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A GP’s Insight into Osteoarthritis of the Knee29th April 2020
By Dr Alastair Dickson, GP and Health Economist
To reduce the burden of joint health conditions, and improve quality of life for sufferers, the Joint Health of the Nation Report calls for early intervention and treatment at the first signs of joint pain to reduce the physical and mental impact of arthritis.
As a GP, about a third of all the patients I see suffer from osteoarthritis (OA), with a lot of them having knee pain. It is typical for sufferers to be in their 50s, 60s or older, but not everyone is, as I often see people in their 20s and 30s. Frequently, the younger patients have damaged their knees by trauma, for example, sports or work injuries. Good physiotherapy and keeping up knee exercises after therapy are key here.
Older patients often present with more ‘wear and tear’, where the pain has developed gradually over the years, leaving them struggling now. Sometimes this is just age related, but weight is often a large contributing factor. It is important they when dealing with knee pain, discussions are taking place to try and help address strategies for weight loss in people who are overweight or obese.
Another common story is that knee pain has come on over recent months, and when a history is gathered, there is a common theme of the person having changed their routine, often reducing their exercise and fitness levels 12 to 18 months previously.
Typically, the first pain that people describe experiencing is in their knee when walking down hills or stairs or those who had suffered trauma in the past. In both cases, reduced activity has also contributed to knee pain, often identified as anterior knee pain, due to a reduction in fitness and muscle strength.
Once again, treatment requires muscle strengthening exercises, avoidance of impact loading (like jogging and running), consideration of how knee pain occurs, and why fitness is important.
I often find that a handout of exercises is as effective as referral to a physiotherapist, with the option of a patient being referred to physio as a backup option if there is a need for more help and reassurance. In many of the practices I work in, people are increasingly able to self-refer to the in-house practice physiotherapist and so I advise my patients of this option too. Knowing that this option for self-referral exists means they do not need to make yet another appointment to see their GP, as well as helps put the person back in control of their knee pain.
Similarly, it is worth looking at creating long-term habits to keep up fitness levels. I discuss yoga and Pilates classes, doing exercises with children and grandchildren, such as swimming and cycling, and, increasingly, I am starting to use social prescribing options where my patients can attend group workouts with their local football teams and similar sporting organisations.
For pain control, I tend to advocate topical non-steroidal anti-inflammatory (NSAID) gels initially, before considering oral NSAIDs or low dose opiates. I try to avoid opiates due to concerns over risks of addiction and increased risks of falling, which might damage the knee further.
It is important to explain that the purpose of painkillers is not to ‘cure’ the pain, because we increasingly realise that this is often not possible, rather manage the pain so that patients can move better. Helping with this allows people to move their knee more, do the recommended exercises with less pain and, in turn, get fitter. Ultimately, it tends to be these actions that help minimise the pain over the long term.
In some cases, people require surgery, but the good news is that most of my knee pain patients do need this if we have proactively addressed issues such as fitness, muscle strength, pain control and weight loss early.
Some products have also been proven to help your health. The clinically-proven galactolipid GOPO® has been proved to reduce within three weeks, as well as improve mobility and repair cartilage. It also has no recognised side effects so is suitable for long-term use. It is clinically effective in reducing pain and can reduce the need for analgesic medications, which have a risk of dependency.
In summary, the approach to knee pain can be best summarised with the following four simple steps that we can all take to help reduce the risk of arthritis in later life:
- Take action - as soon as you notice joint pain or stiffness to help prevent the onset of OA symptoms, which can take many years to develop.
- Keep moving - keeping as fit and active as you can is important for protecting our joints from OA and reducing pain. Switching from high-impact exercise, which puts greater strain on joints and wears down cartilage more, for low-impact exercise like walking, swimming and cycling can often help.
- Watch your weight - every pound of excess exerts roughly four pounds of extra pressure on the knees. Speak to your GP about a referral to a weight loss programme on the NHS.
- Look after your joints - using simple analgesia to help with the pain can help you keep active and moving, as well as keep your weight down. The main treatment for mild to moderate arthritis is exercise.