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Do you have knee pain from osteoarthritis? You might not need surgery. Here’s what to try instead

<p><em><a href="https://theconversation.com/profiles/belinda-lawford-1294188">Belinda Lawford</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/joshua-zadro-504754">Joshua Zadro</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/rana-hinman-1536232">Rana Hinman</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p>Most people with knee osteoarthritis can control their pain and improve their mobility without surgery, according to <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">updated treatment guidelines</a> from the Australian Commission on Safety and Quality in Health Care.</p> <p>So what is knee osteoarthritis and what are the best ways to manage it?</p> <h2>More than 2 million Australians have osteoarthritis</h2> <p>Osteoarthritis is the most common joint disease, affecting <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">2.1 million Australians</a>. It <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">costs the economy</a> A$4.3 billion each year.</p> <p>Osteoarthritis commonly <a href="https://pubmed.ncbi.nlm.nih.gov/33560326/">affects</a> the knees, but can also affect the hips, spine, hands and feet. It impacts the whole joint including bone, cartilage, ligaments and muscles.</p> <p>Most people with osteoarthritis have persistent pain and find it difficult to perform simple daily tasks, such as walking and climbing stairs.</p> <h2>Is it caused by ‘wear and tear’?</h2> <p>Knee osteoarthritis is most likely to affect older people, those who are overweight or obese, and those with previous knee injuries. But contrary to popular belief, knee osteoarthritis is <a href="https://pubmed.ncbi.nlm.nih.gov/31192807/">not caused by</a> “wear and tear”.</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/21281726/">Research shows</a> the degree of structural wear and tear visible in the knee joint on an X-ray does not correlate with the level of pain or disability a person experiences. Some people have a low degree of structural wear and tear and very bad symptoms, while others have a high degree of structural wear and tear and minimal symptoms. So X-rays are <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">not required</a> to diagnose knee osteoarthritis or guide treatment decisions.</p> <p>Telling people they have wear and tear can make them worried about their condition and afraid of damaging their joint. It can also encourage them to try invasive and potentially unnecessary treatments such as surgery. We have <a href="https://pubmed.ncbi.nlm.nih.gov/37795555/">shown this</a> in people with osteoarthritis, and other common pain conditions such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9545091/">back</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/33789444/">shoulder</a> pain.</p> <p>This has led to a global call for a <a href="https://pubmed.ncbi.nlm.nih.gov/38354847/">change in the way</a> we think and communicate about osteoarthritis.</p> <h2>What’s the best way to manage osteoarthritis?</h2> <p>Non-surgical treatments work well for most people with osteoarthritis, regardless of their age or the severity of their symptoms. These <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">include</a> education and self-management, exercise and physical activity, weight management and nutrition, and certain pain medicines.</p> <p>Education is important to dispel misconceptions about knee osteoarthritis. This includes information about what osteoarthritis is, how it is diagnosed, its prognosis, and the most effective ways to self-manage symptoms.</p> <p>Health professionals who use positive and reassuring language <a href="https://pubmed.ncbi.nlm.nih.gov/35750241/">can improve</a> people’s knowledge and beliefs about osteoarthritis and its management.</p> <p>Many people believe that exercise and physical activity will cause further damage to their joint. But it’s safe and can reduce pain and disability. Exercise has fewer side effects than commonly used pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/36593092/">paracetamol and anti-inflammatories</a> and can <a href="https://pubmed.ncbi.nlm.nih.gov/26488691/">prevent or delay</a> the need for joint replacement surgery in the future.</p> <p>Many types of exercise <a href="https://pubmed.ncbi.nlm.nih.gov/30830561/">are effective</a> for knee osteoarthritis, such as strength training, aerobic exercises like walking or cycling, Yoga and Tai chi. So you can do whatever type of exercise best suits you.</p> <p>Increasing general physical activity is also important, such as taking more steps throughout the day and reducing sedentary time.</p> <p>Weight management is important for those who are overweight or obese. Weight loss <a href="https://pubmed.ncbi.nlm.nih.gov/34843383/">can reduce knee pain and disability</a>, particularly when combined with exercise. Losing as little as 5–10% of your body weight <a href="https://pubmed.ncbi.nlm.nih.gov/36474793/">can be beneficial</a>.</p> <p>Pain medicines should not replace treatments such as exercise and weight management but can be used alongside these treatments to help manage pain. <a href="https://pubmed.ncbi.nlm.nih.gov/33786837/">Recommended medicines</a> include paracetamol and non-steroidal anti-inflammatory drugs.</p> <p>Opioids are <a href="https://pubmed.ncbi.nlm.nih.gov/35137418/">not recommended</a>. The risk of harm outweighs any potential benefits.</p> <h2>What about surgery?</h2> <p>People with knee osteoarthritis commonly undergo two types of surgery: knee arthroscopy and knee replacement.</p> <p>Knee arthroscopy is a type of keyhole surgery used to remove or repair damaged pieces of bone or cartilage that are thought to cause pain.</p> <p>However, high-quality research <a href="https://pubmed.ncbi.nlm.nih.gov/24369076/">has shown</a> arthroscopy is not effective. Arthroscopy should therefore not be used in the management of knee osteoarthritis.</p> <p>Joint replacement involves replacing the joint surfaces with artificial parts. In 2021–22, <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">53,500 Australians</a> had a knee replacement for their osteoarthritis.</p> <p>Joint replacement is often seen as being inevitable and “necessary”. But most people can effectively manage their symptoms through exercise, physical activity and weight management.</p> <p>The new guidelines (known as “care standard”) recommend joint replacement surgery only be considered for those with severe symptoms who have already tried non-surgical treatments.</p> <h2>I have knee osteoarthritis. What should I do?</h2> <p>The <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">care standard</a> links to free evidence-based resources to support people with osteoarthritis. These include:</p> <ul> <li>education, such as a <a href="https://www.england.nhs.uk/wp-content/uploads/2023/07/making-a-decision-about-knee-osteoarthritis-v1.pdf.pdf">decision aid</a> and <a href="http://www.futurelearn.com/courses/taking-control-hip-and-knee-osteoarthritis">four-week online course</a></li> <li>self-directed <a href="https://healthsciences.unimelb.edu.au/departments/physiotherapy/chesm/patient-resources/my-knee-exercise">online exercise</a> and <a href="https://myjointyoga.com.au/">yoga</a> programs</li> <li><a href="https://www.gethealthynsw.com.au/program/standard-coaching/">weight management support</a></li> <li>pain management strategies, such as <a href="https://www.myjointpain.org.au/">MyJointPain</a> and <a href="http://www.paintrainer.org/">painTRAINER</a>.</li> </ul> <p>If you have osteoarthritis, you can use the <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">care standard</a> to inform discussions with your health-care provider, and to make informed decisions about your care.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236779/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/belinda-lawford-1294188"><em>Belinda Lawford</em></a><em>, Postdoctoral research fellow in physiotherapy, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/joshua-zadro-504754">Joshua Zadro</a>, NHMRC Emerging Leader Research Fellow, Sydney Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/rana-hinman-1536232">Rana Hinman</a>, Professor in Physiotherapy, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">original article</a>.</em></p>

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Researchers puzzled by results of anti-inflammatory medications for osteoarthritis

<p>Researchers in the US are calling for a re-evaluation of the way some well known painkillers are prescribed after research showed they may actually lead to a worsening of inflammation over time in osteoarthritis-affected knee joints.</p> <p>NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen and naproxen are designed to reduce inflammation for the estimated 2.2 million Australians suffering from the sometimes debilitating effects of osteoarthritis.</p> <p>Osteoarthritis is a degenerative condition affecting joints in the body – most commonly hips, knees, ankles, spine and hands – which results from the degradation of cartilage on the ends of bones within the joints. As the cartilage wears away, the bones rub together resulting in swelling, pain and restricted movement.</p> <p>To combat this pain and swelling, NSAIDs are commonly prescribed, however the long-term impact of this type of medication is unclear, including its effect on the progression of the condition.</p> <p>“To date, no curative therapy has been approved to cure or reduce the progression of knee osteoarthritis,” said the study’s lead author, Johanna Luitjens, from the Department of Radiology and Biomedical Imaging at the University of California, San Francisco. “NSAIDs are frequently used to treat pain, but it is still an open discussion of how NSAID use influences outcomes for osteoarthritis patients.</p> <p>Surprisingly the report says: “…the impact of NSAIDs on synovitis, or the inflammation of the membrane lining the joint, has never been analysed using MRI-based structural biomarkers.”</p> <p>The study compared 793 participants with moderate to severe osteoarthritis of the knee who did not use NSAIDs, with 277 patients who received sustained treatment with NSAIDs for more than a year. Each patient underwent Magnetic Resonance Imaging (MRI) scans of the joint, which were then repeated after four years.</p> <p>The researchers were able to assess the images for indications of inflammation and arthritis progression including cartilage thickness and composition.</p> <p>The data showed the group using NSAIDs, had worse joint inflammation and cartilage quality than those not using NSAIDs, at the time of the initial MRI scan. And the follow-up imaging showed the conditions had worsened for the NSAID group.</p> <p>“In this large group of participants, we were able to show that there were no protective mechanisms from NSAIDs in reducing inflammation or slowing down progression of osteoarthritis of the knee joint,” said Luitjens.</p> <p>According to Luitjens, the common practice of prescribing NSAIDs for osteoarthritis should be revisited as there doesn’t appear to be any evidence they have a positive impact on joint inflammation nor do they slow or prevent synovitis or degenerative changes in the joint.</p> <p>There is also a possibility that NSAIDs simply mask the pain. Despite adjusting the study’s model for individual levels of patient physical activity, “patients who have synovitis and are taking pain-relieving medications may be physically more active due to pain relief, which could potentially lead to worsening of synovitis,” said Luitjens.</p> <p>Luitjens hopes future studies will better characterise NSAIDs and their impact on osteoarthritic inflammation. With one in three people over the age of 75 in Australia suffering from osteoarthritis and an estimated one in 10 women and one in 16 men set to develop it in the future, unlocking treatment options for this crippling condition is an imperative.</p> <p><strong>This article originally appeared on <a href="https://cosmosmagazine.com/science/osteoarthritis-puzzled-antiinflammatory/" target="_blank" rel="noopener">cosmosmagazine.com</a> and was written by Clare Kenyon.</strong></p> <p><em>Image: Shutterstock</em></p>

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The incredibly common disease making everyday life painful

<p>I have vivid memories of my gorgeous grandma sitting in her favourite chair in our living room at the end of the day, watching the chaos and bustle of family life unfolding around her.</p> <p>In my mind, she is always rubbing her knees, and when it came time for her to go to bed, helping her up was always accompanied by groans and utterances (she was far too polite to swear) as her joints had seized up and moving was agony.</p> <p>I know now that she had osteoarthritis (OA), and probably quite severely. But back then it was just "grandma's knees" and something that was to be expected for all older people.</p> <p>Sadly for many older people, and some younger ones too, this is true – this type of joint disease is incredibly common, and more so as we age. Figures show that half of us will get OA in our knees during our lives, and 1 in 4 of us will have it in our hips by the time we reach 85 years old. Other joints commonly involved include hands, neck and lower back.</p> <p>OA is really a process of "wear and tear". The overuse of our primary weight bearing joints (ie knees and hips) as well as joints we are constantly moving (such as the small joints in our hands) eventually leads to destruction of the cartilage, whose role is to provide a cushion between the bones ends.</p> <p>Once this cartilage starts to erode, fluid and inflammation build up in the joint, the bone ends become ragged and can even start to chip off, and eventually all that is left is bone rubbing against bone.</p> <p>The symptoms caused by this process vary depending on which joints are affected, but classically include:</p> <p>- Pain on movement, especially when getting out of bed in the morning, or, as in my grandma's case, after sitting or resting for a long time</p> <p>- Pain in the affected joints at rest</p> <p>- Swelling in and around the joints – this may be particularly evident in joints such as knees and hands</p> <p>- Weakness of the muscles around the joints</p> <p>- Creaking or crackling in the joints with movement</p> <p>- Restricted movement in the affected joints</p> <p>- Permanent deformity of the joints, especially evident if the fingers are affected.</p> <p>Sadly, there is no magic cure for avoiding OA, but knowing if you are at risk is important, as there are steps you can take to try and look after your joints.</p> <p>Although most of us will develop some degree of OA as we get older, there are definitely groups of people who are likely to be affected at a much younger age – these include those with a strong family history of OA, athletes who have "overused" their joints or had repeated injuries (the classic being rugby players who often need joint replacements in their 40s and 50s), people with high impact occupations such as farmers, and those who are obese as the extra weight puts more strain on ageing joints.</p> <p>If you think you fall into a high risk group, it's important to try and minimise the impact on your joints as much as you can – you can do this by altering what kind of exercise you do (for example water based activities are far less likely to cause a problem than running on a hard surface); ensuring you wear good, cushioned footwear at all times; reducing your weight if that is an issue; following a good "Mediterranean" diet high in olive oil, fruit, vegetables, fish and nuts; and avoiding injury where possible. Easier said than done I know.</p> <p>The other key piece of advice for anyone suffering from OA is to talk to a health professional early. The pain and immobility OA causes can have a huge impact on your life, and eventually may start to affect your mental well-being as well as your ability to function as you would like. You don't need to suffer to that extent and managing your symptoms early will lead to a much better quality of life.</p> <p>There are great options now for pain relief, most of which work best if they are used regularly, as well as good exercise regimes that will help ensure your joints stay mobile and functional for as long as possible. Alternative therapies such as acupuncture can help some people reduce the swelling and pain, and good physio or hydrotherapy can vastly improve functioning.</p> <p>If the "first line" treatments haven't worked, I would suggest you ask your doctor what else can be done – more invasive management includes steroid injections into the affected joints, surgery to "clean up" the wear and tear in a joint, or joint replacement where the affected joint is removed and replaced with an artificial one. The good news is that OA is an area where much research is happening, so the future will hopefully bring different treatment options that avoid the need for major surgery.</p> <p>If you or a loved one suffer from OA, or any other type of joint problem, I would highly recommend you get in touch with Arthritis New Zealand (<em><a href="http://www.arthritis.org.nz/" target="_blank">www.arthritis.org.nz</a></em>) – they are there to help, support, connect and advise and have a wealth of really useful resources.</p> <p><em>Written by Dr Cathy Stephenson. Republished with permission of <a href="https://www.stuff.co.nz/life-style/well-good/teach-me/106397044/dr-cathy-stephenson-the-incredibly-common-disease-making-everyday-life-painful" target="_blank">Stuff.co.nz</a>.</em></p>

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