Medication and lifestyle adjustments for the management of osteoarthritis in the knees

Osteoarthritis is a condition that causes joints to become painful and stiff, thus affecting mobility, function and quality of life.

Mr Sunil Kumar, one of our top consultant orthopaedic surgeons practising across London and Essex, explains the five stages of osteoarthritis, how quickly it can develop in the knees and what medications and lifestyle changes are needed to stop it from worsening.

What are the stages of osteoarthritis?

Classically, osteoarthritis is described as having five stages, ranging from healthy and showing no signs of the condition, to severe and causing significant symptoms. The five stages are as follows:

1. Normal — a normal healthy knee which shows no signs of joint damage nor osteoarthritis.

2. Minor – very minor wear and tear symptoms and unlikely to cause significant discomfort or a restriction of function.

3. Mild – patients will experience occasional joint pain and stiffness. Little or no changes may be seen on X-rays but may be detectable using MRI scans.

4. Moderate – this includes the breakdown of cartilage coating on the bone surfaces in the joint, presence of joint inflammation, leading to fairly regular pain, reduction and restriction of more demanding physical function.

5. Severe – joint space (the gap between the bones) is greatly reduced as a result of complete loss of cartilage coating leading to bone-on-bone articulation, severe inflammation, constant pain, severe restriction of function and night pain resulting in regular disturbance of sleep.

How can you prevent early osteoarthritis progressing?

In the early stages of osteoarthritis, pain and limitation of function, including stiffness, is often episodic and responds well to weight-loss, lifestyle modifications, muscle strengthening and analgesic/anti-inflammatory medication. Supplements such as glucosamine and chondroitin sulphate may also occasionally help and herbal remedies like turmeric may also give some relief.

There are many different medical approaches you can take to control symptoms and prevent early osteoarthritis from getting worse. These include:

• Education and psychosocial — if you are overweight, you should be focusing on losing weight to take the load off your knee joints by adopting a more healthy diet. You should also focus on posture training and setting yourself goals.

• Physical treatments — many exercises will help you maintain strength, range of motion and mobility. These include pilates, Tai-Chi, yoga and balance training. Walking aids, braces or orthotics may be tried and attention to footwear is essential. Acupuncture and taping may also be beneficial.

• Pharmacological — you can take analgesics e.g. paracetamol and codeine, NSAIDs (anti-inflammatory medication) both oral and topical e.g. ibuprofen and naproxen to relieve any discomfort and pain. Steroid and Visco supplement injections may also be beneficial.

If you are suffering from stage 4 osteoarthritis, you will require some form of surgical intervention to improve pain, correct the deformities and restore function.

What lifestyle and diet changes are needed to slow progress?

You must watch your weight and take part in regular low impact, low resistance exercises. Both of these simple measures can be extremely beneficial and do not require any specialist equipment.

Which foods should you eat and which should be avoided?

Small well-balanced meals at regular times are ideal and it is best to avoid processed foods, red meat, fried foods, cheese and high-fat dairy, sugar/sugar alternatives, refined carbohydrates (white bread and white pasta) and alcohol. Adopting a Mediterranean diet has been shown to help reduce pain and inflammation, thus improving joint function and protecting you against future damage to your joints. This includes:

• fresh fruits and vegetables
• healthy fats found in nuts and extra-virgin olive oil
• pulses and beans
• whole grains like brown rice and quinoa
• omega-3 fatty acids like salmon and tuna​

Sticking to a Mediterranean diet will not only help you better manage your osteoarthritis in the longterm but will help to protect you against weight gain, fracture risk and disability. You can find more information on this diet and detailed food plans from the Arthritis Foundation.

If you wish to book an appointment with Mr Sunhil Kumar, visit his Top Doctors profile and check his availability.