What are the symptoms?
The main symptoms are pain and limited joint function. They can be added: rigidity, crepitus, swelling, restriction of the range of joint movement, joint instability or muscle atrophy, depending on the case.
As of today, knee osteoarthritis is a disease that has no cure, but there are therapies to control pain, reduce the limitation of functionality and delay the progression of the disease.
What treatments are currently available?
Non-pharmacological therapies are basic and are recommended to all patients. They include: access to quality information, 5% weight reduction in 6 months, the use of cushioned footwear and the maintenance of a physical activity of moderate intensity that avoids a direct impact on the knee.
Within pharmacological therapies we have different options: oral, topical, and intra-articular.
Regarding oral pharmacological therapies: paracetamol is widely used, however, its efficacy is, in various cases, mild and short-term. Glucosamine sulfate and chondroitin sulfate are considered slow-acting disease modifiers by part of the scientific community and may have a benefit on pain and function in highly selected patients. Non-steroidal anti-inflammatory drugs are effective in improving pain, but the safety profile must be carefully considered in each patient. Duloxetine may play a role in controlling pain sensitization phenomena in certain candidates and the use of opioid derivatives, whether minor or major, must be decided with caution in specific cases.
Regarding dietary supplements (nutraceuticals) such as Boswellia serrata, avocado unsaponifiable lipids, collagen, Curcuma longa, Unicaria tomentosa, passion fruit peel extract, omega-3 fatty acids, gamma-acid linoleic acid, L-carnitine, green-lipped mussel extract, methylsulfonylmethane, pine bark extract, magnesium, etc. They are not generally recommended, since the clinical trials they present have important methodological problems that make it difficult to interpret the results, and the difference with the placebo may be minimal. If you are interested, it is recommended to discuss this possibility with your doctor and receive reliable information on each compound, adjusted to each specific case, and avoid self-medication without good prior advice.
At the level of topical therapies, capsaicin or non-steroidal anti-inflammatory drugs in gel or cream may have short-term benefits, but their use must be consulted for each specific case.
Corticosteroid injections have a short-term effect on pain and could be used in patients with joint effusion. However, the frequency of these infiltrations must be limited in time due to the risk of loss of cartilage thickness in the long term.
Infiltrations with platelet growth factors or platelet-rich plasma are another option in selected patients. They have the advantage of being an autologous treatment (of our own body), minimizing the risk of adverse reactions in the short and long term.
Finally, knee replacement is a common procedure for the treatment of knee osteoarthritis in an advanced stage, but it must be reserved exclusively for those patients who have not responded satisfactorily to less aggressive therapies, because although in some cases it is a Definitive treatment is not exempt from the possibility of complications.
What treatments are expected in the future?
Currently, there are 4 major lines of tremendously active research, focused on what today are considered the 4 key targets of osteoarthritis treatment: inflammation, cartilage anabolism and catabolism, bone remodeling and control of pain. These great efforts by the scientific community could begin to bear fruit in the coming years with new injected or oral pharmacological treatments that improve the current therapeutic armamentarium.
In the case of pain in your knee, you should go to your rheumatologist, receive a clinical assessment, and if necessary, carry out the complementary examinations that your rheumatologist considers in your case. After the evaluation, the risks and benefits of existing therapies should be discussed and then the treatment strategy that fits the specific case should be chosen.
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