Ask The Doctors: January 2014
Arthroscopic surgery for knee OA....Rheumatoid nodules...Exercise and weight loss for knee OA
Q. After having an MRI, my primary care doctor referred me to an orthopaedic surgeon because he thought I might need arthroscopic surgery to treat my knee osteoarthritis (OA). But the surgeon disagrees. He says the procedure isnít the best solution and wonít help my knee pain. Who is right?
A. Findings on an MRI can sometimes be misleading. To determine the cause of your knee pain, an orthopaedic surgeon who specializes in the diagnosis and treatment of conditions of the knee may be very helpful in interpreting the results. By combining MRI findings with other factors, including additional X-rays, a physical exam and a patient history, he or she can verify the best approach for your knee pain.
If you have significant OA, the MRI may show a meniscus or cartilage tear, but the bigger issue could be the arthritis itself, which often does not respond to arthroscopic surgery. While arthroscopic surgery has been shown to be an effective approach for meniscal repair and ligament reconstruction, a study published in the New England Journal of Medicine (May 8, 2013) showed that those patients who underwent arthroscopic surgery to treat a meniscal tear and knee OA had the same overall results six months following the procedure as those who were treated with physical therapy only.
These findings emphasize the need for standing X-rays in all adults to help determine the true degree of arthritis before making a treatment decision based solely on MRI findings. A second opinion is also recommended.
Q. I was recently diagnosed with rheumatoid arthritis (RA) in my elbow. While I expected pain in my elbow joint due to the condition, I now notice hard lumps forming around the area. Is this due to the RA, or something else?
A. Rheumatoid arthritis (RA) is predominantly a disease of the joints, yet the disease and many of the medications used to treat it can also affect the skin, including firm lumps of tissue called nodules.
Approximately 20 percent of people with RA develop rheumatoid nodules. Typically about the size of a pea, these hard lumps may form under the skin over boney areas such as the elbow or ankle. Nodules are the most common cutaneous manifestation of RA, and they typically form along pressure points (as in this case over the olecranon process of the elbow). They may also occur on the internal organs of the body, such as the lungs or heart. We often see nodules on the occiput (back of the head) and ischial areas (lower buttock), Achilles tendon and the vocal cords. †
To help shrink nodules, some people may benefit from treatment with disease-modifying anti-rheumatic drugs (DMARDs) to control RA or injections of corticosteroid medications. Surgery may be necessary for removal if the nodules become infected or painful.
Q .Iíve been struggling with painful knee osteoarthritis for a couple of years, which has led to me to gaining 20 extra pounds. Could the extra weight be making my symptoms worse?
A. Carrying extra weight is problematic for your knees, especially if you have osteoarthritis (OA). In a recent study published in the Journal of the American Medical Association (Sept. 25, 2013), researchers showed that diet and exercise eased knee OA better than either alone for overweight and obese patients. While the combination of exercise and modest weight loss can ease pain and improve physical function, itís important that an exercise and diet plan be discussed with your doctor to ensure itís tailored to your abilities and needs.