Monday, February 17, 2014

Knee Osteoarthritis - what do I prescribe?

When Dr. Irwin Lim posted "Knee Pain? I prescribe diet & exercise" a couple of months ago, I asked myself, what do you yourself prescribe. Not the same, but much the same. It comes down to three points:
·        exercise
·        diet
·        drugs
I come back to these three in a moment. What I don't prescribe is:
·        chondroitin
·        hyaluronic acid
·        MSM
·        supplements in general
And I use patient education.

There are lots of studies on exercise. Some people can't fulfill a whole program, which we with in-patients: a combination of aquatic, aerobic, and strength exercise. In general I also recommend these for out-patients, but would have to tailor my recommendations due to availability. For some patients exercise might mean walking on flat ground.

Diet is important to reduce weight in obese patients as it reduces weight load on the knees. Diet alone won't be too successful; but we already talked about the necessity of exercise. I advocate lots of veggies (easy as I'm vegetarian) and studies are in favour of a diet rich in antioxidants. I always stress that diet does the trick and not supplements. There's a study by Y. Wang and colleagues addressing this issue: " Effect of antioxidants on knee cartilage and bone in healthy, middle-aged subjects: a cross-sectional study." The author's concluded: "The present study suggests a beneficial effect of fruit consumption and vitamin C intake as they are associated with a reduction in bone size and the number of bone marrow lesions, both of which are important in the pathogenesis of knee osteoarthritis. While our findings need to be confirmed by longitudinal studies, they highlight the potential of the diet to modify the risk of osteoarthritis." Link:
Also reducing arachidonic acid in the diet may be beneficial.

How about drugs? I keep a low profile with drugs. I counsel patients to be very critical about opiates, being a cause for falls. I use paracetamol or novaminsulfon instead, if not successful NSAIDs.

Patient education
I think it's important to educate patients on therapeutic goals and do so right away while they 're in the consultation. As there isn't enough time I recomment both evening talks, which I and my colleagues do on various topics at the hospital, and information texts I've put on my blog. As our center has once been the navel around which the evaluation of an educational program on RA was turning, I know for sure that education will increase the adherance rate of patients to therapy.

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