The good news: There are more non-surgical treatments for arthritis of the knee than ever before. While some treatments are proven, others are still being studied. The result can be confusion for patients trying to find relief.

The knee is one of the joints most frequently involved in arthritis. As baby boomers enter the prime "arthritis years" and life expectancies are steadily prolonged, the number of patients with arthritis of the knee will increase.

Goals for Treating Arthritis of the Knee

The goal in treating arthritis of the knee is to relieve pain and improve movement. Available treatments include reducing your activity level, maintaining a healthy weight, and physical therapy, as well as anti-inflammatory drugs, analgesics, injections, and nutritional supplements. Surgery may be considered when these non-surgical treatments do not provide relief.

Here are some of the conservative medical treatments that are most commonly used to treat arthritis of the knee.

Just Live with It

One option that is valid for many patients is to do nothing about their knee problem.

If arthritis of the knee is not dramatically interfering with a patient's lifestyle, they can choose to do nothing if they want. After a diagnosis is confirmed, the patient knows what is causing the problem with their knee and that they are not going to die from it. So the patient can try treatments, or simply do nothing. The patient is best able to decide if this option is realistic, depending on the degree of pain and immobility.

Resting the Knee: Pros and Cons

Another option is to change your habits to rest the knee. Decreased physical activity can diminish symptoms or reduce arthritis flares in some patients. However, these advantages must be balanced against the negative aspects of decreased activity, including weight gain, a reduction in general fitness, and increased muscle weakness. Clearly, this isn't an ideal long-term solution.

Weight Loss Does Your Knee a Favor

Weight loss may decrease the severity of knee symptoms, but it is less certain whether weight loss can slow the rate of disease progression. Excess bodyweight influences arthritis by putting extra strain on already burdened knee joints. Clinical experience shows that people who are 20 percent or more over normal bodyweight have more problems with their arthritis. The increased pain, resulting sedentary lifestyle, and further weight gain can become a vicious cycle.

Physical Therapy

Physical therapy treatments for the knee are designed to help establish or restore physical function, relieve knee pain, and maximize the abilities of the patient. A physical therapist will usually conduct an in-depth evaluation of the knee patient and then develop an individual treatment plan. Patients may also be referred to an occupational therapist, who can evaluate the effect of knee arthritis on the activities of the patient at home and at work. The therapist considers lifestyle factors, occupational considerations, hobbies and recreational activities when making the assessment.

Bracing

Some patients experience improvement with the use of an elastic support around the knee, according to The Physician and Sportsmedicine Journal, May 2000. Bracing may also be effective. "I have had some good results with bracing for some types of arthritis," said Dr. Yates.

Knee braces are designed to protect arthritic knees from stresses that could damage the ligaments. Braces also are used to stabilize the knee. "Additional studies are needed to demonstrate objectively the benefits of all knee braces," according to the American Family Physician Journal, January 2000. "Knee braces should be used in conjunction with a rehabilitation program that incorporates strength training, flexibility, activity modification and technique refinement."

Medication

Medicines play an important role in the treatment of knee pain. Following is a brief look at just a few of the drugs regularly used to treat arthritis of the knee.

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) have long been used to treat osteoarthritis of the knee. Some, like ibuprofen, are sold over-the-counter; others require a prescription. NSAIDs provide anti-inflammatory activity by blocking certain enzymes. But at the same time, they also inhibit an enzyme that plays an important role in maintaining normal functions in the stomach, liver, kidneys, and platelets. Thus, complications of NSAID treatment include ulcers and internal bleeding.

Topical NSAID therapy (creams and rubs) has been advocated as a potentially safer alternative to oral NSAIDs for knee arthritis, according to The Physician and Sportsmedicine Journal, May 2000. Indeed there is some evidence to support the use of topical NSAIDs, according to the journal.

COX-2 Medicines

COX-2 inhibitors - Vioxx®, Celebrex® and Mobic® -- have increased the safety of anti-inflammatory medication used in the treatment of osteoarthritis of the knee, according to the journal Orthopedics, September 2000. COX-2 inhibitors reduce pain and swelling in knee osteoarthritis as well as traditional NSAIDs. The chief advantage of these medications is a reduction in side effects such as ulcers and internal bleeding. These medications are now a mainstay of medical therapy for osteoarthritis of the knee.

"I regularly prescribe COX-2 medicines for knee treatment," said Dr. Yates. "These new drugs are a good alternative for some of my patients."

Capsaicin Cream

Topical capsaicin cream, sold without a prescription, is used to relieve the pain of osteoarthritis of the knee. Capsaicin is a substance derived from peppers. Studies support the safety and effectiveness of capsaicin, according to The Physician and Sportsmedicine Journal, January 2000.

Analgesics and Narcotics

Acetaminophen (the active ingredient in Tylenol®) is a non-narcotic analgesic that has an excellent safety profile and provides good pain control for many osteoarthritis knee patients. Acetaminophen can be an effective alternative to NSAIDs, with fewer side effects. One non-narcotic pain reliever, tramadol (Ultram®) is also available by prescription only.

Narcotic analgesics can be very effective for relieving pain in osteoarthritis of the knee. However, the side effects associated with narcotic drugs, most notably dependence, should limit their use to short-term treatment of severe pain associated with an acute arthritis flare.

Glucocorticoids (Corticosteroids)

The most powerful anti-inflammatory agents are glucocorticoids, also known as corticosteroids. They are sometimes prescribed to treat arthritis of the knee. These are synthetic versions of the hormone cortisone, which is produced naturally in small quantities by the adrenal gland. Synthetically produced glucocorticoids are used to reduce inflammation. The most commonly prescribed are prednisone and dexamethasone. Glucocorticoids taken in low doses can safely reduce inflammation in the joints. They are either taken orally or administered by injection at the doctor's office. When used in large doses or over long periods of time, these drugs, which are similar to a hormone our bodies produce naturally, can cause weight gain, thinning of the skin, cataracts, and osteoporosis.

Viscosupplement Injections

If your knee hurts to begin with, to some the idea of injecting a needle into the joint may be alarming. However, a therapy called viscosupplement injection actually can provide relief for some knee patients. Viscosupplementation has been used since the 1970s in veterinary medicine. A physician injects a substance called hyaluronic acid (derived from rooster combs) into the knee to lubricate and cushion the joint. Two products - Hyalgan(r) and Synvisc(r) - were approved by the FDA in 1997 for use in osteoarthritis of the knee. Although hyaluronic acid is cleared rapidly from the joint, the relief appears to last for six to 12 months. Adverse reactions are mild, usually limited to local reactions at the injection site. (Read more about Viscosupplementation here)

Emerging and Alternative Therapies

We've highlighted a few of the proven, time-tested non-surgical treatments for the knee that your doctor may recommend. There are also new treatments arriving on the scene almost every day. Some of these new therapies are considered "alternative treatments" because they lack the proven scientific support that traditional treatments have. You should always work with your physician to determine whether a specific non-traditional therapy might complement your current treatment.

Nutritional Supplements: Glucosamine and Chondroitin

There are two nutritional supplements widely promoted to arthritis sufferers: glucosamine and chondroitin. While there is some evidence that they provide modest relief, many marketers have gone overboard in hyping their use as an arthritis "cure." Claims that report actual restoration of cartilage as the result of using glucosamine and chondroitin have not been proven, according to the journal Orthopedics, September 2000. Glucosamine and chondroitin have been used for a number of years in veterinary medicine, according to a report by Robert C. Schenck, MD, associate professor, University of Texas Health Science Center, delivered at a 1999 meeting of the American Academy of Orthopaedic Surgeons. "For doctors, this is a fuzzy area," said Dr. Schenck. While studies have established that patients experience some pain relief, more conclusive studies are needed. However, Dr. Schenck reports that these supplements can be a reasonable option to consider for pain relief. He tells his patients, "It's not a cure, but it's worth a try."

Summary

Non-surgical therapies can be effective at relieving knee pain and improving movement in osteoarthritis of the knee. However, there is a need for studies that thoroughly assess the safety and effectiveness of non-surgical alternative therapies. You should work with your physician to find the right non-surgical treatment for you. It is important to try non-surgical methods first, and if the patient still does not see improvement, then opt for surgery.