Osteoarthritis or osteoarthrosis of the knee is a mainly degenerative disease in which there is a progressive loss of articular cartilage, there is damage to the joint capsule and changes in the synovial membrane, among other structures of the knee.
· It is a very common disease
· It is the most common cause of disability in people over 65 years of age worldwide.
· About 13% of women and 10% of men over 65 have osteoarthritis of the knee.
· Over the age of 55, 25% of people have intermittent knee pain.
Causes of knee osteoarthritis
Its origin is multifactorial, although it is considered a degenerative or wasting disease, today it is known that there are hereditary and inflammatory factors involved in its appearance. It is not only a mechanical effect due to the weight or support that the knee has.
Over the age of 55, 25% of people have had intermittent knee pain.
Risk factors for knee osteoarthritis
Apart from the influence of inflammatory and degenerative factors, several risk factors for suffering from osteoarthritis of the knee are recognized:
· Genetic susceptibility
· Female gender
· Previous trauma
· Repetitive trauma to the knee increases the risk of knee Osteoarthritis in younger ages 4 times
· Muscular weakness
· Joint elasticity
· Mechanical forces
· Occupational mechanical factors: (for more than 1 hour a day)
· Kneel frequently
· Knife position frequently
· Low levels of Vitamin D, especially in young individuals.
· More than 6 pregnancies.
Symptoms and diagnosis
The main symptom is knee pain that increases with activity, with morning limitation or stiffness and limitation of movement with or without pain.
A rubbing sound or sensation may be heard when mobilizing the knee.
To corroborate the diagnosis, imaging studies are performed: plain X-rays, tomography and magnetic resonance imaging.
Conservative treatment for knee osteoarthritis
There are many non-surgical treatment options. Now we present many of the therapies used and the recommendations in each case:
Supports or mechanical treatment:
· Use of a cane: it manages to reduce pain and improve function and quality of life, during the first month of use, but improvement has not been shown for a long time. Additionally, its use is controversial due to the potential damage to other joints on the opposite side to the affected one.
· Crutches: there is no evidence that it improves pain or mobility.
· It improves pain and functionality to the joint, although scientific works do not agree on the time of exercise. There are several works that support the practice of Tai-chi for osteoarthritis of the knee.
· Exercise in water (swimming): has a slight benefit in quality of life, but no change in pain.
· Strength training: to increase tone and strength of thighs (quadriceps) and legs, they achieve a clear improvement in pain and mobility.
Spa-therapy or balneotherapy
This is the therapy in thermal baths based on mineral salts, sulfur or carbon dioxide, which has been approved in cases of pain in various joints apart from the knee.
· Electrotherapy or electrical neuromuscular stimulation: its use has been tried but it has not been shown in scientific works as beneficial for osteoarthritis of the knee.
· Transcutaneous electrical nerve stimulation (TENS), is safe in cases of knee osteoarthritis although only effective in some cases.
It is the most important factor, by reducing body weight, it significantly improves the support pressure of the knees, small weight losses of up to 5% have been shown to improve knee osteoarthritis.
· Ultrasound: it is a risk-free method, but there are studies that do not reveal many benefits. Little-used.
· Kinesotherapy: physiotherapy with different techniques has been shown to be effective in improving the quality of life and mobility of patients.
· Acupuncture: there is scientific evidence that reveals its benefits to improve joint pain.
Pharmacological treatment of knee osteoarthritis
Here are the physician-approved drug treatments for treating knee osteoarthritis:
· NSAIDs (Non-steroidal anti-inflammatory): safe and well tolerated improves pain.
· Capsaicin: there is pain reduction and its use is safe.
· Transdermal opioids (fentanyl patches): their use is limited by adverse effects and without substantial improvement in quality of life.
· Paracetamol or acetaminophen - effective but used for a limited time.
· NSAIDs are widely used but have many gastric effects.
· Anti-inflammatories (Coxibs) such as celecoxib, are effective but have long-term cardiovascular risks.
· Hyaluronic acid: it is injected intra-articular with a good effect that begins at 2 weeks and is optimal between 12 and 26 weeks after use.
· Intra-articular corticosteroids: they only have a short-term effect.
Treatment based on diet supplements:
· Glucosamine / Chondroitin - Many studies show its effectiveness in long-term pain in some patients.
· ASU (Advocate soybean unsaponifiables): natural plant extracts that have been shown to be effective for pain and mobility.
There are many alternatives to treat osteoarthritis of the knee and ask your doctor which ones are the most appropriate for you.
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