FIGURE: (i) healthy knee joint. (ii) arthritic knee joint with joint space narrowing (i.e. bone on bone)
So your doctor has told you your x-rays show arthritis. Should you be worried? Do you need treatment? What are the next steps? What is arthritis anyways? Let’s take a deep dive into what arthritis is and whether or not you need to do something about it.
Arthritis is one of the most common conditions that occurs with aging. In fact, after heart disease, it is the most common chronic condition that affects people all over the world. Specifically, a particular subset of arthritis, known as osteoarthritis, is the most common form of this condition. Arthritis occurs as the cartilage in our joints (e.g. knee, hip, ankle, shoulder) wears away which in turn leads to a process of inflammation, tissue breakdown, and reactive bone formation. You may have heard sayings such as “bone on bone”, “narrowing of the joint space” and so forth. If you compare joint space to the tread on a tire, the end result of the arthritic process is analogous to the tread on the tire that wears out over time with mileage. Similarly in the knee joint for example, as the cartilage wears out over time, joint space decreases.
What causes arthritis? The most common reasons for arthritis are a joint injury, repetitive and long term micro-injuries over time, or simply wear and tear over years and decades. Some of the factors that place people more at risk include a state of inflammation that involves the entire body, obesity, alignment (i.e. being bow-legged or knock-knee), physical activity, and genetics.
Now back to our original question – do you need treatment and should you be worried? Simply put, if the arthritis was observed on x-rays or an MRI and you have no symptoms (i.e. your joint does not hurt, has no swelling, is not stiff and/or does not lock) then formal treatment is not needed. However, optimizing your balance of risk factors by improving quadriceps and core strength, maintaining range of motion, taking supplements (e.g. chondroitin, glucosamine), changing your activity profile (i.e. more low impact activities), maintaining a healthy weight, and preventing the onset of systemic conditions such as diabetes and other comorbidities is certainly protective. Rule number one is musculoskeletal medicine is ‘treat the patient, not the MRI’. So to emphasize once again, no symptoms = no treatment. Do not worry but do optimize the environment in your joints by optimizing your balance of risk factors.
If your joint osteoarthritis is symptomatic, then an escalating approach to treatment is warranted. You should consult with your physician and come up with a customized treatment plan that may a combination of physical therapy, analgesics (e.g. Tylenol), anti-inflammatories (e.g. ibuprofen), injectables (e.g. cortisone, platelet-rich plasma), and physical therapy. Surgeries that may be considered when the aforementioned approach fails would include an osteotomy (i.e. to realign the limb), arthroscopy (if there are mechanical symptoms), or a knee replacement. Having the right team, comprised of an orthopaedic surgeon and physiotherapist, will help you decide what is right for you and get you started on your road to recovery.
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