Knee oiled

Published November 11, 2018, 12:05 AM

by Charissa Luci-Atienza & Bernie Cahiles-Magkilat



 “No thank you. Kneel until my knee-caps fester,”

Edmond Rostand (1868-1918), French poet and dramatist

Cyrano de Bergerac, Act II (1897)

At some point, people just give up on their arthritis. They say, “Well I’m getting old so I’m bound to get painful, deformed, creaky joints”  (not always true). I have operated on a 90-year-old with broken hips but no arthritis. Aging and arthritis do not always go together. It’s also no coincidence that our language is hopelessly inadequate in explaining arthritis. We simply call it “rayuma” which literally translates into “rheumatism.” This incompleteness in describing arthritis leads to a perception that it just happens, like cancer or a heart attack or diabetes – and that nothing can be done about it.  The very word “rheumatism” has a quaint 19th century ring to it. You know, the kind of condition cured by electric current or mustard salves. Now if you need electricity but not for light, or mustard but not for dressing, maybe it’s not a good thing.

Degenerative Arthritis. As the world population becomes grey, more and more people will suffer from the most common type of arthritis – degenerative arthritis (also known as osteoarthritis). The WHO reports that “osteoarthritis accounts for half of all chronic conditions in persons aged over 65. Some 25 % of people over the age of 60 have significant pain and disability from osteoarthritis. The economic consequences of osteoarthritis are enormous. For example, it is rated the highest cause of work loss in USA, despite being a condition that causes most problems to populations after retirement age.” The Department of Health (DOH) claims that: “There are about 11 million Filipinos who suffer from osteoarthritis based on a prevalence survey of 16%.”

Causes. The “wear and tear” explanation is certainly the easiest to grasp. We can wear out the ends of our long bones (the white, slippery smooth cartilage). I tell my patients to examine a fried chicken drumstick after eating all the meat. The translucent and tasteless tip of the chicken thigh bone is cartilage. This is the part that wears down in degenerative arthritis. Once cartilage becomes rough and underlying bone is exposed, chronic pain results. “Wear and tear,” however, doesn’t explain everything. For why are there 80-year-old marathoners or women in their twenties who can hardly walk from excruciating pain in the knees? For these reasons, investigators continue working on why the cartilage breaks down.

Risk Factors. Still, age is the most powerful predictor of getting osteoarthritis. Xray signs increase from 4% in 18-year-olds to 80% in persons 65 and older.  The next risk factor is a no-brainer: it’s obesity. Imagine pounding on those knees or hips with every step. The heavier you are, the more suffering your joints endure. The good news is that weight loss as little as 5kg (11 pounds) can mean a 50% reduction in the odds of developing osteoarthritis. Heredity just means that if your parents have osteoarthritis, you are more likely to get it. Finally, mechanical factors such as trauma, joint shape (deformed by infection, for example), sports, all conspire to allow osteoarthritis to manifest early.

Medical approach. Symptomatic relief of arthritic pain is standard. The doctor has a wide range of drugs available: from over-the-counter NSAIDS (non-steroidal anti-inflammatory drugs) – ibuprofen, mefenamic acid, piroxicam, diclofenac, etc.,  to COX-2 inhibitors such as etoricoxib and celecoxib. The trouble with NSAIDS is that, abused, they can cause bleeding ulcers in the small intestine (duodenal ulcer) or stomach (gastric ulcer). There’s even a chance of renal (kidney) toxicity. With COX-2 inhibitors, doctors now screen patients before prescribing because of complications leading to stroke. In cases of acute flare-ups, the doctor may suggest a corticosteroid injection. However, long-term use may actually accelerate joint deterioration.

Visco supplementation. A reliable non-surgical approach to osteoarthritis is visco supplementation. An example is sodium hyaluronate that is injected into the knee either once or thrice.  This natural substance acts as a lubricant and a cushion between the bone ends – or what’s left of the cartilage. Consequently, pain is relieved with some patients claiming feeling good up to six months. In the clinic, the doctor will probably recommend this if the degenerative arthritis is mild or moderate, noted by weight-bearing xrays and, of course, by physical examination. Severe arthritis is treated by surgery.

For those who dread any kind of arthritis surgery, visco supplementation may be a godsend.

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