Symptoms
Knee osteoarthritis manifests itself as knee pain, which occurs primarily during physical activity and when the joint is under stress. They are often triggered at the beginning of movement (start-up pain), when climbing stairs, when standing up or when walking longer distances. Other complaints include limitation of mobility and quality of life, instability, an audible crunch, swelling, inflammation, bony enlargement, limping, and stiffness that resolves with movement.
Causes
Knee osteoarthritis is a chronic degenerative joint disease that results from damage and wear of the protective and shock-absorbing cartilage substance. This leads to increased stress on the bones and eventually to the femur rubbing directly against the tibia and kneecap. All structures of the joint are affected. Known risk factors include:
- Obesity
- Age
- Inheritance
- Female gender
- Sedentary lifestyle
- Occupation with increased knee load
- Stimulants: alcohol, smoking
Osteoarthritis can also occur secondarily as a result of disease, deformities and injuries.
Diagnosis
Diagnosis is made in medical treatment on the basis of physical complaints, patient history and imaging techniques (eg, X-ray, MRI). Knee pain from other causes must be excluded.
Nonpharmacologic treatment
There is currently no cure for osteoarthritis. The two main goals are to relieve symptoms and halt progression of the disease. Treatment is complex and requires multidisciplinary interaction among various specialists. Possible nonpharmacologic measures include:
- Nutritional counseling, weight reduction
- Physical exercise that is easy on the joints
- Physiotherapy
- Physical therapy: heat, cold, electricity, light
- Knee supports, taping, shoe inserts.
- Psychological support
- Aids, for example walking aids
- Minimally invasive to surgical interventions, corrective surgery, knee replacement
- Complementary medicine
Drug treatment
Pain medication:
- For symptomatic treatment of pain, analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, and opioids such as codeine and tramadol may be used.
- Because of the potential adverse effects of NSAIDs, paracetamol should be started. The maximum daily dose is 4000 mg for adults. NSAIDs should be combined with gastric protection such as pantoprazole.
Local therapy:
- Topical treatments include rubbing in topical NSAIDs such as a diclofenac gel, as well as arnica, green lipped mussel, devil’s claw and comfrey ointments. The use of capsaicin is also mentioned in the literature.
Intra-articular hyaluronic acid:
- Has lubricating, shock-absorbing and nourishing properties. It is used for symptomatic treatment. The drug is injected into the diseased joint 3 to 5 times at weekly intervals. The effect lasts up to 6 months or longer. The treatment is usually well tolerated.
Glucocorticoids (cortisone):
- Such as triamcinolone acetonide are also injected directly into the joint and have analgesic and anti-inflammatory properties. The application should not be too often.
Nutritional supplements:
- There are many dietary supplements for the treatment of osteoarthritis on the market. Among the best known is chondroitin sulfate, which is approved as a drug in many countries. It is a natural component of the proteoglycans in cartilage. The drug is believed to have analgesic, anti-inflammatory and immunomodulatory properties. Possible adverse effects include digestive disturbances. Others: glucosamine, green-lipped mussel, diacerein.
Phytopharmaceuticals:
- Preparations from the roots of devil’s claw native to southern Africa and are attributed anti-inflammatory and analgesic properties. They are taken in the form of finished medicines.
- Willow, rosehip powder
Evidence of efficacy has not been provided for all listed drugs and other supplements such as S-adenosylmethionine, turmeric and ginger are mentioned in the literature.
