Hands up all the readers over the age of 60. Hands up all those readers over the
age of 60 who don’t get stiff knees in the mornings. Not so many hands this
time!
As you get older, you will get to meet ‘Arthur’. That’s
almost a 100 percent money-back guarantee. And since it is my money that might
go astray, I must be very confident. The ‘Arthur’ I am referring to is one of
the banes of mankind and is “arthritis”.
Unfortunately, there are many types of arthritis, and
descriptions of these go back into antiquity. Perhaps the oldest known type of
arthritis, called gout or gouty arthritis, has been described since Hippocrates
in the 5th century B.C. In fact, at one time, the term “gout” was used to
describe all types of arthritis. Then it was known as the “Disease of Kings” due
to its association with rich foods and alcohol consumption, something in which
the commoners were not able to indulge. Things have certainly changed.
One of the most common forms of arthritis today is
osteo-arthritis, and rather than being of a biochemical nature, osteo-arthritis
is much more of a mechanical wear and tear situation. In America, the estimated
incidence is that 37 million adults are suffering from it.
Unfortunately, we all wear out. Joints in particular are
mechanical devices, with one bone sliding on another with a slippery bit (called
cartilage) in between as the bearing surface, cum-shock absorber.
Most joints, especially knee joints, are designed to last our
three score years and ten, and that’s about it. We do know why they wear out,
and because they are mechanical, increase the loading on the joint and it wears
out quicker. Imagine that your knee has been designed to hold up 80 kg for 70
years, and now increase that loading to 120 kg. That same knee now has to
support 50 percent more than it was ‘designed’ for, so you can expect it to wear
out 50 percent sooner. Simple.
So they hobble down to the doctor and ask for something for
the pain. The doctor flips mentally through the latest medical drugs for this
condition, and most probably will hand over some Non Steroidal Anti Inflammatory
Drugs (NSAID’s) and tell the patient to lose weight.
Now I am not saying that this is totally wrong - but - when
the NSAID’s first came out (hands up all those who remember Indocid) they were
heralded as being the answer to these problems. Some were even supposed to
‘grow’ new cartilage. The answer the osteo-arthitic’s prayers.
Unfortunately, we very quickly found that Indocid and its ilk
drilled holes in the lining of the stomach and were more than slightly
dangerous. So we developed newer and better and more stomach-sparing NSAID’s.
Unfortunately, these too produced problems.
Nothing daunted, we came up with even newer and more
wonderful NSAID’s, which came with even newer and more wonderful array of side
effects. So wonderful that one called Vioxx had to be withdrawn by the
manufacturers.
So what can the poor patient do? Most patients have already
tried paracetamol, hot water bottles, someone else’s great new tablets, NZ green
lipped mussels, a cabbage leaf (which does work for mastitis, or so the ladies
tell me), various herbal or homoeopathic medications, yoga, meditation, magnets,
copper bracelets, muttering mantras and goodness knows what else. Exercise does
help to improve the mobility in the knee joint, and by strengthening the muscles
and ligaments around the knee, give it more stability. But it will not re-grow
cartilage.
There is another avenue in the treatment, and that is direct
injections into the affected joints. This produces spectacular results, but
unfortunately are short lived. However, even a couple of weeks can make it such
that the person can go on holidays and actually enjoy some mobility. But it is
not the long-term answer.
Finally, there is surgery, which is currently the treatment
of last resort. Since around 90 percent of patients show lessening of pain,
improvement in functional status and overall quality of life, I think we should
be looking at operation sooner, rather than later. But that’s just my opinion.
