Osteoarthritis of the knee is a common condition that eventually leads a lot of people to knee replacement surgery. But does anything short of this drastic surgery help?
New recommendations from the American Academy of Orthopaedic Surgeons advise people to lose weight, begin exercising and take acetaminophen or non-steroidal anti-inflammatory drugs (as well as intra-articular corticosteroids for short-term pain relief).
The guidelines, titled "Treatment of Osteoporosis of the Knee" advises against such common remedies as: arthroscopic lavage -- or washing out the joint; glucosamine and/or chondroitin sulfate or hydrochloride; needle lavage or custom-made foot orthotics.
Arthroscopic lavage is not recommended when the patient's only symptom is osteoarthritis. The procedure may be helpful in patients with other problems such as loose bodies in the knee or meniscus tears. "The current science shows us that just washing out the joint does not decrease the patient's osteoarthritis symptoms and can expose the patient to additional risk," said Dr. John Richmond, chairman of the AAOS work group, in a news release.
What may be most helpful for people whose body mass index is greater than 25 is to lose a minimum of 5% of their body weight and begin or increase participation in low-impact aerobic exercise. "As far as losing weight, this has the highest potential to actually slow the progression of the disease," Richmond said.
The committee was not able to recommend for or against bracing, acupuncture or intra-articular hyaluronic acid because not enough scientific evidence exists on those therapies.
A copy of the guidelines can be found on the AAOS website.
The pain caused by knee osteoarthritis can be debilitating and kick off a downward spiral of inactivity, exacerbating the problem.
Mounting evidence shows that for those who suffer from knee osteoarthritis, exercise may be a key component in dealing with pain and difficulty walking. One 2006 study showed that by strengthening the quadriceps — those muscles in the front of the thigh — less cartilage was lost behind the kneecap, possibly resulting in more range of motion and less pain.
A new study suggests that the Chinese martial art tai chi may be effective in treating pain and disability from knee osteoarthritis. The mind-body discipline features slow, controlled movements that increase strength, balance and flexibility, and been shown in at least one other study to improve strength and possibly reduce the risk of falling in older people.
In this study, presented this week at the annual science meeting of the American College of Rheumatology in San Francisco, 40 people who had knee pain were assigned to tai chi instruction twice a week for 12 weeks, or to a control group in which they did stretching and received wellness education. At the end of the 12 weeks, those in the tai chi group showed much greater improvements in pain, physical function, depression, self-efficacy and health status than the control group. Those who stuck with the tai chi program continued to show benefits in lessening pain and increasing function.
"Tai chi mind-body exercise appears to provide an important approach for self-care and self-management for knee OA," said lead author Dr. Chenchen Wang, a physician in the division of rheumatology at Tufts Medical Center in Boston, in a news release. He added that the results need to be confirmed by large studies. Also, people are cautioned to talk to their doctors before starting any exercise program.
When knees and hips are forced to carry around extra body poundage day after day, year after year, it takes a toll. The first and largest study examining the association between overweight, body mass and osteoarthritis, the most common form of arthritis usually affecting middle-age and older people, found that overweight people are more likely to suffer the pain of arthritis in their hips and knees as they age.
The research, led by Dr. Stefan Lohmander, professor of orthopedics at Lund University in Lund, Sweden, measured the body mass, waist, waist-to-hip ratio, weight and percentage of body fat in about 28,000 men and women ages 45 to 73. They also adjusted for other risk factors, such as age, sex, smoking history and level of physical activity. The study was presented Sunday at the American College of Rheumatology annual scientific meeting in San Francisco.
They found that of all the factors, a higher body mass index was the highest risk factor for developing painful arthritis in the hips or knees. Body mass index is a calculation of body fat by using height and weight, and you can calculate yours at this National Institutes of Health site.
“[Being] overweight is one of the few factors leading to osteoarthritis that we can actually do something about,” Lohmander said in a news release. “Understanding the connection between being overweight and getting osteoarthritis, and the size of the risk, is therefore important when considering disease prevention. We have shown that the risk increase starts already with being moderately overweight, and increases with each further increase in body mass. This is true for men and for women, and for knees and for hips.”
Those extra pounds, it seems, accelerate the progressive damage done to the cartilage around joints. The damage can lead to fluid accumulation, bony overgrowth, and loosening and weakness of muscles and tendons around the joints. It's not surprising that it hurts enough to limit movement.
The study was done in Sweden, where the incidence of obesity is far less than in the U.S. Here in America, we ought to add arthritis to the growing list of ailments -- heart disease, diabetes, some cancers -- that are linked to the obesity epidemic.
Osteoarthritis of the knee plagues millions of people -- and many undergo arthroscopic surgery looking for relief from the stiffness and pain. But a new study says this popular approach just doesn't work. It's the second such study to find that minimally invasive surgery to remove cartilage fragments and smooth the knee surface is ineffective.
The new study, published in the Sept. 11 issue of the New England Journal of Medicine, examined 178 Canadian men and women with an average age of 60. All of the study participants received physical therapy and medications, such as ibuprofen. But half of the participants also underwent arthroscopy at the Fowler Kennedy Sport Medicine Clinic at London Health Sciences Centre.
The eight-year study found that all the patients reported improvements in pain, stiffness and joint function and that surgery provided no additional benefit. A study published in 2002 in the New England Journal of Medicine also concluded that arthroscopic surgery didn't help with knee osteoarthritis, but that study never gained traction with doctors. Now, said the authors of the new study, maybe doctors and patients will think twice.
"Based on the available evidence, we believe that the resources currently allocated towards arthroscopic surgery for osteoarthritis would be better directed elsewhere," said the researchers, from the University of Western Ontario and Lawson Health Research Institute.
Arthroscopy is still helpful for other knee conditions, such as meniscal repair and ligament reconstruction. But for those with worn-out, achy knees, find a good physical therapist.
- Shari Roan
Photo: Arthroscopic knee surgery. Credit: University of Western Ontario
Around the time that the Magi, according to the traditional Christmas story, made it one of their gifts to Jesus, frankincense was being used in Indian Ayurvedic medicine. Now, 2,008 years later, medical science has proved that frankincense, an aromatic resin used in incense and perfumes, provides relief to arthritis sufferers.
In a study in the journal Arthritis Research & Therapy, researchers found that an enriched extract of Indian frankincense, known as 5-Loxin, a product developed by Laila Nutraceuticals, not only reduces the pain of arthritis, but does it quickly.
Researcher Siba Raychaudhuri, professor at UC Davis, recruited 75 patients who had the pain of arthritis in their knees, hips, hands, wrists, feet or spines. One group of 25 people got a placebo. Two other groups of 25 each got the supplement, one taking 100 mg daily for three months, and the other taking 250 mg daily for three months. Both groups that took the supplements reported they could move with less stiffness and pain, and the group that took the higher dose began feeling relief in about a week.
Tests of the fluid within their affected joints showed lower levels of enzymes linked to arthritis, and the people taking the pills had no ill side effects. But because the study size was small, some scientists urge caution and more study, according to a BBC news report.
But if future studies hold up, the nations 21 million arthritis suffers could find frankincense to be worth its weight in gold.
-- Susan Brink
Varieties of frankincense. Photo by Anne Cusack, Los Angeles Times
Tami Dennis, who takes the word "skeptic" to previously uncharted territory, is the Times' Health and Science editor. She's adamant that pitches promoting awareness days, weeks or months are, by their nature, non-stories. And, because she's an adult, she refuses to use words like "veggies," "tummy" and "yummy."
Rosie Mestel, deputy Health and Science editor, studied genetics before abandoning flies, fungi and DNA for health/medical writing. Her hero is the biologist Ernst Haeckel, whose jellyfish paintings inspired snazzy chandeliers. Her favorite toast-spread is Marmite, a British delicacy made of yeast extract. Her least-favorite word is "millenniums."
Melissa Healy is a staff writer for the Health section reporting from Washington D.C. Healy's a veteran of The Times' National staff, having covered the Pentagon, Congress, poverty and social welfare, the environment, and the White House before shifting to Health in 2003. She writes frequently about mental health and human behavior, about federal health policy, prescription medication and ethics in medicine. More wonk than wellness freak, Healy chooses to believe in the health benefits of coffee and wine, and considers water a better work-out medium than beverage.
Karen Kaplan covers genetics, stem cells and cloning. She and colleague Thomas H. Maugh II comprise about 25% of the unofficial MIT-Alumni-in-Journalism Club, and she is proud to have taken more math (5) than English (0) courses in college. Her contributions to Booster Shots will, she hopes, appear more frequently than postings to her mommy blog.
Thomas H. Maugh II has been a science and medical writer at the Times for 23 years. Before that, he was on the staff of the journal Science for 13 years.
He has bachelor's degrees in English and chemistry from MIT and a doctorate in chemistry from UC Santa Barbara.
After a brief stint as a sports writer, Shari Roan turned to health journalism and has covered the topic for The Times for 18 years. She is the author of three books and the mother of two daughters, both teenagers who refer to her as a "health freak." She likes to jog, watch baseball and is very happy that dark chocolate contains some health benefit.
Jeannine Stein writes about fitness, sports medicine and obesity for the Health section. She’s a gym rat from way back and never met an elliptical trainer she didn’t like. Well, maybe one or two. She tempers exercise with a steady diet of reality television because she believes it’s all about balance.
Osteoarthritis of the knee is a common condition that eventually leads a lot of people to knee replacement surgery. But does anything short of this drastic surgery help?
Mounting evidence shows that for those who suffer from knee osteoarthritis, exercise may be a key component in dealing with pain and difficulty walking. One 2006 study showed that by strengthening the quadriceps — those muscles in the front of the thigh — less cartilage was lost behind the kneecap, possibly resulting in more range of motion and less pain.
common form of arthritis usually affecting middle-age and older people, found that overweight people are more likely to suffer the pain of arthritis in their hips and knees as they age.
science has proved that frankincense, an aromatic resin used in incense and perfumes, provides relief to arthritis sufferers.