JOINT PAIN NO MORE: ARTHRITIS MANAGEMENT TIPS THAT ACTUALLY WORK

A substantial population in India, especially elderly people suffer with the chronic pain in the knee, mainly because of osteoarthritis. The arthritis of the knee is characterised by wear and tear of the cartilage resulting in joint space reduction and deformity. The clinical presentation is mainly pain, swelling, deformity, difficulty in walking, effusion and stiffness . The main clinical symptoms is pain and difficulty in activities, such as sitting down, squatting, sitting, cross legged, stair, climbing, and sitting on the floor - thus reducing the mobility of the person. This will have a tremendous impact on the quality of the life and functional capacity.

The cure of arthritis remains elusive.

However , a multi modal approach in the form of lifestyle modification, weight reduction, exercises, medical and surgical management can help these subset of patients to improve mobility by reducing pain, which will result in far better quality of life. A personally designed management paradigm can efficiently help in managing the arthritis in the initial stages.

Exercise as therapy

Controlled physical activity is one of the main cornerstone of management of arthritis. Targeted exercises for strengthening the muscles around the knee, such quadriceps and hamstring exercises helps in strengthening the muscles across the arthritic knee. This will help in managing the early arthritis as the strengthening the muscles will help in reducing the pain across the arthritic knee. High impact exercises such as running, jogging, treadmill are best avoided once the arthritis is set in. This helps in mechanical stress reduction across the joint.

Regular activities, walking, low intensity exercises, and muscle strengthening exercises are helpful.

Aquatic exercises, such as swimming and water aerobics makes the gravitational forces and beneficial in minimising the joint stresses while improving the range of movements.

Stationary cycling is a non-impact activity that provides cardiovascular stimulus with the minimal loading of the joint.

Structured muscular strengthening program around the knee is essential for optimising the joint support and bio mechanics.

Weight reduction helps in reducing the mechanical stress on the joints

Excessive body weight causes, increased joint stresses in already arthritic Knee. Even moderate reduction of the body weight helps in significant improvement in the arthritic symptoms. Dietary modification as per the dietician in optimising macro nutrient profile and calorie restrictions helps a long way.

Pharmacological methods to improve the symptoms

Management of pain is of paramount importance, whether it is acute pain during arthritis or the chronic pain.

Thermal therapyCold or cryotherapy helps in reducing the inflammation in arthritis. Warm fermentation or thermal therapy can improve the joint stiffness and assists in getting better moments. This has to be decided based on patient, preference and clinical context.

Oral analgesics Judicious use of analgesics (painkillers) has to be done in patients with arthritis. While choosing the type of pain medication, one has to consider whether the patient is having any form of other systemic involvemnet - such as gastritis or gastric ulcer, kidney disease, cardiac disease or liver disease.

Judicious use of analgesic is indicated as excessive use can cause gastric ulcer and have a detrimental effect on the renal function.

The potential risk of using these in a patient who is having other medical comorbidities has to be considered.

Tropical analgesics like gels and sprays, mostly containing diclofenac sodium, give symptomatic relief.This has potentially reduced systemic effects.

Assistive devices such as external support in the form of a cane , Walker for assistance and a wheelchair in advanced cases will help to keep the mobility on, in this subset of patients.

Advanced strategies in managing arthritis

Intra articular corticosteroid injections

Patients who are not responding to conventional methods and physical therapy can be considered for intra articular injection. The use of these kind of injections has to be judicious and the frequency and dosage has to be adjusted according to the patient profile and expectations.

Visco supplementation

Use of hyaluronic acid intraarticularly helps in improving the lubrication and reducing the inflammatory mediators. This gives a good symptomatic relief for the patient. This works better in early stages of arthritis. However, in severe arthritis, it might work for variable time. Optimising the patient expectations before choosing them for this therapy is required.

Surgical approach

This involves management of advanced arthritis in the form of a joint replacement surgery. With the increased experience in the field of joint replacement and availability of various advanced cutting edge technologies, such as robotic assistance for performing the surgeries, which has become a game changer. This is giving the patient a new lease of life with relief of pain and getting them back into painfree mobility status.

The candidates for surgery to be selected based on comprehensive evaluation of clinical radiological and patient specific fractures.

A holistic and patient centric approach

Management of arthritis has to be tailor made to the requirements of the patient and the severity of involvement of the joints in a particular case. Patient education regarding the pathophysiology of arthritis is important. The techniques for self management and adhrence to the regimen given to them needs due attention.

Regular follow up with the orthopaedic surgeon, physiotherapist, dietician, and with the healthcare team is essential to optimise outcome and enhance the patients quality of life. An evidence based multi model approach will help the patient with knee arthritis in achieving more active and pain free mobility