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Are these popular therapies effective or just snake oil?

You might be tempted to try just about anything to relieve the pain and stiffness from your arthritic knees. And while your doctor will likely support other treatments before recommending a knee replacement, not all therapies are proven effective, and the hype on some seems too good to be true. So what's the best approach? "Arm yourself with information," says Dr. Eric Berkson, director of the Sports Performance Center at Harvard-affiliated Massachusetts General Hospital.

Doctors first recommend cortisone shots and pain relievers such as nonsteroidal anti-inflammatory drugs such as ibuprofen. But physical therapy and weight loss are the most effective, says Dr. Berkson. "Strengthening all of your muscles will mean you have less force on your knee during an activity. It's been shown to have an excellent effect on knee pain and future pain, and may be one of the best things for it. Losing weight makes a significant difference, too, since the force you place on your knee can be up to six times your body weight. So losing five pounds can result in taking off 30 pounds of pressure with every step." He recommends finding a physical therapist who's experienced in your particular diagnosis and won't overwork your knee.

Supplements

The most popular supplements for arthritis knee pain are chondroitin and glucosamine. Both substances are found naturally in the body. Chondroitin sulfate helps to keep cartilage from deteriorating. Glucosamine stimulates cartilage formation and repair. But do they work in supplement form derived from animals? "There's a lot of evidence that they work, but only in a certain percentage of patients," says Dr. Berkson. "I recommend them because there's little downside to trying the supplements." The bigger risk is that the supplements aren't tested by the FDA, so you can't be sure you're getting what you pay for. Dr. Berkson suggests asking your pharmacist for a good recommendation. He also says the supplements take about four weeks to be effective.

Anatomy of a painful knee

Knee

Viscosupplementation

Viscosupplementation injects hyaluronic acid into the knee. It's a naturally occurring substance in joint fluid that lubricates bones so they can move smoothly over each other. Scientists still don't agree how this medicine actually works. Even more concerning is the fact that studies don't agree about whether viscosupplementation even works at all. In fact, a recent study in the Annals ofInternal Medicine found hyaluronic acid is ineffective and may cause infection. Dr. Berkson notes, "Despite the lack of agreement, I have some patients who think it's a miracle drug that keeps their symptoms at bay. Given that the risks of an injection are very low, it makes sense to try it if insurance will pay." The treatment is usually covered by insurance, but otherwise it's pricey. "About $1500," says Dr. Berkson.

Platelet rich plasma

In platelet rich plasma (PRP), doctors extract platelets from your own blood, then inject increased concentrations of the cells into your knee. "The platelets contain hundreds of proteins called growth factors which can stimulate and speed up the healing response in your body," explains Dr. Berkson. "There's increasing evidence that PRP might work, but it may not. I do offer it in my practice, but it really is a last resort. It's not covered by insurance and it's expensive." PRP is also used to treat tendon, muscle and ligament injuries, but there's no definitive proof it's effective yet.

Prolotherapy

Prolotherapy also calls on the body's own healing process. Doctors inject an irritant such as glucose into the knee, which may stimulate the body to call healing cells to the site. It's usually combined with massage and exercise. "I don't see there's evidence that shows it works," says Dr. Berkson, "it may not work and it has a risk of infection. I think it's a consideration if everything else has failed, but I don't promote it."

Reference: Arthritis section on Better Medicine


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