Knee Arthritis

Osteoarthritis: cause is not known

• Age: risks increase with advancing age
• Sex: women are more likely to have osteoarthritis
• Bone deformities: results in mal-alignment of weight bearing joint and acceleration of wear and tear of the articular cartilage
• Joint injuries: injuries that occur during sports activities or accident
• Other diseases: Diabetes, dysfunctioning thyroid

Rheumatoid arthritis: is an autoimmune disease

• Age: any age, mostly around 40-60 years of age
• Sex: women are more likely affected
• Family history: positive family history of the disease
   

Post-traumatic arthritis

• Direct injury: articular cartilage injury
• indirect injury: injury to knee ligament, meniscus or limb alignment may accelerate the process of cartilage wear and tear

These include pain, swelling and stiffness. The pain is typically worse in early morning after period of inactivity, will be transiently improved with movement but then worse again with prolonged activities. These symptoms impair activities of daily living e.g. walking, squatting and standing and may become severe enough to disturb the sleep at night time.

Knee arthritis can be diagnosed by detailed medical and family history, physical examination, biochemical tests as well as radiological imaging.
 

Biochemical tests:

• These tests are useful for diagnosing inflammatory arthritis.
• Inflammatory markers like ESR, CRP and autoimmune markers like RF, ANA, ds DNA etc may be helpful in diagnosis of certain types of inflammatory arthritis.
• Knee arthrocentesis for joint fluid may also be taken for investigation of septic arthritis and gouty arthritis

X-ray will disclose:

• joint space narrowing, osteophytosis, subchondral sclerosis and subchondral cysts in osteoarthritis
• soft tissue swelling, bony erosion in Rheumatoid arthritis
• malunion, malalignment in post-traumatic arthritis
   

MRI is useful for study of soft tissue and pathologies.

• early detection of articular cartilage changes
• early detection of knee synovitis, inflammatory aggregate
• early detection of knee ligaments and menisci injury

Conservative management:

Majority of knee arthritis can be treated conservatively as the followings:

• Lifestyle modification
  • weight control: aims to reduce load in osteoarthritic knee
  • avoid aggravating activities: e.g. running, jumping, certain sports
  • walking aids: like cane and crutches, help to share loads across the knee
• Physiotherapy
  The physiotherapist will design tailored programme to control symptoms of pain and swelling as well as exercise therapy to stretch and strengthen muscle group to improve limb function for daily activities.
• Medications
  The doctor will prescribe drugs to treat types of arthritis accordingly.
• NSAIDS
  Most common drugs are nonsteriodal anti-inflammatory drugs (NSAIDs). Cox-2 inhibitor is a group of NSAIDs with excellent pain control and fewer GI side effects.
• Glucosamine
  Glucosamines are constituents of articular cartilage and may be prescribed as supplement for you.
• Intraarticular injection of hyaluronic acid
  Hyaluronic acid is a chief component in extracellular matrix and joint fluid. It may be helpful in case of osteoarthritis.

Surgical management:

Surgical management will be recommended if conservative measures failed.
Options include: knee arthroscopy and knee arthroplasty

• Knee arthroscopy
  The doctor may offer knee arthroscopy for treating intra-articular pathologies.
• Knee arthroplasty:
  Knee arthroplasty is artificial component designated to replace worn out joints.
   

Rehabilitation management:

The doctor and physiotherapy will collaborate to design an optimal rehabilitation program to suit your clinical condition.