Ask the Doctors January 2010 Issue

Ask The Doctors: January 2010

Knee-Cap Pain . . . RA and Depression . . . Gout and Heart-Attack Risk

My doctor tells me I have patellofemoral (anterior knee) pain syndrome. What is it, how is it treated, and is surgery ever necessary?

Patellofemoral pain is a common knee problem, which isnít surprising when you consider that forces on the patella, or knee cap, range from between one-third and one-half of your body weight during walking to three times your body weight during stair climbing. It can result from malalignment of the patella on the femur, weakness of the quadriceps muscles, or tight structures on the lateral aspect of the knee. It sometimes is caused by wearing down, roughening, or softening of the cartilage under the kneecap. The first step in treatment is to stop doing any activities that hurt the knee, especially high-impact activities such as running, and donít start again until you can do them without any pain. If you want to continue exercising, try swimming or another low-impact activity. Placing ice on your knees for 10 to 20 minutes after activity can help ease pain. Making sure you have proper shoes for walking or running also can help. A physical therapy program to strengthen and stretch the muscles around the kneecap has been shown to be effective in decreasing patellofemoral pain. Surgery rarely is needed, but if your pain persists and your physician has ruled out other causes of the pain, arthroscopic surgery may be necessary to remove fragments of the damaged cartilage.

I have heard that rheumatoid arthritis often leads to depression. Are there any strategies that can help newly diagnosed RA patients avoid depression?

People suffering from rheumatoid arthritis (RA) and other conditions that cause chronic pain are more likely than the general population to experience depression because the painful limitations of RA affect so many facets of daily lifeófrom performing our jobs, to managing our homes and families, to just getting a good nightís sleep. Because depression is closely linked to the chronic pain of RA, itís important to get early medical treatment. With many treatment alternatives currently available, RA doesnít have be the disabling condition it once was. In addition to following a medical treatment plan, you can take several steps to help avoid depression. So-called "self-management" techniques include learning all you can about RA; finding ways that work for you to reduce joint pain and stiffness; staying as active as possible; and taking an active role in managing your RA by identifying and eliminating as many causes of stress as possible If you experience symptoms of depression, donít hesitate to discuss it with your doctor. He or she can help you decide if antidepressant medications are appropriate.

Iíve been diagnosed with gout and have been told that the elevated level of uric acid that brought it about may also increase my risk of heart attack. Is this true?

A recent study seems to confirm the association between gout and risk of heart attack. Researchers found that men who had gout have a 26 percent higher chance of having a heart attack than those who did not have gout. Gout was the third largest risk factor for heart attack, after smoking and family history. Gout is a kind of arthritis that is caused by uric acid in the blood which deposits as crystals in the joints and sets off the bodyís inflammatory immune response. Inflammation is part of a process that results in blood clots that can cause heart attack and stroke. Even though no studies have shown that lowering uric acid levels or preventing gout lowers the risk of heart attack, these goals are worthwhile if only to avoid the pain of gout. Hyperuricemia can be reduced by not overindulging in meats and seafood, which contain purines, substances known to raise uric acid levels, and by limiting alcohol intake. In addition, several uric acid-lowering drugs are available.