Knee arthritis is inflammation in the joints or area of the body where two bones come together. Joints are responsible for the movement of body parts. It is a condition that can be experienced all over the body or in a specific area. The types range from those related to wear and tear of cartilage, such as osteoarthritis to those associated with inflammation resulting from an overactive immune system, such as rheumatoid arthritis. The one part of the body that is most affected by arthritis is the knee and it can suffer from both rheumatoid or osteoarthritis.
Rheumatoid arthritis (RA), is a chronic inflammatory disorder that most typically begins in the small joints in your hands and feet. However, the course can begin with other nonspecific symptoms, such as tiredness. After attacking the smaller joints of the body, RA often progresses into larger joints, such as the shoulders, elbows, hips, and knees. Symptoms include joint pain, swelling, red and puffy hands, and fatigue. RA degrades the lining of the joints and causes swelling that is painful and can lead to joint deformity in the affected joints. Rheumatoid arthritis tends to worsen over time. Though there is no permanent cure, the course of the disease can be modified so that the damage is less, the patient is more comfortable and the patient can continue to engage in and enjoy daily activities. Treatment is most effective when it is begun as early as possible, before the process of deformity is far progressed, but some relief can be offered by treatment at any stage.
Osteoarthritis is a joint disease that causes the cushion layer between one's bones, or cartilage to wear away. It is also called degenerative joint disease. Symptoms are similar to RA and develop in the same slow manner. They include pain, tenderness in the knee, stiffness when standing or walking, loss of flexibility, and grating sensations that can be heard when the knee joint is used.
Osteoarthritis in the knee begins with the gradual deterioration of cartilage. Without the protective cartilage, the bones begin to rub together, causing pain, loss of mobility, and deformity. It affects approximately 16 million people. The majority of arthritis cases involving the knee are osteoarthritic cases.
It is not always certain why arthritis of the knee develops. Most physicians believe that it is a combination of factors that can include muscle weakness, obesity, heredity, joint injury or stress, constant exposure to the cold, and aging. Cartilage in the knee begins to break down and leaves the bones of the knee rubbing against each other as you walk. Persons who work in a place that applies repetitive stress on the knees are at a high risk of developing this condition. Bone deformities increase the risk for osteoarthritis of the knee since the joints are already malformed and may contain defective cartilage. Having gout, rheumatoid arthritis, Paget's disease of bone or septic arthritis can increase your risk of developing osteoarthritis. Some physicians and most podiatrist believe that Pes Planus (flat feet) cause increased rates and earlier incidence of knee osteoarthritis. In a study of army recruits with moderate to severe flat feet, the results showed that they had almost double the rate of knee arthritis when compared to recruits with normal arches.
Diagnosis of knee osteoarthritis depends on a focused medical history and on a physical examination of the affected knee. In particular, a history of persistent knee pain, limited (low) morning stiffness and reduced function in addition to physical exam findings of crepitus (feeling of cracking or popping with movement of the joint), restricted movement and bony enlargement were found to be the most useful diagnostics markers in one study. Standardized medical questionnaires like the Knee injury and Osteoarthritis Outcome Score (KOOS) and short form KOOS JR. or the Knee Injury and Osteopaedic Outcome Score (WOMAC) can also be used to diagnose and monitor progression of knee osteoarthritis.
Depending on the level of pain and damage suffered by a patient, a physician will recommend a treatment regimen that will relieve symptoms. Some of the most common recommendations include avoiding activities that make the pain worse, ice the knee for 20 to 30 minutes throughout the day to reduce inflammation, use over the counter anti-inflammatory medications, paracetamol (acetaminophen) and physical therapy.
Topical creams and patches can also be used for pain treatment and they have been proven to reduce pain by 33 to 57%.
Exercises can help increase range of motion and flexibility as well as help strengthen the muscles in the leg. Physical therapy and exercise are often effective in reducing pain and improving function. Working with a physical therapist to find exercises that promote function without risking further injury is effective for most patients. Many of the exercises used can be performed while sitting in a chair or standing in place. They are performed so that additional stress or weight is not placed on the knee joint. Water exercises are highly recommended along with the use of elastic bands.
A Cochrane review could not conclude whether high-intensity exercises provide better results than low-intensity exercises.
Supportive devices like knee braces can be used. In most cases, the arthritis is centered on a single side of the knee, so braces are effective in providing stability to one side. Two different forms of braces are available. A support brace provides the aid the entire knee requires, where an up-loader brace shifts the pressure away from the specific part of the knee that is experiencing the pain. Shoes or inserts that are considered to be energy absorbing are found useful for some patients as well as walking devices like a cane. Shoe insoles that are fitted to correct flat feet have provided relief to many patients.
The use of oral steroids and anti-inflammatory medicines help to reduce the amount of inflammation and pain felt in the knee. If over the counter medicines like ibuprofen or naproxen are not strong enough, prescription strength medicines are used. If oral medicine and physical therapy don't help your knee enough, doctors may consider giving patients injections with pain medicine. Hyaluronic acid is present in the knee, but injections of it can be used to protect the joint when the cartilage becomes thinner and can't do it alone. These injections can provide more pain relief than oral medications lasting from six months to a year.
Surgery is the final option but may be required to relieve symptoms. Arthroscopy is performed through tiny cuts where damaged parts of the knee can be removed. Osteotomy is performed to reshape the bones in the knee and is only performed if one side of the knee is damaged. Arthroplasty is a replacement surgery where an artificial joint is used.
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