ARTHROSCOPY NOT RECOMMENDED FOR DEGENERATIVE KNEE DISEASE, PER NEW RESEARCH

A recent systematic review concluded that arthroscopic surgery for degenerative knee disease (including arthritis and meniscal tears) did not result in lasting pain relief or improved function. As a result, panelists strongly recommend against arthroscopy for patients with degenerative knee disease in most cases. 

The review (Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline- May 2017) was published in BMJ.

According to the review, about 25% of people older than 50 years of age experience pain from degenerative knee disease (the percentage rises with age), and costs for arthroscopies for this condition are in excess of $3 billion per year in the United States. Furthermore, only 15% of arthroscopy patients reported a small or very small improvement in pain or function at 3 months post surgery, and those benefits were not sustained at 1 year post surgery. 

In place of arthroscopy, panelists recommend effective alternatives including an individualized regimen combining rest, weight loss as needed, a variety of treatments provided by a physical therapist, exercise, and nonsteroidal anti-inflammatory drugs.

In an interview with the New York Times, Dr Reed A.C. Siemieniuk, a methodologist at McMaster University in Hamilton, Ontario, Canada, and chairman of the panel, said, "Arthroscopic surgery has a role, but not for arthritis and meniscal tears." The procedure, he elaborated, "became popular before there were studies to show that it works, and we now have high-quality evidence showing that it doesn't work."

#MOVEFORWARD WITH YOUR RA

Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects approximately 1% of the United States population. RA often results in pain and inflammation in joints on both sides of the body, and can become disabling due to its effect on the immune system. A physical therapist can help manage the symptoms of RA, enhancing an individual's quality of life.

RA is classified as an autoimmune disease—a condition where the body’s immune system attacks its own tissues. Although the exact cause of RA is not known, multiple theories have been proposed to identify who is most likely to develop it. The cause may be related to a combination of genetics and environmental or hormonal factors. Women are more likely to develop the disease; women are diagnosed with RA 3 times more than men. Although RA may begin at any age, most research suggests it often begins in midlife.

How Does it Feel?

RA symptoms can flare up and then quiet down (go into remission). Research shows that early diagnosis and treatment is important for easing symptoms and flare-ups.

People with RA may experience:

• Stiff joints that feel worse in the morning.
• Painful and swollen joints on both sides of the body.
• Bouts of fatigue and general discomfort.
• Fever.
• Loss of joint function.
• Redness, warmth, and tenderness in the joint areas.

How Is It Diagnosed?

RA is generally diagnosed by a rheumatologist. Diagnosis is based upon factors, such as inflammation of the tissues that line the joints, the number of joints involved, and blood-test results. A physical therapist may be the first practitioner to recognize the onset of RA; the physical therapist will refer an individual with suspected symptoms to an appropriate clinician for further tests.

How Can a Physical Therapist Help?

Physical therapists play a vital role in improving and maintaining function that may be limited by RA. Your physical therapist will work with you to develop a treatment plan to help address your specific needs and goals.

Because the signs and symptoms of RA can vary, the approach to care will also vary. Your physical therapist may provide the following recommendations and care:

Aerobic Activities. Studies have shown that group-based exercise and educational programs for people with RA have beneficial effects on individual strength and function.

Goal-Oriented Exercise. Studies also show that achievement of personal physical activity goals helps reduce pain and increase the general quality of life in people diagnosed with RA.

Modalities. Your physical therapist may use modalities, such as gentle heat and electrical stimulation to help manage your RA symptoms.

DIAGNOSED WITH OSTEOARTHRITIS

Our last post, ARE YOU AT RISK FOR OSTEOARTHRITIS? focused on the "before" aspect of a diagnosis, and what risk factors increase your chances for a diagnosis. DIAGNOSED WITH OSTEOARTHRITIS is going to focus on the "after" aspect - what to do after you've been diagnosed. 

1. First and foremost: do not self diagnose.

See your primary care physician, or an orthopaedic specialist. A series of tests and health history questions will allow most medical practitioners to be positive about an osteoarthritis diagnosis, but for physical proof, you'll need either an X-ray or an MRI. 

Why an X-ray? More advanced cases of osteoarthritis will be visible in an X-ray.  Severe cartilage degeneration will be visible (or more realistically, will be nonexistent) by recognizing what's out of place in comparison to where they're anatomically in place.  Joints that are suffering from osteoarthritis will look noticeably different in an X-ray compared to that of a healthy joint. 

2. Talk to your doctor about your options.

Depending on the severity of your case, your doctor may present you with a multitude of paths to assess, or potentially just a fair few.

Non-surgical opportunities include but are not limited to: steroid injections to lessen inflammation and reduce pain, physical therapy to strengthen muscles and therefore lighten the load on the joint, or pain medications to allow you to continue functioning with minimal pain.

Surgical opportunities, or joint replacements, are extremely common. Depending on age or the severity of your case, you may be a prime candidate for a partial or total joint replacement. This will require physical therapy to aide your body in returning to full range of motion and strength, but most cases are completely successful and will allow you to return to the lifestyle you enjoy with less pain than in you have had in probably 5 or more years. 

3. In the meantime: less is not more.

While it may feel as though movement is going to aggravate and inflame that joint, lack of movement is consequentially worse. The lack of movement weakens the muscles, and therefore, adding more pressure on the joint when it's loaded. Lack of movement will essentially make it significantly more painful to move - and therefore, making the condition feel much worse. Movement, as well as strengthening, is key to maintaining a quality of life until the correct treatment option for you can be identified and agreed upon. 

4. Ice, and Anti-inflammatories

Icing the joints can lead to some stiffness, but it can also decrease the activity of inflammatory responses that lead to increased swelling from bone-on-bone activity and therefore, decreases the residual pain. Not only does it limit the inflammatory response by constricting the blood flow into that joint, but also allows you to feel relief temporarily until the numbness from the cold entirely wears off. An anti-inflammatory can help aide in minimizing your inflammatory (immune) response, but be sure to talk with your doctor about which anti-inflammatory works best for you and your specific medication protocol. 

ARE YOU AT RISK FOR OSTEOARTHRITIS?

What is osteoarthritis?

Osteoarthritis, also known as Degenerative Joint Disease (DJD) but more commonly known as "arthritis", is the degeneration of cartilage in a joint leading to bone-on-bone degradation. 

What causes osteoarthritis?

Osteoarthritis results in the deterioration of the cartilage that acts as a protective cushion between bones.  It is more common in the general population in partially weight-bearing joints, such as the hips and knees. As bones grind against one another, it can result in hardening of the joint, inflammation of the fluid-filled, protective bursa sacs, and possibly bone spurs and other problems that lead to pain. 

What risk factors increase my chances of getting osteoarthritis? 

Unfortunately, not qualifying for any risk factors does not guarantee you'll never have osteoarthritic symptoms, but it can help to decrease chances. Some risk factors are out of our control, but some definitely aren't!

1.  Old Age increases your risk significantly, as not only do the proteins in the body that recreate and make up cartilage become more sparse in the joints, but the fluid that protects the cartilage is produced less as you age, as well. 

2. Obesity puts added stress on weight-bearing joints, and adipose (fatty) tissue produce proteins that can lead to harmful, degrading inflammation in the joint cavities. 

3. Joint Injuries that stemmed from an accident or sports injury can increase your risk of osteoarthritis.

4. Bone Deformities or Protein Deficiencies can increase the amount of stress on a certain area of the joint that will later lead to a breakdown of cartilage, and life-long protein or hormonal deficiencies diagnosed at a young age can eventually cause an early onset of osteoarthritis. 

5. Genetics has also proven to be a major factor in developing osteoarthritis, not only because of gene function, but lifestyles. Some are more prone to the breakdown of cartilaginous proteins and fibers. As far as genetically inherited lifestyles, that's probably more accurate when described as a nuture versus a nature problem. More often than not, children are going to have similar lifestyles to that of their parents. Parents who developed osteoarthritis due to being extremely active in their youth and adulthood likely passed those same habits onto their child, which could, in turn, potentially lead to the same osteoarthritic developments. 

Does meeting these risk factors necessarily mean you'll develop osteoarthritis? No. Like every medical condition, qualifying for a risk factor is not a guarantee. Simply worry about the ones you can control. 

OUR NEXT BLOG POST: What to do when you already have osteoarthritis.