Way back in 2003 Times Magazine reported that the Arthritis Epidemic is growing more then ever before and the bad news is that more and more younger people are suffering from the same . However the good news is that the treatment for arthritis is more effective than ever! The arthritis of the knee can affect any age. We provide consultation to patients in the age group of 45 – 64 years. They will account more than 50% of the patients in the next decade. Because of the level of activities, the pressure on the knees is more. The weight related issues are also another factor that cause the early wear and tear of the knees.
Many of the patients of a younger age group are willing to undergo knee replacements in order to improve their quality of life.
The biological knee transplantation in the form of perspective articular cartilage regeneration or meniscus allograft are few increasing trends seen theses days.
What is the best option?
The best of option should be attempts to save these knees from surgical insults and provide conservative treatments focused on medication and injections which may be standard non surgical options for young arthritics. It makes sense and is more effective that the attempts should be made for preservation of these knee for the long time with physical measures, weight loss and use of orthotics. In treatment of arthritis the standard ‘pyramidal’ approach has become outdated, instead these days we customise treatment by using multimodal approach. In the pyramidal therapy, the mainstay was exercise, education, weight loss were desired.
These days the definition of a multimodal approach has changed. Today it means when more than one modality is being used for a particular patient simultaneously. May it be physiotherapeutic mobilisation, off loader bracing and NSAIDs for few initial days.
Painkillers may be killing you:
The use of paracetamol remains as first line of medication to reduce pain of arthritis however it also remains as a leading cause of drug – induced liver failure in USA and also in our part of the world. It needs monitoring and intake of more than 4gm. of acetaminophen a day has proven significantly detrimental for liver functions and can end up causing liver failure. Its seen that 1-4% of NSAID users experience GI bleeding and its related complications and in elderly there is the increased risk of deaths at least 4 times more due to use of painkillers.
The Cox 2 group of painkillers are also not too safe as US FDA has recommended blackbox warnings to highlight potential risk of CV events and serious life-threatening GI bleeding .Hence natural contraindications of their use would be in patients suffering from hypertension and having undergone bypass surgeries, or having compromised renal functional profile.
The antibiotics revolutionizing OA treatment:
The use of nutraceuticals in management of osteoarthritis is the big leap forward today. However their role is treatment of OA is unclear, safety and tolerance being good but the effect on the disease progression is unproven at the moment. The use of Glucosamine sulphate in combination with chondroitin has been used for long time without major evidences support on Cochrane data base. WHO has already declared this combination no better then placebo, having more adverse reactions and complications. There are newer generation of nutraceuticals like S Adenosyl methionine, curcumin, ginger, avocado extract, rose hip extract, collagen peptide type II and I, showing more promise as far as regeneration and repair of articular cartilage is concern. However their clinical efficacy may take longer time to prove and we require larger number of patients data to support that. So far we do not have any true disease modifier for curbing the menace of osteoarthritis.
Is there another option that could postpone surgery in younger patients suffering from arthritis?
There is very poor compliance for the patient education programs, physical therapy and occupational modifications. The importance of weight reduction, exercises and assistive devices remains still in infancy for OA treatment and prevention. The use of acetaminophen remains hepatotoxic and NSAIDs attract a very high risk of GI bleed and CV risks and renal complications. The surgical options are costly, invasive and it may be the primary indication for ‘end-stage’ OA, but may not be the right solutions for younger arthritics. The best is to maintain a healthy body weight, manage your pain without self medication and above all eat a well balanced diet. You can also improve your gait by practicing doctor recommended physiotherapy and other exercises. Remember that opting for a surgery totally depends on your pain scale.