Osteoarthritis is caused by long-term joints condition that causes erosion of cartilage, and patients experience pain while moving. Their knees can appear to be deformed and affect the patients’ quality of life.  An interesting fact is that today osteoarthritis is a concern not only for the elderly, as middle-aged people also have an equal chance of being plagued by this debilitating condition that affects their daily routines.  Although the numbers are still small, there are increasingly more patients from the age of 45 who are afflicted by the disease.  

Causes of Osteoarthritis 

• Excessive force in the knee joints or their over usage: for example, marathon runners have 3 times higher risk than other groups of people.
• Knee joint injuries: such as a prior accident, broken or injured bone, torn ligament as in footballers.  These cause an imbalance and instability in the knees.
• Congenital disease: such as rheumatoid and chronic inflammation which can accelerate degeneration of the knees.
• Accident:  main cause for osteoarthritis in young people is accident, such as a broken bone that alters the leg axis.  It may be a broken shinbone, femur or around the knee that causes a shift in body support and leads to deterioration.
• Blood disorder: these may be rare in Thailand, such as polycythemia or increase in the absolute red blood cell (RBC) mass in the body.
• Drinking and Smoking: excessive drinking and smoking can slow the production of bone-forming cells.
• Overweight: this is another risk, especially in those with BMI over 40.  Greater weight is not as bad as gaining BMI over 40.

Symptoms

• Frequent knee pain.
• Pain while squatting, kneeling, folding legs.
• Pain while climbing up or down the stairs.
• Severe pain when sitting or standing in the same position for a long time.  Need to consult a doctor.
• Swollen knees and warm to the touch – these are symptoms of inflammation and injury.

Stages of Osteoarthritis

X-ray can indicate stages of osteoarthritis – ranging from normal, early or minor degeneration, intermediate, to severe.  It should be noted that X-ray can only reveal degenerative stage of the patient’s knee joints but not the treatment.  Principal diagnosis relies on physical examination and the patient’s health history, while the X-ray reading confirms and measures severity of the disease.

Treatments of Osteoarthritis

The early and intermediate stages can be treated without surgery through the following methods:

1. Medication – This can relief pain faster, and patients can return to their normal routines quicker.  There are both oral and injectable medicines.
   • Oral medicine (such as those in nonsteroidal anti-inflammatory drugs, NSAID, group).  Before prescribing this type of medicine, the doctor must check whether or not the patient has any congenital disease so that appropriate medication can be advised.
   • Injectable medication.  There are 2 kinds:
   • Steroids – Unlike regular steroids which affect the whole body, corticosteroid (a type of anti-inflammatory drug) is injected directly into the joint to reduce a specific area of inflammation. But this is not recommended for younger patients because there are reports that crystalized steroids can actually accelerate the degeneration.
   • Lubrication injections – When a knee starts to degenerate, joint fluid decreases and becomes less viscous.  So, it needs more lubrication the same way as a car needs lubricating oil to help for better movement.  Lubrication injection is only appropriate for patients in early and intermediate stages of the disease.  It is not helpful for those in the severe stage.
2. Non-medical Treatment involves lifestyle modification, after which the doctor may recommend additional use of medication. 
   • Some people who like to sit in squat, folded knees or kneeling positions, should now change to sitting on a chair instead.
   • People who are overweight need to lose weight to help reduce friction in the knees.
   • Exercise to strengthen thigh muscles, to help support and tighten knee joints.  This should be a no impact exercise: sit comfortably on a chair, lift a straight leg parallel to the floor and hold it to 10 seconds before lowering it again.  You can lift both legs at the same time or alternate between left and right legs. Do this at least 100 or 200 times a day.  The more exercise, the better the knees.
   • Low impact exercise for heart, lungs and the whole body such as swimming, bicycling, and walking in water.  Non-swimmers can walk, run or exercise in a pool which reduces pressure and help relax the muscles.  It is popular in many countries and has many alternatives, such as water aerobics. 

Some patients do not experience many symptoms but, through an x-ray, the doctor may find that they are already in the severe stage.  In these cases, the doctor can prescribe a non-surgical method, because osteoporosis generally progresses gradually.  The disease, though non-fatal, it can be debilitating.  Therefore, treating it is to preserve your quality of life, and the treatment has to be persistent by a specialist. In a case with younger patient who has been involved in an accident, knee replacement surgery may become inevitable.   

Knee replacement surgery, less pain, faster recovery, able to walk within 24 hours

Osteoarthritis can be inherited if either of your parents has deformed knees.  But the most important thing is to take good care of yourself by controlling your weight and keeping your BMI at less than 20 to avoid obesity: exercise your thigh, do aerobics, swim, eat fish with Omega 3 and broccoli which are both good for your knees and help reduce inflammation.   Moreover, fruits in the berries family and oranges are antioxidant, while beans – such as red beans, peanuts and mung beans – have protein and essential fatty acids which strengthen the knees.  Calcium helps reduce bone loss but not necessarily knee osteoporosis.