Month: November 2017

Osteoarthritis of the Knee

Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of bones in our joints gradually worn off. This causes the bones over the joints to rub against each other causing friction and thus the symptoms of osteoarthritis.

The most common joints to be affected is the knees. Hips, spine and finger joints are also commonly affected.

It is an ongoing process that cannot be reverse but there are some interventions that can help manage the symptoms and slow down the process.

Symptoms

Osteoarthritis symptoms includes painful and stiff joint/s, and loss of movement or function of the affected joint.

Risk factors

Factors that may increase your risk of osteoarthritis include:

• Older age.
• Being female.
• Obesity.
• Previous joint injuries.
• Genetics
• Bone deformities.

Diagnosis

Usually with physical examination and history, your doctor can diagnose a knee osteoarthritis. However sometime we might need to perform X-rays and blood test to confirm the diagnosis. Occasionally, the fluid in the joint can be aspirated to send for Joint fluid analysis to help us make the diagnosis.

Treatment

Exercising and maintaining a healthy weight are the most important ways to treat osteoarthritis.

Lifestyle and home remedies

1. Exercise.

Try walking, biking or swimming. Avoid running on uneven grounds or going up and down too much stairs. Exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. If you feel new joint pain, stop.

1. Lose weight.

Obesity or even being somewhat overweight increases the stress on your weight-bearing joints, such as your knees and your hips. Even a small amount of weight loss can relieve some pressure and reduce your pain.

1. Physical therapy.

Physical therapist can work with you to create an individualized exercise program that will strengthen the muscles around your joint, increase your range of motion and reduce pain.

1. Use heat or cold compress to manage pain.

Medication

1. Topical cream: Over the counter cream such as Deep heat gel or Voltaren gel for mild cases.
2. Pain medication: Try paracetamol as first line oral medication. If not better, your doctor may give NSAIDS (eg, ibuprofen, naproxen, Arcoxia)
3. Supplement: Glucosamine, chondroitin or collagen II. Studies have been mixed on these nutritional supplements. A few have found benefits for people with osteoarthritis, while some indicate that these supplements work no better than a placebo.

If conservative treatments don’t help, we may need to consider procedures such as:

1. Cortisone injections. Injections of corticosteroid medications may relieve pain in your joint. We generally try to do this as little as possible as the medication can worsen joint damage over time
2. Lubrication injections. Injections of hyaluronic acid may offer pain relief by providing some cushioning in your knee.
3. Acupuncture. Some studies indicate that acupuncture can relieve pain and improve function in knee osteoarthritis.
4. Joint replacement. In severe cases or when other methods failed, total knee replacement is an option.

Speak to you doctor today if you are suffering from knee pain.

Osteoporosis causes bones to become weak and brittle. In osteoporotic bone, a fall or even mild stresses such as bending over or coughing can cause bone fracture.

Osteoporosis affects men and women of all races. But Asian women — especially older women who are past menopause — are at greatest risk.

Symptoms

There are usually no symptoms for osteoporosis until complication has occur.

Complication includes:

• Bone fractures.
• Back pain, caused by a fractured or collapsed vertebra
• Loss of height over time

Screening and Diagnosis

As women are at greater risk of osteoporosis, all women 65 years old and above should consider screening for osteoporosis with a BMD scan (a low level xray).

Women below 65 year old but with high OSTA score (see below) should consider screening also. 

Speak to your family doctor if you are at risk. They will determine if you need a BMD scan to meansure your bone density. It is just like a Chest X-rays or a bone X-rays, where during this painless test.

OSTA score : Age (year) minus Weight (kg)

20 and above: High risk. For BMD scan.

0-20: Moderate risk. Discuss with your doctor if you need BMD scan.

Less then 0: Low risk. No need for BMD scan.

Prevention

1. Protein

Protein is one of the building blocks of bone. Protein supplementation is an option.

1. Body weight

Being underweight increases the chance of bone loss and fractures. Excess weight is now known to increase the risk of fractures in your arm and wrist. As such, maintaining an appropriate body weight is good for bones just as it is for health in general.

1. Calcium

Men and women between the ages of 18 and 50 need 1,000 milligrams of calcium a day. This daily amount increases to 1,200 milligrams when women turn 50 and men turn 70.

1. Vitamin D

Most multivitamin products contain between 600 and 800 IU of vitamin D. Up to 4,000 IU of vitamin D a day is safe for most people.

1. Exercise

Exercise can help you build strong bones and slow bone loss. Combine strength training exercises with weight-bearing and balance exercises.

Treatment options

For those  who are proven to be osteoporotic on a BMD scan, treatment options are: 

1. Oral or injectable bisphosphonate
2. Strontium Ranelate
3. Raloxifene (selective estrogen receptor modulator)Osteoporosis causes bones to become weak and brittle. In osteoporotic bone, a fall or even mild stresses such as bending over or coughing can cause bone fracture.