Treatment Plan

ETC

I’m after guidance on the best way forward with what I should expect from my GP and nhs in general in way of treatment for OA in both knees,

Background - my right knee was diagnosed in 2016 & left in 11/21. Private X-rays in 07/22 showed my right knee is bone on bone, while my left still had some cartilage between the joint, both knees had bone spurs. I was very active up until late 2021, daily walks & twice weekly Zumba classes, but Zumba became too painful & I can now only manage a 20 minute walk on a good day. I saw a Physio after my initial diagnosis in 2016, but have not had any follow up sessions & at that stage I was still active anyway. I’m a 67 year old female, I still work full time & hope to do so for a while yet. as I work from home 90% of the time & my OA is not an issue with work, yet!

Pain Management- I'm now in pain 24x7 and my reduced mobility is having an impact on my mental health. I take ibuprofen for pain when I have a flare up but am worried about the affect long term. At my request I started having steroid injections in Feb 2022. I have just had my 3rd set of injections & while I was there I asked the Doctor if there are any stronger alternatives to over the counter medication I.e creams painkillers that they could prescribe. I was told to just keep on with ibuprofen & creams don’t work anyway. I’m never asked how I’m managing my OA, if the pain is any worse or even if the injections are working. I would like to be referred to a consultant for ongoing treatment & to discuss possibly surgery in the future but don’t feel my Doctor is listening to me. Can you advise the best way I should approach my GP?

jonr

Welcome to the Community ETC,

I'm sorry to hear your surgery isn't particularly helpful bu the good news is you've come to the right place.

First of all, let's start with some facts:

1: Taking anti-inflammatories long term can cause internal bleeding and I am surprised your GP was so dismissive.

A commonly-prescribed anti-inflammatory is Naproxen, it's stronger than Ibuprofen and is usually prescribed along with Omeprazole to protect the stomach lining. There is no reason on earth why your GP shouldn't prescribe these for you upon your request given you've been formally diagnosed

2: Steroid injections are usually applied to cartilage so if you're bone-on-bone they're less likely to be successful

3: Creams and gels DO work and there's a lot to try. I would recommend you visit this page on the website to read up on managing your condition: https://www.versusarthritis.org/about-arthritis/managing-symptoms/ There is one cream, Capsaicin Cream which is generally prescribed but you may find your GP will refuse due to it's cost, the rest are available in pharmacies and health food shops or online with Amazon and eBay, etc.

4: For prescribed painkillers the usual one most GPs will offer is co-codemol. If yours refuses to do so it can be bought behind the counter at Pharmacies, usually in differing strengths

5: Other routes to treatment and assessment. When you contact your GP about being prescribed Naproxen, etc also ask for a referral to Connect Health for further assessment by the MSK department: https://www.connecthealth.co.uk/

This is an organisation attached to the NHS as a sort of specialist fast-track service for people with MSK conditions, that's the route I took when my own GP was being obstructive and it was a game-changer.

If your GP asks why, say your condition is worsening, that your mental health is suffering and your quality of life is greatly reduced. If he or she refuses, you can actually self-refer.

6: Exercise. If your health centre has a physio attached to it then you can call up to ask for an appointment to be assessed for a tailor-made physio plan. These will be designed to strengthen the knees and surrounding tissues, etc, plus stretches to keep you supple. It takes several months but with application and determination you should begin to see an improvement. My recommendation would be to invest in some good elasticated or velcro strapped knee supports to aid stability and ease the swelling.

So, in summary, if you can get on top of your pain you'll be able to do the exercise and physio and if you can do those you'll be fitter, happier and ultimately have a decent quality of life but it does sound like you're going to have to be forceful with your GP.

Good luck and do let us know how you get on

Jon

helpline_team

Hi @ETC

Thank you for posting on the Online Community. I am sorry to hear that you are experiencing pain in your knees due to osteoarthritis (OA) which is affecting your mobility and daily activities. This can feel very debilitating, and it is understandable that you feel it is beginning to impact you mentally as well as physically.  Jon has given a helpful link for managing your symptoms. As he suggested, Capsaicin may be worth a try if you haven’t tried this already. It is available on prescription. It may help to go back to your GP to review your pain medication again and talk things through further.

As the X-ray of your right knee now shows bone on bone, it sounds as if referral to an orthopaedic specialist would be helpful to discuss the possibility of knee replacement surgery.  I am glad you had the opportunity to see a physiotherapist in 2016. However, as this is a long time ago now, a new referral may be worth considering for an assessment and advice. A healthy balanced diet and keeping a healthy weight will help to put less strain on your joints. Pacing yourself and balancing activity with rest will help too. I am glad to hear you are getting out for short walks.

It is good that you are managing to work mainly from home. Under the Equality Act, your employer is legally obliged to make reasonable adjustments, if you are living with a long term condition, to help make your job more manageable. This could be flexibility of hours, working part time and provision of equipment, such as a more suitable chair. Help with funding is available from the government scheme Access to Work.

I hope the information given below will be of some help. 

https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis-of-the-knee/

https://www.versusarthritis.org/about-arthritis/living-with-arthritis/work/

If you would like to have more replies to your post, you are welcome to repost on our 'living with arthritis' forum which is another source of support to share experiences with others living with arthritis facing similar challenges.

Best wishes,

Fiona, Helpline Advisor