Dear Readers,

Evadne is a 57-year-old. She writes lifeline from St Mary. Her mother, 75, who resides in the US, has, over the last three years, had surgical replacement of both her knee joints due to severe arthritis.

Evadne has also been experiencing some pain and stiffness in her joints, especially in the knees, over the last few years and her doctor has told her that X-rays confirm early arthritic changes in both knees. Evadne says she looks a lot like her mother but she doesn't want to end up with knee surgery!

Over-the-counter medications like Panadol and Advil give her some pain relief, but not all the time. Evadne asked lifeline what can she do to control her knee pain and prevent the (osteo) arthritis from worsening?

Osteoarthritis is the leading chronic illness reported by older people. there are several treatment choices which, when used properly, are very effective in the control of osteoarthritis, especially in the mild to moderate stages, and can even help people with advanced arthritic disease.

Proper management of osteoarthritis is very important in order to maintain a good quality to life with continued social activities and contentment. People are unhappy and self-centred when life revolves around pain.

People with arthritis do not always suffer pain, when present, varies in intensity. There are people with severe manifest joint changes who are pain free while other people with mild joint changes experience severe pain. Because of this, treatment for osteoarthritis is very individualised.

The components of a successful osteoarthritis-treatment regimen include:

It is the cumulative effect of all these components that controls the pain and the physical manifestations (joint deformities).

LIFESTYLE MODIFICATION

People with arthritis should try to be as physically active as possible. High-impact sports which involve a lot of running and jumping is not good for the arthritic joints. low impact activities such as walking, swimming and bicycle riding are good choices.

Weight loss in overweight persons is also important as the weight acts as a heavy burden on the joints. Removing weight from the joints results in less pain and other symptoms. Good shoes with proper insoles should always be worn.

Diet is also important and a high-fibre, low-fat diet helps with weight management. Obesity worsens arthritic pain.

SUITABLE MEDICATIONS

Over-the-counter medications do help a lot of people with their arthritic pain. Advil, Tylenol, Panadol, Motrin and others are all good pain relievers for mild to moderate pain. When the pain is associated with joint swelling, non-steroidal anti-inflammatory drugs (NSAIDS) are preferable if they can be tolerated. These include Voltaren, Cataflam, Nise, Ponstan and many others. These NSAIDs are associated with stomach burn and nausea, stomach ulcers, even bleeding from the stomach and ulcer formation in susceptible people, so must be used with care.

COX-2 inhibitors such as Celebrex, Arcoxia and others also give good pain relief with moderate pain and are safer for use than NSAIDS, but are usually more costly.

When pain is severe, drugs like Panadine (which contains codeine) and Tramacet can also be tried.

In severe situations, opioids such as Panadine and Morphine can be prescribed. Corticosteroid joint injections can also give months of pain relief.

The intra-joint injection reduces joint inflammation and can allow the person to begin exercising.

Topical analgesics and anti-inflammatory topical preparations are also available for use by local administration to the skin over the affected joint.

Glucosamine Sulfate and Omega- 3 fatty acid preparations work with some individuals to reduce joint pain. These supplements don't work for everyone, so the individual will have to try using the product to determine the effects.

PHYSICAL THERAPY

Muscle exercises and stretching helps to strengthen the muscles surrounding the joints and reduce contractures where the joints seize up and cannot straighten or move normally. For example, strengthening the muscles around the knee joints helps take the pressure off the knees and cartilage and can help to reduce impact on the knees.

Knee braces can be used to stabilise the knee joints, but the really effective ones are bulky in size.

Canes and tripods can also be used to take some of the weight off an affective limb and reduce symptoms.

Evadne need not worry herself at this time (if ever) but should put in place a good joint-care programme and follow this up with interval visits with her doctor.

Knowledge is power so she should keep track of new osteoarthritic-management developments and leave the future to God.

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