Arthritis is a painful disease that requires long-term care.

Living with arthritis can throw up a multitude of concerns and questions such as: When is it safe to exercise? Which sports should you avoid? What is the difference between cold and hot packs and which ones should you apply when you are in pain?

Dr Darren Tay, Consultant from the Department of Orthopaedic Surgery​ at Singapore General Hospital, gives detailed answers to your questions.

Question by meowy

Dear Sir or Madam, due to old injuries, I have knee joint pain and wrist joint pain. Why is it that the TGC transdermal glucosamine cream (www.lynk-biotech.com) effectively kills the pain after 2 nights, but does not have much of an effect at the hand joint? Thank you.

Answered by Dr. Darren Tay Consultant Dept of Orthopaedic Surgery Singapore General Hospital

Glucosamine is normal constituent of articular cartilage and joint fluid. Scientific studies have shown that the use of glucosamine is able to reduce pain associated with osteoarthritis (cartilage degeneration).

Glucosamine can be delivered either as an oral preparation or a transdermal application such as TGC by Lynk-biotech.

Knee and wrist joint pain can occur as a result of osteoarthritis but also from many other causes as well such as joint instability. In addition the severity of the underlying degeneration will influence the efficacy of the cream.

I would recommend that you consult your doctor to firstly work-out the cause of your symptoms and subsequently advise you on the appropriate treatment.

Question by dave

My friend and I are avid tennis players - at club competitive level. Recently he's been having knee pain. When he went to see the Ortho doctor, he was referred to the physio for exercises, and will be reviewed in 3 months. Is this normal? How does one determine when physio exercises willl be effective, versus other forms of treatment such as medication etc. Any updates on some kind of "wonder jab" to cure pain? Just hoping!!

Knee pain can result from several causes, the most commonly being degeneration of the lining cartilage (also known as osteoarthritis), tears of the specialized shock-absorbing cartilage (known as the meniscal tears). ligament injury leading to joint instability and inflammation of the muscles and tendons around the knee joint. In addition, problems of the spine and hip joints can occasionally manifest as knee pain as well.

For most musculoskeletal conditions, a non-surgical approach will be able to manage the majority of patients. This would include physiotherapy which your friend is undergoing and also pharmaceutical agents such as pain-killers, anti-inflammatory drugs and glucosamine supplements. Most often, some improvement of your friend’s symptoms should be felt after 4 to 6 sessions of therapy. If no improvement is noted, your doctor may consider complementing the physiotherapy with some medication.

Currently in practice, viscosupplementation in which a gel-like substance consisting of hyaluronic acid is injected into the arthritic knee for pain relief is occasionally performed. This procedure, however, is able to only bring about temporary relief (usually from 3 to 12 months) and varies from patient to patient.

Question by ncashl

Dear Doctor,

I got a problem with my left knee. There is abit of swelling above the knee and it has been hardened. Sometimes I feel tightness around the joint and on some occasions while walking I encountered clicking sound coming from my patella area followed by a sharp pain. Because of this I began to develop a phobia walking and bending my knee at the same time. So I started to walk without bending my knee as much as before. Thus, I am limping. I am unable to squat or sit cross-legged anymore.

I am not sure if I have arthritis and I have seen a doctor and he saw the swelling and prescribed to me a cream to rub and pain killer to ease the pain. It didn't help at all. Please advise what is the likely cause of my knee pain and what I should do?

Thank you

Answered by Dr. Darren Tay Consultant Dept of Orthopaedic Surgery Singapore General Hospital

From you description of your symptoms, it seems that you have developed degeneration of the cartilage lining between the undersurface of your knee cap and the front of the lower end of your thigh bone.

This is known as patellofemoral osteoarthritis. This leads to the clicking when you move your knee as the cartilage is no longer smooth, and is frequently associated with increased knee joint fluid production also known as an effusion. I would recommend you be referred to see an orthopaedic specialist who could confirm this diagnosis and request for some xrays of your knees to help guide subsequent management.

Question by kcfoong

Under what circumstances a person can get OA at the later part of life? What preventive action can one take to prevent the onset of OA? Once inflicted with OA, what are the cure and/or relieve? KC Foong

Answered by Dr. Darren Tay Consultant Dept of Orthopaedic Surgery Singapore General Hospital

Osteoarthritis is a chronic, degenerative joint disorder where the lining cartilage breaks down and develops cracks and erosions. In time, this exposes the underlying bone and also leads to degenerative changes in the surrounding soft-tissue such as the ligaments and muscles.

The majority of osteoarthritis is idiopathic (no definite cause) and is influenced by age, gender and genetics. Contributory causes would include being overweight, having prior joint injuries (e.g. from sports or trauma), previous infections of the joint, occupation and hobbies and well as malalignment of the leg.

There is really no way to prevent cartilage degeneration from happening per se, but keeping your BMI within the healthy range could possibly retard the progression of degeneration.

This will reduce the loads taken by the knee and hip joints. Unfortunately, once you develop osteoarthritis, there is no known cure for it. Symptomatic relief from osteoarthritis can be obtained from weight-reduction, activity modification, use of walking aids, physical therapy, pharmaceuticals and once all-else fails, surgery (e.g. total knee replacement).

Question by hnulhll

Dear Dr,

can sufferers of arthritis ever be cured? I am living with old folks who suffered from it. May I know if additional supplements eg. glucosamine need to be added to their diet other than the medications that they receive from their specialists whom they see for their arthritis? If so, what is the recommended dosage? Any other food to avoid other than bean products? Will pain relieve creams work?

Answered by Dr. Darren Tay Consultant Dept of Orthopaedic Surgery Singapore General Hospital

Currently there is no known cure for arthritis and management is targeted more at functional improvement and symptom relief.

Glucosamine can be taken as a supplement and has been shown to have pain-alleviating properties if taken at the right dosage. It has also been proven to be a safe supplement. Side effects such as gastrointestinal disturbances or skin reactions can occur but are rare.

Generally, the prescribed dosage is around 1000 to 1500 mg of glucosamine per day. This should be taken from around 4 to 6 weeks to observe the effects.

Question by joynhope

Hi Dr Tay,

I am 53 & was recently diagnosed with Osteoarthritis. Had knee pains (sharp pains) for about a month & was not able to walk without an aid. Climbing stairs was impossible. I am allergic to painkillers like NSAIDs, thus had to bear with the pain. I've gone for acupuncture treatment, tried various glucosamine pills & cream, & now on physiotherapy. The pain is not so severe now & I can walk without aid. Climbing stairs is still a challenge. Before all this, I have been exercising 3 times a week in the gym, doing cardio ex on the cross trainer & treadmill. Since I dont feel so much pain now, is it safe for me to hit the gym again? Will this aggravate my condition. If so what can I do to keep fit & healthy? (I cant swim, tho this was recommended by the doc). Also may I know if the glucosamine cream is effective for preventing further deterioration of the cartilage?

Thank you for your time.

Susan

Answered by Dr. Darren Tay Consultant Dept of Orthopaedic Surgery Singapore General Hospital

Osteoarthritis occurs when there is a degeneration of the cartilage lining of joints. Essentially it is a chronic condition that develops over time but occasionally will have sudden painful exacerbations in which walking and climbing stairs can become very difficult. As in your case, these symptoms generally abate with time and are alleviated further with physical therapy and painkillers.

Once your symptoms are better, you can gradually return to exercise. Often there is still some residual stiffness and swelling and I would not recommend you go back full-swing into you previous physical regime. It would be safer to plan out a graduated training program with your physiotherapist who may incorporate low-impact interval training which would consist of aerobic and strength-training exercises. Hydrotherapy, in which you perform exercises in a shallow pool, is very helpful as the water provides resistance while at the same time, the bouyancy reduces high impact to the joints.

Glucosamine cream is available in many preparations and is available off-the-shelf. Its theoretical benefit over that of oral preparations is that the glucosamine enters the bloodstream directly through the skin and does not have to pass the gastrointestinal system where much of it is broken down. Hence, there is an increase blood concentration for the topical preparation compared to an oral preapration of the same dosage. Although some studies have shown glucosamine to reduce the rate of degeneration of cartilage, this unfortunately has not been universally reported.

Question by pelee0804

What exactly is arthritis? I was feeling at pain at the side and behind the knee area after a workout. I was told by differently by GP and chinese physician. One said it's arthritis and the one other said it's a degeneration of the knee joint. It took more than 3 months for the pain to be gone but any further rigourous workout still get the ache.

Answered by Dr. Darren Tay Consultant Dept of Orthopaedic Surgery Singapore General Hospital

Osteoarthritis occurs when there is a degeneration of the cartilage lining of joints. Essentially it is a chronic condition that develops over time but occasionally will have sudden painful exacerbations in which walking and climbing stairs can become very difficult.

From the diagnoses given by the GP and the Chinese Physician, they both seem to indicate that you are suffering from osteoarthritis of the knee joint. Having developed osteoarthrtis, there is currently no known cure for this disease and treatment is generally targetted at symptom relief and functional improvement.

This can be achieved by lifestyle modification, physical therapy, medication and in severe cases, surgery. In the earlier stages of arthritis, pain in the joint occurs only after strenuous activity but as the severity level increases, pain can occur during or even at rest, without strenuous physial activity.

Question by furkids

My wife age 47 years old is having problem getting her fingers straighten every morning starting about 2 months ago,about a year ago she used to complaint about slight pain around her knees and started on supplements,Glucosamine Plus,which helps to ease the pain around the knees. The pain on the fingers will attack every morning and also affect to the arms and shoulder and back areas However after few minutes of massaging the pains will ease off.. Please advice

Answered by Dr. Darren Tay Consultant Dept of Orthopaedic Surgery Singapore General Hospital

From the symptoms you describe that your wife is suffering from, she may either have osteoarthritis or rheumatoid arthritis affecting her hands. Osteoarthritis is a chronic degneration of the cartilage of the finger joints, the so-called “wear-and-tear” process. In rheumatoid arthritis, there is a swelling and overgrowth of the lining of the joint capsules of the fingers (and possibly other joints).

This overgrowth leads to secondary damage of the cartilage of the joint. I would recommend that she seek a medical opinion from her GP or polyclinic doctor who may request for radiographs of her hands and perform a blood test to check her level of “rheumatoid factor (RF)”.

This RF is often raised in rheumatoid arthritis but not in osteoarthritis. Her GP may subsequently refer her to see a rheumatologist or orthopaedic specialist for further management.

Question by YF

I would like to know what is the main different between Arthritis & Gout?

Answered by Dr. Darren Tay Consultant Dept of Orthopaedic Surgery Singapore General Hospital

Arthritis is a general term to describe cartilage degeneration in a joint. There are numerous causes for arthritis with the most common being idiopathic in which there is no known cause. In idiopathic arthritis, although no specific cause can be identified, age, gender and genetics appear to be strong influencing factors. In other types of arthritis, a known cause can be identified and these are termed secondary arthritis. These would include previous joint injury and inflammation of the joints from diseases such as rheumatoid arthritis, gout and infection.

Gout develops when a person has a high level of uric acid in the blood stream and this forms microscopic crystals in the body. These crystals cause an inflammation and depending on where they accumulate, can cause joint cartilage damage and kidney problems. The most common joint that gout affects is around the big toe. In addition, when gout has been present for a long time, the crytals can accumulate in the skin and tendons forming lumps known as “tophi”.

Question by mayheng

Hi Dr. Tay,

Recently, I kneel cap is very day and night. I almost no sleep at night. Am I suffer from Arthritis? Can I apply hot pack when i sleep? Should i avoid all kind of nuts and soyo beans?

Please advise.

Mrs. Heng

Answered by Dr. Darren Tay Consultant Dept of Orthopaedic Surgery Singapore General Hospital

Typically, osteoarthritis causes pain with activity and is relieved by rest although many patients may continue to ache. From the description of your pain, it is possible that you have arthritis of the knees but because your pain is present even at rest and affects your sleep, I would strongly recommend you seek a medical opinion from your GP or an orthopaedic specialist to rule out other causes of your knee pain.

In general, applying hot packs must be avoided when you go to sleep as if left unattended may lead to scalding burns on your skin. Hot packs and even ice packs should be applied for only 20 minutes at a time so as to avoid such complications.

Certain nuts and soya beans can contain high levels of a chemical called “purine” that if taken excessively can result in high levels of uric acid in the bloodstream. This in turn could increase the risk of triggering a gouty attack. My recommendation is to always eat in moderation. If you have been diagnosed with gout or high uric acid levels, then you should speak to your doctor or dietician on maintaining a low purine diet.

Question by guethui

Dear doc, I go to the gym twice a week. Sometimes I experience discomfort at my knees and shin. Will running lead to arthritis?

Answered by Dr. Darren Tay Consultant Dept of Orthopaedic Surgery Singapore General Hospital

Whether or not running leads to arthritis is a frequently debated topic. Current medical evidence, however, does not support this and even proposes a protective effect of moderate levels of running on the cartilage. Although running subjects the knees and hips to high impact, our body is able to adapt over time through changes in our musculoskeletal system and furthermore, keeping body weight down further retards joint cartilage degeneration. That being said, running injuries, especially when involving the ligaments that stabilize the knee, or the specialized shock-absorbing cartilage known as the menisci, can lead to joint cartilage injury and degeneration. If you do sustain a sports injury, it is important to consider getting a medical opinion so as avoid further damage to the joints.

Occasionally, pain can be experienced around the knees and shins after a period of exercise. This often occurs due to “micro-injury” of the soft tissue and bones that persist because insufficient time is given for the body to rest and recover. Knee pain without any preceding traumatic event is often as a result of inflamed tendons around the knee. Shin pain on the other hand, is often associated with “micro-fractures” of the shin bone also known as shin splints, stress injuries or stress-fractures. As these conditions are generally self-limiting and resolve spontaneously with rest over 4 to 6 weeks, no specific treatment other than pain-killers and anti-inflammatory medications are required.

Question by helene

How do you tell the difference between arthritis and trigger finger? I experience stiffness and swelling of the index, middle and ring finger on the right hand. Its quite an effort to clench the hand into a fist. The condition has persisted for 6 months already. Invariably the middle finger is locked.

Answered by Dr. Darren Tay Consultant Dept of Orthopaedic Surgery Singapore General Hospital

Arthritis is a degeneration and break-down of cartilage and can affect any of the synovial joints of the finger, hand and wrist.

Trigger finger is a condition whereby the tendon which bends the finger becomes focally swollen and starts getting trapped in its outer sheath. As a result, the tendon is unable to glide smoothly and starts to click and in worse cases lock-up in a bent position. In addition, the pain is usually not along the finger but where the finger is connected to the palm. Occasionally, you may need to use your other hand to straighten out the finger. From your description of your symptoms, you seem to be suffering from a trigger finger.

I would recommend that you see an orthopaedic specialist to evaluate your condition. Treatment can range from physical therapy and steroid injections to reduce the swelling to surgical release of the tight outer sheath.

Ref: U11