knee pain Brace yourself … arthritic knee pain can be debilitating. 

Once you hit your 50s or 60s chances are one or more of your joints, probably your knees or hips, will start to niggle or become arthritic. And if pain or stiffness begin to limit your ability to enjoy life and perform routine tasks, chances are you will consider replacing the troublesome joint.

Rates of knee replacement surgery in the West are skyrocketing as populations get older and fatter, but there are ways to help prevent and ease knee pain and damage.

Osteoarthritis results from wear and tear on the joints. Rheumatoid arthritis, on the other hand, is an autoimmune disorder.While most people think of osteoarthritis as a breakdown of the cartilage that keeps bones from rubbing together, recent studies have shown it is a far more complicated disease that also involves tissues in and around joints, including bone and marrow. Inflammation can be a contributing factor and genetics play a role. Three genes have been identified so far that accelerate the development of arthritis.

Any kind of joint injury or surgery raises the risk that a joint will become arthritic. That is why so many professional and recreational athletes develop arthritis at younger ages.
Still, there are many potential remedies short of surgery to relieve arthritic pain and to preserve, and perhaps restore, normal joint function. Even if surgery is needed, it can be postponed for many years with treatments proven to help in well-designed clinical trials.

Artificial joints usually last 10 to 15 years. But both devices and surgical techniques are constantly being improved; by delaying a joint replacement, you may end up with a simpler operation or more durable device.

WHAT WORKS, WHAT DOESN'T

If you weigh more than you should, do your best to shed those extra kilograms as losing body weight can make a big difference.

Stephen Messier, a professor of health and exercise science at Wake Forest University, has shown in a trial of 450 men and women with osteoarthritis, a weight-loss diet combined with a well-designed exercise program could significantly reduce knee pain.

The most helpful exercises are those that strengthen the quadriceps, like leg presses, mini-squats and wall squats, and flexion and extension exercises that restore and preserve range of motion, said Dr Glen Johnson, who reported on arthritis prevention and treatment at the annual meeting of the National Athletic Trainers' Association last month. Several visits to a physiotherapist can help.

''The severity of pain is directly correlated with the degree of muscle weakness,'' Dr David Felson, a rheumatologist and epidemiologist at Boston University School of Medicine, wrote in The New England Journal of Medicine.

Although most experts endorse walking for exercise, Johnson instead recommends non-impact activities such as stationary or outdoor cycling, swimming, or working out on an elliptical or rowing machine. Those who choose to walk, he says, may benefit from runners' shoes.

Bracing an arthritic knee can help, too, especially with an unloader brace that shifts the stress away from the damaged part of the joint. Knee braces can help arthritis sufferers continue to participate in physical activities and postpone the need for surgery.

Pain relievers usually bring only temporary relief, if any. Daily dosing with paracetamol should be tried first, experts say, because it is significantly safer than ibuprofen and other non-steroidal anti-inflammatory drugs.

Clinical studies have shown no significant relief of arthritic knee pain from supplements of glucosamine and chondroitin sulfate, though Felson said that if people feel better taking them, he does not discourage the practice.

Nor is there good evidence of benefit from methylsulfonylmethane, SAM-e or acupuncture. Some evidence suggests osteoporosis drugs may be helpful, although they have not yet been tested for arthritis relief in a randomised clinical trial, Felson said.

There are also hints of benefit from vitamin K, an essential nutrient found in cruciferous vegetables (broccoli, kale, cabbage and the like), which are good for health in general (unless you take blood thinners).

Doctor-administered treatments include steroid injections every three or four months to control pain and buy time, and injections of a synovial fluid replacement twice a year. In general, though, these are not very effective when arthritis has reached the bone-on-bone stage, Johnson said.

The New York Times