Tuesday, April 12, 2011

Knee Pain, Osteoarthrosis (OA) & Management in Short

Osteoarthritis of the left knee. Note the oste...Image via WikipediaPain in knees may have several causes, many are of academic interest. For practical purposes;
are of particular concern.
Osteoarthrosis (OA) is mostly seen;
  • In both the sexes, perhaps male are a little more likely to get it.
  • Single most important predisposing factor is obesity and weight gain.
  • Stress and strain to knees due such nature of work or sports activity.
  • Age related wear and tear.
  • Osteoporotic females after menopause.
Can be diagnosed from;
  • Typical history of starting pain, relief after some walk; in late cases pain either in rest or walk; and age of patient.
  • Restricted movement in late cases.
  • Digital x-rays examination of knees.
  • MRI (Magnetic Resonance Imagining), usually not required; but a good tool.
  • Absence of positive markers for more aggressive inflammatory collagen diseases like;
  1. Much raised ESR (Erythrocyte Sedimentation Rate)
  2. RF(Rheumatoid Factor).
  3. CRP(C - reactive protein), but may sometimes seen to be raised in OA.
  4. ASO (Anti-Streptolysin-O) titer.
  5. LE Cell Phenomenon. Or
  6. ADSDNA ( Antibody against Double Stranded DNA)
So, mostly OA is established by exclusion of some other diseases affecting the knee joint.
Treatment of OA is a cumbersome task. Still some conservative approaches give good result and surgery can be avoided.
  • Weight reduction if overweight.
  • Avoiding more strenuous work/sports activity those put pressure on knees.
  • Physiotherapy, especially swimming, easy walking; and lifting some weight kept on the foot from a hanging leg supported at knees; like sitting on a table top and hanging the legs freely from the edge of table.
  • Apart from these measures, medicinal treatment like;
  1. Simple analgesics like paracetamol.
  2. Vitamin D and calcium supplementation.
  3. Methylcobalamin or Vitamin B 12.
  4. Prescription of Diacerein and pregabalin.
  5. Application of diclofenac on the joint after moist heat application.
  • Interventions like;
  1. Arthroscopy and removal of free floating bodies in the joint space if any.
  2. Injection of steroids like Triamcenolone into the joint space which gives quick results but effect lasts short requiring more session, which may eventually have adverse effect on the joint.
  3. Injection of Hyaluronidase may be of help in early disease.
As a last resort, knee replacement may be the answer.
However, conservative treatment with good physiotherapy will go a long way in coping with Osteoarthrosis (OA).
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