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​Don't suffer in silence – Encouraging people to seek help

11th October 2018

Osteoarthritis (OA) of the knee is a very common long-term condition. Data collected in the UK and in the USA indicate that at least one-in-five people over the age of 45 have the condition to some degree. And, as you get older, the likelihood of the condition developing increases.

But this does not mean that you have to put up with the pain and discomfort. There is plenty that can be done to help you - so, the sooner you go and see your doctor the sooner the treatment can start.

OA changes to your knee

Your knee joint is the largest, and one of the most complex, joints in your body. It connects the femur (large thigh bone) with the tibia (shin bone). It also has to hold the bones together at the same time as allowing them to move like a hinge. Without our knees we could not stand, sit, twist or turn! The knee joint must withstand a lot of stress and over time it can suffer from wear and tear. The surfaces of the joint can become damaged and the joint itself cannot work as well as it used to.

When you have OA of the knee, the following changes may have occurred to the structure of the joint:

Cartilaginous changes. The cartilage is the soft cushion at the end of bones; it gets both rougher and thinner.

Bone changes. The bone underneath the cartilage gets thicker and wider. Bone spurs (bits of bone that stick out) can form at the edges.

Soft tissue. These tissues become more active as the body reacts to the damage. The ligaments may thicken and get shorter.

Synovial changes. The synovium is a membrane that surrounds the joint. It may swell and produce more fluid, which makes the whole knee look swollen (water on the knee).

The body is very good at taking care of itself, and many of these changes are part of the body’s normal response to damage and can be very successful. However, when the repairs don’t work, you will feel pain and instability. This is a sign that your body is not going to get better by itself and it is time for you to seek some help.

Seeking treatment for OA knee

OA knee is a progressive condition, so the sooner you start treatment the better. The treatment is designed to relieve pain and to make you more mobile as well as slowing down the progression. A lack of mobility and being in chronic pain are not beneficial to your general physical or mental health. The quicker you get your treatment for OA knee underway, the less impact it will have on your life and on your general health.

Medication for OA knee

When you go to see your doctor, they will discuss your options for pain-relief. The medication that they recommend will depend on the severity of pain that you are experiencing and on any other existing medical conditions.

Painkillers (analgesics) are usually recommended for occasional use such as when the pain occurs or when you are exercising. They are not a long-term fix and won’t repair the damage to your joint. Taking painkillers yourself to mask the pain without getting a proper diagnosis or treatment plan is never a good idea.

Common painkillers include:

Paracetamol. This is a well-tolerated medicine but you must take the correct dose. It is available without prescription.

Combined painkillers. Typical examples are co-codamol and co-dydramol. They are useful for more severe pain but are more likely to cause side-effects.

Non-steroidal anti-inflammatory drugs (NSAIDs). The most commonly available are ibuprofen and naproxen. They help with inflammation (swelling) as well as pain. There can be side-effects such as digestive problems so they are sometimes prescribed with other drugs to counteract this. Taking NSAIDs in the long-term does carry health risks. Do not take over-the-counter NSAIDs for more than a few days without consulting your doctor.

Non-steroidal anti-inflammatory creams and gels. These are a good option for those who cannot take NSAIDs orally. They are applied directly to the knee and the active ingredient is absorbed through the skin.

Capsaicin cream. This is made from the pepper plant (Capsicum) and is a prescribed medication. Some people do find that it burns a bit when first using it but that it works well within two weeks.

Powerful painkillers. For severe pain, there are very strong painkillers available, including opioids. They are only available on prescription and can have side-effects.

Other treatments for OA knee

In order to avoid taking painkilling medication, and to improve mobility, you may be offered steroid injections. These injections place steroids directly into the joint and they usually start working in a day or so and the effects last for several weeks. Hyaluronic acid injections will also help to lubricate the knee joint. Something as simple as applying heat or cold is also very effective in many cases. Heat lamps, a hot-water bottle or a hot pad all work well. An ice pack can also ease pain but ensure that you place a cloth between the pack and bare skin. Transcutaneous electrical nerve stimulation (TENS) does not work for everyone but it may be an option for you. The device sends electrical pulses to the nerve endings in the knee which get in the way of pain messages arriving at the brain. Knee braces are another popular option and have proved very successful for some people. Ultimately, surgery to provide you with a new knee joint is the only long-term option. However, the artificial joint will have a limited life expectancy (15 years), so they are not usually provided to younger people. Prior to a total knee replacement, you may be offered an arthroscopic lavage to wash out loose fragments of bone that are causing problems in the knee joint.

Living with OA knee

Tackling issues early on will make living with OA knee a lot easier. Talk to your friends, family and doctor about how you are feeling especially if it is getting you down and affecting your mood. Long-term pain can trigger feelings of depression in some people that makes OA even harder to deal with. Act early to tackle your pain by working with your doctor. It may help if you get in touch with local support groups where you can talk to people who are going through the same things as you are: it can help to share feelings and experiences.

Losing sleep because of pain is not something that you should have to put up with. Warmth can heIp, so try a hot bath, a hot-water bottle, a wheat bag or an electric blanket. Placing a pillow between your legs may also ease any pain. Don’t struggle on in silence at work because this can seriously affect your morale. Most employers have an occupational health service who can advise on changes to your workplace to accommodate health conditions. There may also be local Disability Employment Advisor who can come to your workplace and carry out an assessment. You may need to change your work pattern, access additional equipment or, in extreme cases, retrain for an alternative role.

Helping your OA knee yourself

Start managing your condition early and you will find it a lot easier to deal with. You can do a lot yourself to reduce your pain and keep mobile.

Reduce your weight. There is plenty of medical research to show that being overweight increases the strain on your knee joints. This puts you at increased risk of developing OA and will make it worse. By losing weight, you can reduce the strain on your knees when you walk and especially when you climb stairs. Every pound you lose will make a difference. There are plenty of groups that can help you to safely reduce your weight by adopting a balanced, healthy diet.

Start exercising. Exercise may be the last thing you feel like doing but the right exercises can help a lot with OA knee. Aerobic exercise is good for your general health, will make you feel a lot better and will alter your perception of pain. Strengthening exercises target the knee joint and the muscles and ligaments surrounding it. They will tone and strengthen muscle and therefore help to stabilise and protect the knee joint. This will both reduce pain and prevent the knee from giving way. Physiotherapists are highly trained medical professionals who can put together an exercise regime that is perfect for you. You will start with some gentle exercises and build up over a number of weeks. Swimming is an excellent exercise for you if you have OA knee because the water supports your weight but gets your joints and muscles moving. Your physiotherapist or doctor may recommend that you take some painkillers prior to exercising to avoid pain.

The important message is that there is plenty of help available for OA knee and that the earlier you start accessing that help, the better.

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