- Last Word
1. What is Osteoarthritis (OA) And How Is It Diagnosed?
The Merriam-Webster Dictionary defines it as “a common form of arthritis typically with onset during middle or old age that is characterized by progressive degenerative changes in the cartilage of one or more joints (as of the knees, hips, and hands) accompanied by thickening and overgrowth of adjacent bone and that is marked symptomatically chiefly by stiffness, swelling, pain, deformation of joints, and loss of range of motion —abbreviation OA” (1)
The doctor will check the affected joints for pain, swelling, tenderness and heat. Sometimes, a joint may have an inflammation but does not feel warm. You may also be required to go for an X-Ray and/or MRI (Magnetic resonance Imaging). As the X-Ray will only show bones, loss of cartilage is seen using the MRI. Blood test is also commonly used but as OA cannot be detected via a blood test, this test is usually undertaken to exclude other causes of joint paint, for example, rheumatoid arthritis. Another method used is the Joint Fluid Analysis where the doctor will extract fluid from the distressed joint and test it for inflammation to detect if the pain is triggered by gout, OA or an infection.
Please take note that currently, there is no known cure for OA but the symptoms can be managed.
2. The Four Stages Of Knee Pain
According to the Illinois Bone & Joint Institute, there are four stages of OA of the knee (with “0” allocated to a normal knee). (2) The stages are:
Stage 1 – Minor
Patients usually do not feel any pain or discomfort at Stage 1 where the knees suffer very little deterioration and/or bone spur growths at the knee joints. The doctor will not recommend any treatment other than telling the patient to take daily supplements of glucosamine and chondroitin.
Stage 2 – Mild
Patients will start experiencing joint pain. X-Rays will show more bone spurs at the knee joints which will feel rigid, sore, tight and painful. Although the cartilage and soft tissues may be still healthy, an additional production of enzymes (for example, metalloproteinases) will breakdown the cartilage. The doctor will advise that patients adhere to a stringent exercise regimen to lose weight, build strength and stamina. They will also be encouraged to wear knee braces and sole inserts to support the weak knees.
Stage 3 – Moderate
Patients experience more pain and stiffness in the joints where the cartilage is eroded. There is inflammation which prevents patients from walking properly or steadily, kneeling, climbing up or going down stairs and squatting. There is even soreness, twitches and pain if patients sit or stand for too long and when they get up from bed in the morning. Some may even hear “snapping” sounds when trying to walk. The doctor will prescribe pain killers together with anti-inflammatory medication.
Stage 4 – Severe
Patients experience greater pain at this stage. Running, walking, squatting and kneeling are virtually impossible because the space between the knee joints is so worn out. There is constant pain, swelling and stiffness leading to chronic joint inflammation. During this time, more bone spurs develop at the knee joints. Here, osteotomy or bone realignment surgery may be required.
3. Non-Surgical Treatments
Patients are advised to stick to an exercise routine that helps them to lose weight. This is because by losing weight, there will be less pressure on the knees and when there is less pressure, there will be less wear and tear on the joints. If patients are unable to jog because of the pain, they should swim. In addition, they should also perform exercises that help them to build strength so that the muscles around the knees are able to support them when they are trying to stand up or move around.
(b) Pain Relief Medication
Usually, doctors will prescribe pain killers and anti-inflammatory medicine together so that patients can manage the pain more effectively. In addition, the type of medicine given will depend on the severity of the pain, the patient’s medical history and also whether the patient is currently on any medication that may hinder the efficacy of the pain relief medication to be recommended.
(c) Steroid Injections
These injections contain the hormone, Cortisol (which is man-made) and are prescribed only when other treatments do not work. The patient is given a local anaesthetic and then the injection is made straight to the affected joint. The injection works very quickly and can reduce the pain for many weeks or months.
(d) Capsaicin Cream
The cream is given to patients when normal pain killers do not work. Patients will be able to find some relief after using this for two weeks but it would take up to one month for the treatment to be more effective. The disadvantage is that the cream does not provide immediate relief and often, patients have to use it for quite some time before any effect is felt.
(e) Hot or Cold Compression Packs
Patients can purchase such packs from local pharmacies or lifestyle stores. For a hot compression, patients can use a hot water bottle. For a cold compression, patients can put the packs into the fridge to be used later as required.
Depending on the gravity of the pain and the current physical situation of the patient, the doctor may recommend physiotherapy. Older patients find this especially useful as there is someone to guide them along the way through the exercises.
4. Surgical Treatments
Surgery is proposed only when all the other treatments do not work and/or when one of the joints is significantly damaged. While surgery often improves the quality of life of the patient, it does not guarantee that all symptoms of OA will be removed. A popular surgical procedure called Joint Replacement (Arthroplasty) is used for knee joints. Here the surgeon will remove the affected joint and replace it with a synthetic one made of specialised plastic and metal which can last up to twenty years. After the surgery is completed, the patient will need to attend the relevant physiotherapy sessions to complement a speedy recovery.
5. Last Word
If you are already experiencing joint pain, please consult a doctor early so that you can receive relevant treatment faster and that your quality of life will not be greatly affected.