Ask the Doctors October 2013 Issue

Ask The Doctors: October 2013

Arthroscopic surgery for knee OA pain....Types of inherited arthritis.....

Q. The pain in my knee from osteoarthritis (OA) has worsened considerably despite medication. My doctor has recommended arthroscopic surgery, but will this relieve my knee pain?

A. Arthroscopic surgery for knee OA can include several different procedures from lavage (a flushing and suctioning of debris from a joint) to debridement (trimming damaged cartilage from bone spurs). Your surgeon may also treat the bone itself with abrasion or microfracture to stimulate the growth of new cartilage.

A review published in the Cochrane Library (January 2009) assessed the effectiveness of debridement via arthroscopic surgery for knee OA. The review analyzed three studies involving 271 patients, with the largest of the studies comparing arthroscopic debridement to lavage and sham surgery. According to this study, the three treatments produced similar results in pain and physical function after two years. Yet, the overall review shows that in people with OA, arthroscopic debridement probably does not improve pain or ability to function compared to placebo (sham surgery), and leads to little or no difference in pain or ability to function compared to the lavage approach.

The best candidates for arthroscopic surgery are patients with mild to moderate disease and mechanical symptoms in the knee. These symptoms are evident when fragments of cartilage interfere with the joint causing popping, locking or knee buckling. Future research on larger groups of patients comparing several arthroscopic techniques will be useful as to who can best benefit from the surgery.

Q. My father has struggled with both rheumatoid arthritis (RA) and osteoarthritis (OA) his whole life, leading to numerous joint replacement surgeries and severely reduced quality of life. While I have minimal OA in my knee, will I eventually inherit the same severe arthritis throughout my body?

A.There are 200 types of arthritis, and the majority of these are not hereditary. However, some people may have a genetic predisposition to certain types of arthritis, but this is not the same as a type of arthritis being inherited. Like most human diseases, the numerous forms of arthritis or rheumatic diseases have their own specific cause(s), including certain genetic or inherited components. Each type has its own specific degree and pattern of heredity in addition to different genes, which influence not only susceptibility to the condition, but also the severity of the disease. Ongoing research studying twins has proven very helpful in examining the genetic and environmental influences that may cause rheumatic diseases.

The two types of rheumatic diseases that appear to have identifiable genes that play a substantial role in passing the disease from generation to generation include ankylosing spondylitis (spondyloarthritis) and rheumatoid arthritis (RA), according to the American College of Rheumatology. A study of systemic lupus erythematosus (lupus) showed eight percent of patients with the condition had at least one first-degree family member (parents, siblings and children) with the same diagnosis.

While OA or degenerative joint disease (DJD) are not autoimmune diseases and are unlikely to share the same genes as spondyloarthritis, RA or lupus, there are types of OA that may have genetic compoenents. Nodal OA in the hands is an autosomal disease with a higher prevalence in women than men, and has shown to have a genetic component. There are also rare forms of premature OA related to the production of collagen, which are genetic.