The knee is the human body’s largest joint and its healthy maintenance is required to perform most of the everyday activities, easily. The knee joint is formed by the thighbone’s (femur’s) lower portion, the shinbone’s (tibia’s) upper portion, and the cap of the knee referred to as the patella. The ends of these three bones where they meet are covered with a smooth substance that protects the bones and enables them to move easily (articular cartilage). The C-shaped wedges present between the thighbone and the shinbone are known as menisci. They function as the natural “shock absorbers” protecting the joint. The thigh and shinbones are held together by large ligaments, lending stability to the joint whereas the long thigh muscles make the knee strong. All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane secretes a liquid that moistens the cartilage, minimizing friction to almost zero in the case of a healthy knee. Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function.

Although there are more than 100 types of Arthritis, the three most common types are Osteoarthritis, Rheumatoid arthritis and Post-traumatic arthritis. In this article, we will majorly focus on Osteoarthritis.

What is Osteoarthritis (OA)?

Osteoarthritis is an age-related “wear and tear” type of arthritis. It generally affects persons aged 50 years or more, but may also affect younger individuals. In this type of arthritis, the cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness. Osteoarthritis (OA) of the knee happens when the cartilage, the cushion between the knee joints deteriorates. This can cause pain, stiffness and swelling. Appropriate treatment can help relieve discomfort and slow the damage. It can also improve your quality of life facilitating you to better keep up with your day-to-day activities.

What are the causes of  Osteoarthritis?

• Age: The risk of developing OA increases as someone gets older because bones, muscles and joints are also aging. 
• Joint injury
• Using the same joints over and over in a job or sport can result in OA.
• Obesity: Extra weight puts more stress on joint and fats cells to promote inflammation.
• Weak muscles: Joints can get out of the right position when there’s not enough support.
• Hereditary: People with family members having OA can also suffer from OA.
• Women are more likely to develop OA than men.

What are the signs &  symptoms of OA?

• Joint stiffness and soreness
• Grating sensation
• Bone spurs
•  Loss of flexibility
• Pain or aching in the joint during activity
• Limited range of motion that may go away after movement
• Clicking or cracking sound when a joint bends
• Swelling around a joint.

How to Diagnose Osteoarthritis?

Osteoarthritis of the major joints is most effectively diagnosed through a combination of medical history, physical examination, and various lab tests including imaging studies such as X-ray. A physician can diagnose most of the cases but in some cases, he may refer you to an Orthopedic surgeon, physiatrist for further evaluation.

Medical History

Medical histories can often be the most useful tool for physicians in diagnosing osteoarthritis. The doctor will look for a family history of the disease as well as the presence of various risk factors to indicate the need for further testing.

Physical Examination

A physical examination will usually follow the medical history as the physician looks for physical signs of the disease. These include signs like swelling and tenderness of the joints, loss of movement in specific joints, or visible joint damage such as bony growths in the surrounding area. The patient may also be asked to perform a variety of physical tasks so the physician can evaluate the range of motion and general joint mobility.

What are the treatment options for Osteoarthritis?

General Management

Patients with osteoarthritis of the hand may benefit from assistive devices and instruction on techniques for joint protection; splinting (a rigid or flexible device that maintains in position a displaced or movable part) is beneficial for those with symptomatic osteoarthritis.

Patients with mild to moderate osteoarthritis of the knee or hip should participate in a regular exercise program (e.g. a supervised walking program, hydrotherapy (water cure) classes) and, if overweight, should follow a healthy and balanced diet. The use of assistive devices can improve functional status.

Medical Management

• Oral nonsteroidal anti-inflammatory drugs (NSAIDs) – Common NSAIDs are ibuprofen and diclofenac; painkillers.
• Topical therapies – Topical NSAIDs are applied to unbroken skin where it hurts in the form of gels, creams, sprays, or plasters.
• Intra-articular injections – A term used to define a shot delivered directly into a joint with the primary aim of relieving pain.

Surgical Measures

Total hip and knee replacements provide excellent symptomatic and functional improvement when the involvement of that joint severely restricts walking or causes pain at rest, particularly at night. Total Knee Replacement is one of the most common surgeries in the world with a large majority of patients going on to lead rich, happy and healthy lives. It requires a surgery of 1-2 hours followed by a hospital stay of 2-3 days.

The knee is the human body’s largest joint and is made up of the lower end of the thighbone, the upper end of the shinbone and the kneecap. A knee replacement includes replacing some or all of the component surfaces of the knee joint with artificial implants. A knee replacement is performed to repair the damaged weight-bearing surfaces of the knee joint caused due to inflammatory diseases or injury. The damage over time leads to extreme pain and can restrict joint mobility. Knee replacement is a major surgical procedure requiring hospital admission for 2 to 3 days.

Depending on the severity of the disease your doctor will suggest the best line of treatment to treat Osteoarthritis.

The Knee and its Structure

The knee is human body’s largest joint and its healthy maintenance is required to perform most of everyday activities, easily. The knee is made up of the lower end of the thighbone which is called the femur, the upper end of the shinbone which is called the tibia, and the kneecap which is called the patella. The ends of these three bones where they meet are covered with a smooth substance that protects the bones and enables them to move easily (articular cartilage). The C-shaped wedges located between the femur and tibia are menisci. These act as “shock absorbers” that cushion the joint. Large ligaments hold the femur and tibia together to provide stability, the long thigh muscles provide strength to the knee. Large ligaments hold the femur and tibia together and provide stability whereas, the long thigh muscles provide strength to the knee. All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage, reducing friction to nearly zero in a healthy knee. Normally, all of these components work in harmony. But disease or injury can disrupt this harmony which results in pain, muscle weakness, and reduced function.

What is Arthritis and different types of arthritis?

The most common disease responsible for disrupting the harmony and causing chronic knee pain and disability is arthritis. Swelling and tenderness in any of the joints of our body, including the knees is referred as arthritis.

Although there are many types of arthritis, mostly knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

• Osteoarthritis is an age-related type of arthritis. It occurs in people 50 years of age and older but may occur in younger people, too. In this type of arthritis, the cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
• Rheumatoid arthritis is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”

• Post-traumatic arthritis is a type of arthritis that can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, leading to knee pain and limiting knee function.

Treatment of Arthritis

Treatment of arthritis concentrates on providing relief from symptoms and improving function of the joint/knee. You may need to try multiple treatments or combine several treatments from the following to help you in getting relief from your arthritis.

• Lose some weight (in case of overweight or obese patients)

• Exercise: Muscle strengthening around the knees through exercise restores stability of the knee joint and reduces pain. Stretching of muscles through exercise aids in maintaining the mobility and flexibility of the knee joint

• Pain-killers: These include over-the-counter paracetamol, naproxen, diclofenac, etc. However, these should not be continued for more than 10 days without your doctor’s consultation.
• Corticosteroid or hyaluronic acid injections directly in the knee: Corticosteroids act as powerful anti-inflammatory agents whereas hyaluronic acid is a kind of lubricant in the knee.
• Alternative therapies such as topical counter-irritant creams containing capsaicin, acupuncture therapy or supplementation with glucosamine and others can sometimes help to improve arthritis symptoms.
• Physical or Occupational Therapy can also aid in teaching you ways of performing routine activity through exercises or alternate ways of performing routine work.

• Using braces: Devices such as braces can either transfer the weight from the sides of the knee affected by arthritis or even support the entire knee.
• Surgery: When every treatment from the above options fail to provide relief from arthritis of the knee, your doctor can recommend surgical options such as arthroscopy (removing the debris in the joint through a tiny telescope and other small equipments), osteotomy (altering the alignment of the knee by changing the knee’s shape) or total knee replacement (where the natural worn out knee joint is replaced by an artificial knee joint made of metals or plastic).

Usually, the treatment of arthritis is dependent on the specific type of arthritis present. But, sometimes the patients may need to try several different treatments, or combination of treatments before they determine what works best for them. However, in most cases, an exact diagnosis increases the chances for successful treatment of arthritis. After undergoing treatment, the doctor may recommend some physical therapy to help the patient regain strength in the knee and to restore range of motion making it possible to perform daily activities more effortlessly.

The word ‘arthritis’ is used to describe pain, swelling, and stiffness in one or more joints. However, it is not a single condition and there more than 100 types of arthritis and related conditions. The underlying cause varies with specific types of arthritis. It can cause everlasting joint changes and the common joint symptoms may include swelling, pain, stiffness, and decreased range of motion gradually.

These differences may be noticeable, such as lumpy finger joints, but usually, the damage can only be detected on X-ray. Apart from joints, some types of arthritis also affect the heart, eyes, lungs, kidneys, and skin. Although there are numerous types of arthritis, the two most common ones are Osteoarthritis and Rheumatoid arthritis.

Osteoarthritis

Osteoarthritis is a chronic (long-lasting) joint condition, affecting millions of people globally. In this case, the cartilage (protective tissues covering the ends of bones forming a joint) breaks down, causing the bones within the joint to rub together. Other causes may include dislocated joints and ligament injuries.

Signs that you may have Osteoarthritis:

• Joint stiffness and soreness
• Grating sensation
• Bone spurs
•  Loss of flexibility

Treatment of Osteoarthritis

A) General Management

Patients with osteoarthritis of the hand may benefit from assistive devices and instruction on techniques for joint protection; splinting (a rigid or flexible device that maintains in position a displaced or movable part) is beneficial for those with symptomatic osteoarthritis.

Patients with mild to moderate osteoarthritis of the knee or hip should participate in a regular exercise program (e.g. a supervised walking program, hydrotherapy (water cure) classes) and, if overweight, should follow a healthy and balanced diet. The use of assistive devices can improve functional status.

B) Medical Management

• Oral nonsteroidal anti-inflammatory drugs (NSAIDs) – Common NSAIDs are ibuprofen and diclofenac; painkillers.
• Topical therapies – Topical NSAIDs are applied to unbroken skin where it hurts in the form of gels, creams, sprays, or plasters.
• Intra-articular injections – A term used to define a shot delivered directly into a joint with the primary aim of relieving pain.

C) Surgical Measures

Total hip and knee replacements provide excellent symptomatic and functional improvement when the involvement of that joint severely restricts walking or causes pain at rest, particularly at night. Total Knee Replacement is one of the most common surgeries in the world with a large majority of patients going on to lead rich, happy and healthy lives. It requires a surgery of 1-2 hours followed by a hospital stay of 2-3 days.

The knee is human body’s largest joint and is made up of the lower end of the thighbone, the upper end of the shinbone and the kneecap. A knee replacement includes replacing some or all of the component surfaces of the knee joint with artificial implants. A knee replacement is performed to repair the damaged weight-bearing surfaces of the knee joint caused due to inflammatory diseases or injury. The damage overtime leads to extreme pain and can restrict joint mobility. Knee replacement is a major surgical procedure requiring hospital admission for 2 to 3 days.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease; a condition in which your immune system mistakenly attacks your body. It happens when your immune system targets your joints lining. While RA affects joints on both sides of the body such as both hands or both knees, it can also affect your whole body.

Signs that you may have Rheumatoid arthritis:

• Joint pain, swelling, and tenderness
• Morning stiffness for at least 30 minutes after waking up
• More than one joint affected (hands or wrists)
• Fever

Treatment of Rheumatoid arthritis

The primary objectives in treating rheumatoid arthritis are reduction of inflammation and pain, preservation of function, and prevention of deformity. Success requires early and effective medication. Disease-modifying anti-rheumatic drugs (DMARDs) should be started as soon as the diagnosis of rheumatoid disease is certain and then adjusted with the aim of suppressing disease activity. NSAID drugs are members of a drug class that reduces pain, decreases fever, prevents blood clots, and in higher doses, decreases inflammation and provides some symptomatic relief in rheumatoid arthritis but do not prevent erosions or alter disease progression. They are not appropriate for monotherapy (therapy that uses one type of treatment) and should only be used in conjunction with DMARDs, if at all.

Possible causes of arthritis may include injury, abnormal metabolism, inheritance, infections, or immune system dysfunction. Seek immediate medical care if you have swelling or stiffness that doesn’t go away in a few days or if it becomes too painful to touch your joints. If joint pain isn’t connected to any recent injury, you must immediately consult your doctor.

It’s normal to have joint pain occasionally, but when the pain starts interfering with your daily movements, it’s time to seek medical help. The initial move is to get an accurate diagnosis of what’s causing your joint pain.  You may be later referred to a rheumatologist or orthopedist (Doctors who specialize in arthritis and related conditions). During the medical examination, your doctor may ask questions related to your symptoms and medical history to assess your situation.

Although there’s no particular cure for arthritis, treatments have developed gradually. The treatment for arthritis aims at controlling pain, lessen joint damage, and enhance the quality of life. A variety of medicines and lifestyle changes can help accomplish this and protect joints from additional damage.