Ask the Pharmacist

Q: I have arthritis in my knees and would rather not have replacement surgery or at the very least, delay it for a few years if I can. What’s actually happening in my knee and how can I make it feel better?

A: Osteoarthritis of the knees (or hips, or back, or hands) is one of those conditions that are so common that when you reach a certain age (say mid-40s for many), it is almost a mild surprise if you don’t suffer from it to some degree or another.

It affects literally millions of Canadians and tends to get progressively worse as we age.

It is a disease caused simply from the wear and tear of a life spent working, walking on hard surfaces and engaging in activities that, while fun and healthy in many respects, often don’t do our joints any great favours.

Its symptoms vary greatly, develop slowly and worsen very gradually over time.

The predominant symptoms are stiffness particularly after a period of inactivity (such as first thing in the morning), pain that occurs during or right after movement, tenderness to the touch, some decrease in the range of motion of the joint, a grating sensation that you may hear or feel when you use the joint, and the presence of bone spurs which are extra bits of bone that develop where bones meet each other and feel like “lumps” that may form around the joint.

In general, if you have a sudden increase in pain or swelling in the affected joint, then it is not just osteoarthritis you’re dealing with.

Physicians grade an arthritic knee in four stages:

In Stage 1, there is very minor bone spur growth and joint spacing (the distance between the two major bones which, when normal, is an indication that your cartilage is healthy, thereby preventing the two bones from rubbing or scraping one another) is normal. Most people with this degree of disease will experience virtually no discomfort and be unaware that they have the early manifestations of arthritis of the knee.

In Stage 2, the condition of the knee would best be characterized as mild. X-rays would reveal greater bone spur growth but joint spacing is normal and the synovial fluid (the thick fluid that fills the joint space between the bones and acts like lubricating oil) is present at a level that is relatively typical of a healthy knee. It is at this stage that some will experience pain after abnormal activities, such as a long day of hiking or when the knees have not been used for many hours.

Treatment at this stage is usually non-medicinal as the symptoms are not severe enough to warrant pain killers. It should be noted that the therapeutic interventions we are about to go through would still be great starting points for more severe grades of arthritic knees as well. All of these have low to no risk associated with them and have been proven to relieve pain and discomfort in the vast majority who embrace them.

The most important treatment is weight loss, if you are overweight. Your knees carry those extra pounds around all day long and that adds up to a lot of wear and tear on the joint even if you engage only in the activities of daily living (e.g. laundry, groceries, chores, walking).

Exercise will obviously benefit those who are overweight but it has also been proven to help with knee pain even in those whose weight is right in line with where it should be. Low-impact aerobics and proper strength training will strengthen the muscles that surround and support the damaged joint, providing increased stability and lessening the likelihood of further damage.

Braces and wraps can provide additional stability to the knee and are a cheap and reusable intervention. For some, orthotics may be of great benefit as they help to realign your legs which can relieve some of the pressure put upon the joint. When breakthrough pain does occur, acetaminophen (Tylenol) is in almost all cases (unless you have substantial liver disease or are on a few select drugs), the first drug you should try to see if it eases your discomfort as its safety profile is second to none when used at the recommended doses – 3,000 milligrams (mg) or less per day, 1,000 mg or less per dose, not repeated any sooner than every four hours).

There is a common misconception that osteoarthritis involves inflammation and therefore, Tylenol should not be attempted first since it lacks the anti-inflammatory properties of the NSAIDs (Advil/ibuprofen, Aleeve/naproxen, Celebrex) making it less effective. This is an erroneous assumption. Osteoarthritis does not contain the same levels of inflammation that other joint conditions have, such as rheumatoid arthritis or even simple sprains.

Unfortunately, Tylenol does not work for everybody so for some of those people, an NSAID can be attempted to see if it proves more effective. There are many people who should not try NSAIDs due to their side effects and interactions so please check with a health professional first before trying even one of the non-prescription alternatives.

A rub-on type NSAID, such as Voltaren or its stronger prescription-type versions, seems to work as well as the pill forms and with significantly-fewer downsides, and might be worth trialling before you buy a bottle of tablets.

It is at this time, if not earlier, that some of the natural alternatives should be considered for pain relief. When it comes to pain, a few specific ginger extracts have the best evidence of efficacy when taken for the occasional pain. Other alternatives, with differing amounts of evidence supporting their usefulness, include Turmeric (curcumin), Boswellia serrata (Indian frankincense), Stinging Nettle, Cat’s Claw and Devil’s Claw.

Next week, we will discuss what’s going on inside the joint of a Stage 3 and Stage 4 knee, as well as treatments for these more aggressive versions and natural supplements that have some degree of proof they may actually help reverse some of the degeneration that has occurred within the knee.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts