KNEE ARTHRITIS

Causes

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Osteoarthritis

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This is the most common form of arthritis in the knee. It has no single specific cause, and is not yet fully understood. It is a degenerative "wear-and-tear" type  of arthritis that usually occurs in people aged 50 and older, although it may occur in younger people too. There are certain risk factors that may make you more likely to develop the disease, including:

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• Increasing age

• Female sex

• Family history of osteoarthritis

• Occupation

• Previous injury to the knee joint

• Obesity

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You can still develop osteoarthritis even if you do not have any of the risk factors listed above.

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Rheumatoid Arthritis

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Rheumatoid arthritis is a chronic autoimmune disease that attacks multiple joints throughout the body, including the knee joint. It is symmetrical, meaning that it usually affects the same joint on both sides of the body. It can often affect other systems in the body as well.

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In rheumatoid arthritis, the synovial membrane that covers the knee joint begins to swell. This results in knee pain and stiffness.

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Post-traumatic Arthritis

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This is form of arthritis that develops after an injury to the knee. It may be the result of previous fractures involving the knee joint or meniscal/ligament injuries that lead to instability and additional wear on the the knee, with the eventual development of arthritis.

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Symptoms

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The most common symptom of knee arthritis is pain. The knee pain tends to develop slowly and worsens over time, although sudden onset is also possible. Pain and stiffness may be worse in the morning, or after sitting and resting for a while. Over time, the pain may occur more frequently, including at rest or at night. Additional symptoms may include:

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• Stiffness and swelling, making it difficult to bend and straighten the knee

• Pain that flares up with vigorous activity

• A grating or grinding noise/sensation in the knee (crepitus)

• "Locking" of the knee during movement

• Pain may cause the knee to give way/buckle

• Increased joint pain with cold or rainy weather.

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Treatment

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Although there is no cure for osteoarthritis, there is a range of treatment options that may help to relieve pain and improve mobility. These include both nonsurgical and surgical treatments.

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Nonsurgical Treatment:

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• Lifestyle modifications

  • Minimising activities that aggravate the conditions e.g. climbing stairs​.

  • Switching from high-impact activities (like running and tennis) to lower-impact activities (like swimming or cycling) will put less stress through the knee.

  • Weight loss can reduce the force and hence the stress through the knee joint, resulting in less pain and increased function.

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• Physical therapy

  • Specific exercises can increase range of motion and flexibility, as well as strengthen the muscles around the knee.

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• Assistive devices​​

  • A walking stick or crutches can improve mobility, and independence​.

  • Wearing a knee brace can also be helpful.

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• Medications

  • Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDS, e.g. Ibuprofen) should be used with guidance from your GP or pharmacist​.

  • Corticosteroids are powerful anti-inflammatory agents that can be injected into the painful joint.

  • Disease-modifying anti-rheumatic drugs (DMARDS) (e.g. Methotrexate, Sulphasalazine, and Hydroxychloroquine) and biologic therapy (e.g. Etanercept, Adalimumab) can be prescribed to slow the progression of rheumatoid arthritis and other inflammatory joint conditions under the guidance of a rheumatologist.​

  • Glucosamine and chondroitin sulphate can be taken as dietary supplements. They are both substances found naturally in cartilage. Although some patients report beneficial effects, there is no strong evidence to support their use to decrease or reverse the progression of arthritis.

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Surgical Treatment:

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Surgery may be recommended if the pain from your arthritis causes disability and is not being managed adequately with nonsurgical treatments. The options include:

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• Total or partial knee replacement

• Cartilage transplantation

• Osteotomy