Expert Q&A: 'Wear and tear' or osteoarthritis of the knee

[September 18, 2012]  (ARA) -- More than 10 million Americans begin their day with their usual routine, only to discover the spring in their step has been replaced by a creak in their knees. "Wear and tear" disease or osteoarthritis (OA) of the knee is the most common form of arthritis and can be life-changing. The associated pain and stiffness decreases an individual's ability to carry out routine day-to-day activities, such as climbing stairs or standing for a long period of time. It is estimated that women older than 50 years of age are more likely to develop OA of the knee than men.ⁱ

Jeffrey E. Rosen, M.D., a leading osteoarthritis expert and Chairman of the Department of Orthopaedics & Rehabilitation at New York Hospital Queens, shares expert insights and advice that all osteoarthritis of the knee sufferers should know, including ways to maintain a healthy, active lifestyle and common disease misconceptions.

What is osteoarthritis?

Often referred to as "wear and tear," osteoarthritis is a chronic disease in which the cartilage, or cushioning tissue between the surfaces of joints, wears away. When cartilage surrounding the joint breaks down, the joint has to bear more weight; this transmits across the joint possibly leading to changes in the underlying bone.

What are some common misconceptions about osteoarthritis of the knee?

Osteoarthritis is often confused with osteoporosis, which is a disease that affects the makeup of the bone, as opposed to the joints and cartilage surrounding the bone. Another common misconception is that osteoarthritis of the knee only affects older people.

Who is at risk of developing osteoarthritis?

There are certain factors that can increase a person's risk including weight, age, gender and injury or trauma to the knee joint. Those who have had repeated trauma to the knee joints, also referred to as "micro-traumas," are at higher risk, and women are affected more than men. Approximately 60 percent of the nearly 27 million people affected by osteoarthritis of the knee are women.ⁱⁱ

What are the symptoms? How can you tell it may be time to see your doctor?

General osteoarthritis of the knee symptoms include stiffness, particularly when getting up in the morning, aching in the joints and pain while walking up and down stairs. Patients will normally use over-the-counter medications to treat the symptoms. However, if symptoms progress over time or you start to feel a "crunching" sensation from inside the joint, this may be a sign that it is time to schedule an appointment with your doctor.

Also, consult your doctor when pain, stiffness or swelling becomes too persistent or starts to affect your stability when standing. Another sure sign to seek medical attention is when symptoms cannot be alleviated with an anti-inflammatory or an over-the-counter medication, such as acetaminophen. The key to a better outcome is seeking support early and before the problem progresses too far.

How is osteoarthritis knee pain treated?

Traditionally, physicians have approached treating osteoarthritis in a step-wise fashion, beginning with improving diet as well as a modified exercise program, then moving towards pharmacological intervention as needed. However, now physicians are starting to try different treatment approaches to help get the best result possible for patients as quickly as possible. My preference is to use multi-modal strategies where I can combine treatments and therapy strategies.

Non-interventional treatment

• Modified shoe wear/orthotics

• Assisting device (e.g. cane)

• Weight loss

• Nutrition and proper diet

Over-the-counter medication

• Glucosamine for joint health

• Pain medication (e.g. acetaminophen)

Interventional treatment

• Cortisone or hyaluronic acid injection therapy

• Partial joint replacement

• Total joint replacement

What type of questions should people who suffer from osteoarthritis knee pain ask their doctors when it comes to diet, nutrition, exercise, treatment options, etc.?

I tell my patients the importance of being informed. Ask your doctor about ways to maintain proper body weight and an exercise program that is appropriate for you. It is also important to keep an open dialogue with your doctor about worsening symptoms so treatment can be adjusted as necessary.

What are three things you would recommend someone diagnosed with osteoarthritis knee pain to keep in mind?

1. Maintain a healthy body weight. It is essential to maintain a healthy body weight. In fact, every 10 pounds, either lost or gained, is magnified by four times depending on the physical activity being done by the individual.

2. Stay active and exercise. Keep up an active lifestyle and make sure this includes a stretching and exercise program. A common misstep is to focus on cardiovascular training only or weight training only, whereas a combination of the two is ideal. Stronger muscles can act like shock absorbers to joints, so a strength training program is beneficial.

3. Educate yourself about your disease. Finally, it is imperative to be educated about your condition and aware of the contributing factors so you know when it is the right time to see your doctor.

For more information, please visit: www.euflexxa.com.

EUFLEXXA® (1% sodium hyaluronate) is used to relieve knee pain due to osteoarthritis. It is used for patients who do not get enough relief from simple pain medications such as acetaminophen or from exercise and physical therapy.

EUFLEXXA is only for injection into the knee, performed by a doctor or other qualified healthcare professional.

IMPORTANT SAFETY INFORMATION

You should not take this product if you have had any previous allergic reaction to EUFLEXXA or hyaluronan products. You should not have an injection into the knee if you have a knee joint infection or skin diseases or infections around the injection site.

The safety and effectiveness of EUFLEXXA has not been established in pregnant women, women who are nursing or children less than 18 years of age. After you receive this injection you may need to avoid activities for 48 hours such as jogging, tennis, heavy lifting, or standing on your feet for a long time (more than one hour at a time).

The most common adverse events related to EUFLEXXA injections were joint pain, back pain, limb pain, muscle pain, and joint swelling.

Please see full Prescribing Information.

Jeffrey E. Rosen, M.D. has authored more than 35 publications and over 40 presentations in the orthopaedic space, and is currently a speaker and paid consultant for Ferring Pharmaceuticals Inc.

EUFLEXXA® is a registered trademark of Ferring B.V.

ⁱAmerican Academy of Orthopaedic Surgeons. (2007). Frequently Asked Questions about Osteoarthritis of the Knee. Retrieved Mar. 8, 2011, from http://orthoinfo.aaos.org/topic.cfm?topic=a00228.

ⁱⁱArthritis Foundation. (2011). Arthritis in Women. Retrieved Mar. 8, 2011, from http://www.arthritis.org/women.php.

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