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Ask the Pharmacist

By: Ron and Marla Chapleau
October 12, 2017

Q: Last week, you talked about mild to moderate levels of arthritis in the knee. I’m afraid my knees are far worse than that. What can be done to help them?

A: Last week, when we discussed Stage 1 or 2 osteoarthritis of the knee, it was mentioned that many people with this level of deterioration may not even know they have this condition since their symptoms may be so mild.

This, unfortunately, does not apply to anyone whose knees are bad enough to be classified as Stage 3 or 4.

Stage 3 osteoarthritis would best be described as a moderate level of pain and impairment. In this stage, the cartilage between the bones shows obvious wear and tear, and the joint-spacing we discussed last week has begun to narrow.

At this stage, people will likely experience pain when engaging in activities, such as running, bending, kneeling or possibly even walking. Stiffness is frequently present after long periods (hours) of inactivity, and there may be some swelling in the affected knee(s) after extended periods of activity.

People with Stage 4 arthritis have severe symptoms. Just about any level of activity causes them a great deal of discomfort due to the fact that the joint space is markedly reduced leaving the joint as almost bone-on-bone. At this point, the cartilage has almost completely been worn away and the synovial fluid, which lubricates the joint, has pretty much disappeared, leaving the joint stiff and full of friction.

All the treatment options mentioned last week can still be, and should be, utilized if helpful. However, most with knee pain of this severity will need to at least consider other options. Activity restriction, to some degree, would be a minimal starting point.

This does not mean you should stop exercising as that would be extremely counterproductive to not only your knee health but also to that of the rest of your body. Instead, try to avoid activities that are known to be hazardous to your knees, such as jumping, kneeling, running and squatting.

The pain killers mentioned last week are still appropriate to trial but, if ineffective, narcotics may be considered. This is extremely controversial given the fact that opioids come with substantial downsides. Their benefits in arthritis are questionable in many cases, and they seem to lead to a steady downward slide in so many people who start down that path. But for those with extreme pain, it might be worth having a discussion with your physician.

Two other treatment options, which come with considerably less risk, involve injections right into the knee. Cortisone shots have been used for decades, can provide significant relief within a few days, and are considered a very safe form of treatment.

However, this relief often lessens quickly so that many find the benefits wear off in as little as two months. As well, cortisone shots have a catabolic effect with repeated dosing, meaning they can cause further damage to your existing cartilage, thereby, actually worsening the joint if used long-term.

Perhaps a better, but more expensive, option is the injection of artificial hyaluronic acid into the joint. Hyaluronic acid is one of the critical components of the synovial fluid that acts as a lubricant and shock absorber within the joint.

There are a number of companies that make these injections, and doctors who are trained in this, will inject it in one or both of your knees either as a single shot or a series, depending on the product chosen.

Results vary greatly with these injections but the consensus seems to be that about 30 per cent of people who receive them become virtually pain-free, with symptom relief lasting up to two years for some.

Unfortunately, another 20 per cent will experience no benefit from the injection when it comes to pain. The rest will fall somewhere between these polar-opposite outcomes.

These are not a quick-fix as it takes, on average, five weeks for most to experience the full benefits that the shot has to offer, and some will find that the effects start to wane after three months or so.

The costs are covered by some private drug plans but not by the government one, and can run somewhere close to $400 per knee.

One intriguing additional factor to consider is that there is a growing body of evidence that these injections do more than just relieve your pain and stiffness. Some experts believe that the hyaluronic acid may reduce the presence of inflammatory substances within the joint and that it may even coax the joint into increasing its own production of this vital fluid, thus helping to preserve the remaining cartilage.

The hope is that hyaluronic injections have both a symptom benefit (less pain and stiffness) as well as a long-term effect (the slowing down of the degeneration of the knee joint).

Another option that can be, and probably should be, tried even before one reaches Stage 3, are the “natural” products that have now been studied for years in the hope that they can both provide pain relief as well as slow down the destruction of the joint. There is a lot to talk about here, so we will leave that for next week.

Failing any of these to improve your quality of life, a total knee replacement (known as arthroplasty) is a last resort. During the surgery, the surgeon removes the joint and replaces it with a plastic-and-metal one. Recovery takes weeks to months (more likely) and requires significant physiotherapy and occupational therapy.

The good news is that these artificial joints seem to hold up far better than we had originally thought they might, with one study finding that 96 per cent of people who had the operation still had the replacement functioning well 20 years after the surgery.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at and the Facebook page at


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