Seeking relief from the chronic knee pain of osteoarthritis
Updated 4:05 pm, Friday, August 15, 2014
Q: I have terrible arthritis in my knees. I was wondering if there are any injections that can rebuild the cartilage and fix my problem. I am scared to have surgery and don't want to have to take pain pills all the time.
A: Osteoarthritis is a common form of arthritis that often affects the knees. It is caused by wear and tear over time. The joints are lined by a smooth tissue called cartilage. This thins out from heavy use and eventually breaks down. The surface of the bones becomes damaged, causing pain, swelling, stiffness and disability. First line treatment for osteoarthritis of the knee is taking such anti-inflammatory medications as ibuprofen or pain relievers, such as Tylenol. These medications can have side effects or interact with other medications, so make sure to check with your doctor first if you plan on using any of these agents on a regular basis.
Weight loss can help arthritis by reducing the amount of pressure on the knee joints. Physical therapy is also important, as it will help build up the strength of the muscles that surround the knee joints and help them work more efficiently. When these strategies fail, doctors try some other medications that they can inject into the knees.
There are two types of injections that doctors will consider. The first type of injection involves draining any fluid out of the knee and then putting in a medication, called a corticosteroid, to help reduce swelling that is caused by the joint bones rubbing against one another. These injections work quickly by reducing the swelling in the joint that is causing pain and limiting flexibility. However, the effects wear off over time. On average, the pain relief lasts from six to 12 weeks. You can't use them too frequently either, because over time, high doses of corticosteroids can damage the cells in the knee that make cartilage. Most doctors limit these shots to two or three a year. There are some side effects to consider, including pain or swelling around the injection site, a small chance for infection and damage to surrounding tissue, especially if this treatment is used too often.
Another option for joint injections is with a group of medicines called viscosupplements. Most of the fluid in a healthy knee is hyaluronic acid. People with osteoarthritis have lower levels of hyaluronic acid in their joints. Your doctor can inject more hyaluronic acid into your knee to boost the supply. There are five versions of hyaluronic acid injections available in the United States. Some types require only one injection. Others require up to five injections, usually within a five-week period. They can be repeated in six months if not effective the first time. Studies have shown that hyaluronic acid injections may help some people with osteoarthritis. Pain relief is not immediate, but over time you may notice less knee pain. It seems to work better in the earlier stages of arthritis.
Another treatment getting attention is platelet-rich plasma. This requires drawing a sample of your blood and processing it to create a fluid that contains a higher-than-normal amount of platelets, which are small clotting agents in your blood. These get injected back into your joints to help heal damage by chemicals contained in the platelets. Experts still know little about whether it works for knee osteoarthritis and use of this method is still experimental.
Other alternative therapies for knee osteoarthritis that have shown benefit in studies are massage, yoga and acupuncture. Some people also feel they have less pain when taking herbal supplements. These treatments have not shown much benefit in controlled studies. As with any supplement, always check with your doctor or pharmacist to make sure there aren't any interactions with your other medications.
Questions can be mailed to Center for Geriatrics, care of Ask Dr. Viv, 95 Armory Road, Stratford CT 06614 or emailed to firstname.lastname@example.org.