Millions of people suffer from degenerative joint disease, or osteoarthritis.  Many search for causes and many more search for degenerative joint disease treatments.  Unfortunately there is far too much commercialized nonsense out there on the web… or someone is trying to get you into their institution for a joint replacement.  Let’s start first with the causes of degenerative joint disease and the commonly accepted, reasonable treatment alternatives available for joint pain sufferers. Any decision you make should be based on your quality of life … and not your X-ray or MRI findings.  We treat patients… not MRI findings!

 

Normal Articular Cartilage

Notice the smooth white Articular Cartilage in a knee

What is degenerative joint disease?

 

Osteoarthritis of the knee

Notice how the cartilage is no longer smooth and shiny… this is early degenerative joint disease

Degenerative joint disease, also known as osteoarthritis is due to the loss of articular cartilage within your joints.   The articular cartilage is the cushioning that is on the ends of our bones.  When we mature or finish growing, that cartilage is fairly thick, it is firm and rubbery … and smoother than glass.  For many reasons we start to loose the cartilage, or we may suffer an injury which will cause us to loose our cartilage.

The causes of degenerative joint disease are numerous, some of the more common causes are:

  • genetics — do you have a family member with arthritis?
  • trauma — injuries can start a degenerative cascade
  • nutritional — some think that vitamin D deficiency can cause arthritis
  • mal-alignment – Are you bowlegged or knock-kneed?
  • meniscus tears: loss of the meniscus function (as a shock absorber) can lead to arthritis

 Why does degenerative joint disease hurt?

If you lose enough cartilage, or cushioning on the ends of your bones, then the bone underneath the cartilage will “see” more stress.  That can cause pain.  If you have had an MRI and they mention bone marrow edema — that means fluid or inflammation in the bone itself because it is subject to stress because of the loss of cartilage.

Another common source of pain in a knee with degenerative joint disease is something we call synovitis.

Degenerative joint disease synovitis

Inflamed synovium: notice how red and “angry” it looks.

The synovium is the tissue which lines the entire inside of our joint. Usually it is thin, clear and produces just enough fluid to allow our joints to move without pain or friction. In patients with degenerative joint disease or osteoarthritis, the synovium can become inflamed.  That inflammation itself can cause significant pain.  In addition, if the synovium is inflamed it may make more fluid than normal and that’s why many of you have a warm, swollen knee — or as you may refer to as “water on the knee”.

Degenerative joint disease treatments:

Treatments and recommendations vary depending on how severe your pain is, your age, your activity level, and any other medical problems you may have.  Any medication or supplements mentioned should be reviewed with your primary care doctor before starting them since they can interact with other medicines or they may not be indicated because of an underlying medical problem you have.  

  • Lifestyle changes: Many people will experience relief from simply slowing down.  Shorter walks, shorter runs, switching to a bicycle or swimming for exercise etc.
  • Weight loss: I know, I know… BUT … for every one pound you lose, you will take 4 pounds of force off your knee!!  Therefore even a relatively small weight reduction will result in pain relief.
  • Braces or sleeves: Simple neoprene sleeves (available at most chain stores) can provide significant relief of pain.  We believe it is because of a biofeedback mechanism… it is not because it “supports” your knee better.  When you purchase one, if it is tight enough to stay on, it is tight enough… do not get a sleeve that is too tight.
  • Supplements and Vitamins:
    • Vitamin D: Get tested. Know your level.  More info on Vitamin D and Arthritis
    • Fish Oils: Fish oils contain chemicals which act in a similar way that aspirin or other NSAIDs do.  But it causes fewer side effects.  Check with your doctor first since in can interact with other medications.  Here is a rather scientific, but complete description of the benefits and side effects of fish oils and why they work.
    • Astaxanthin: a very potent anti-inflammatory 
    • glucosamine/chondroitin sulphate: Some recent research shows that it may work to limit pain… but it will NOT regrow cartilage.
    • Tart cherry juice … yes! tart cherry juice! Here is a scientific article on the benefits of tart cherry juice
  • Injections:  Nobody likes to receive an injection… and yes, they hurt — but they can give you substantial relief.  The options available to us include:
    • Cortisone or steroids.  These potent anti-inflammatories once injected will usually result in significant pain relief which can last for a few months.  You must check with your physician first about potential interactions with other medications and if you are a diabetic, this WILL make your blood glucose rise!
    • Hyaluronic Acid : Examples include Synvisc, Orthovisc, Hyalgan, etc… Many people refer to these as gel injections.  Some people mistakenly believe they are cartilage injections.  They are not.  Hyaluronic acid injections can significantly improve your pain for upwards of 4-8 months.  They are effective in most people… but not everyone.  The most common reason they do not work is probably because they were not injected properly and did not get into the actual knee joint — we’re not perfect and sometimes we miss :-(
    • Platelet Rich Plasma or PRP:  PRP is prepared by collecting a sample of your blood, placing that sample into a centrifuge and then taking off a certain layer and injecting it into your knee.  Recent scientific literature shows that it may work to limit your pain from degenerative joint disease  — .PRP, or platelet rich plasma injections,   involve the injection of your own concentrated platelets, protein-releasing bodies, and other healing growth factors that can aid the body in resolving certain inflammatory conditions and can heal worn out tissues..   It is an office based procedure where a small amount of blood is collected from you — the sample is prepared in a special apparatus placed into a centrifuge and then injected back into the site to be treated. In prior years PRP was investigated for the treatment of tendon related disorders such as tennis elbow.   PRP has received a lot more attention recently as an alternative to minimize or alleviate the pain associated with arthritis of the knee.In a recent study published in the The American Journal of Sports Medicine it was shown that PRP or Platelet Rich Plasma was effective for alleviating or improving the pain from arthritis of the knee.
    • Ozone: No comment
    • Prolotherapy : No comment
  • Physical therapy: Either physical therapy, a pool program, or a gentle land based exercise program can improve your pain and delay the need for more aggressive treatments.
  • Surgery:
    • Arthroscopy:  Tread lightly when someone recommends an arthroscopy or “scope” to “clean out” an arthritic joint.  The results are typically poor, and the research is fairly clear that arthroscopy has a very limited role in management of degenerative joint disease… at best.   Most insurers, and Medicare will not cover the surgery if the primary diagnosis is osteoarthritis.
    • High Tibial Osteotomy: This is a procedure offered to young patients with arthritis limited to one side of the knee joint.  It involves cutting the tibia and changing the alignment of the leg to take the pressure off the side of the knee that is arthritic.  Visit this page for more information about a high tibial osteotomy.
    • Knee replacement:  Knee replacement is unfortunately the only definitive procedure we have to “treat” degenerative joint disease which has not responded to other measures and the pain and disability is significantly interfering with your quality of life.  Knee replacements can be partial, or “total”.  A knee replacement is a big procedure, and you are a key member of the team.  You need to be physically and emotionally prepared for your knee replacement and ready to assume the risks of surgery and be ready to work hard in rehabilitating your new knee.  You need to find a surgeon who does a reasonable volume of joint replacement and doesn’t dabble in joint replacement surgery … volume matters and diminishes the risks of complications in knee and hip replacements.    The NY Times published an opinion piece the other day on the issue of the treatment of osteoarthritis and knee replacements that you may wish to review.

Arthritis Treatment Options