Is it time to change what I'm doing?

When can I keep working on it at home?

Home care may fit a mild ache that settles and isn't growing worse. Shorten a walk when soreness rises, swelling appears, or the joint feels warmer. Heat, cold, rest breaks, and steady strength work may help.

Write down the motion that hurts and how long the soreness lasts. Compare your walking, sleep, and swelling from one week to the next. If motion keeps getting worse, home care isn't doing enough.

When is an office visit worth it?

Book a visit when the ache wakes you or stops usual tasks. Swelling that returns, new weakness, or sudden buckling also needs an exam. Take your medicines and any old joint records with you.

The visit may cover exercise, medicine, or regenerative treatments made with material collected from your body. A useful plan names the first treatment and when to review it. It also says whether you will track pain, sleep, walking, swelling, or motion.

Which signs can't wait?

Get urgent care when strong heat, heavy swelling, and fever happen together. Trouble standing after a hard fall also needs quick help. Fast swelling or a sudden loss of motion can't wait.

New numbness or weakness can mean a nerve problem, not arthritis alone. Don't wait for a routine appointment when either symptom begins suddenly. Slowly growing soreness can wait for an office visit; sudden changes cannot.

Sources

1. The 2019 ACR/Arthritis Foundation guideline makes STRONG recommendations for exercise, weight loss in people with overweight or obesity, self-efficacy and self-management programmes, tai chi, cane use, hand orthoses for first-CMC joint OA, tibiofemoral bracing, topical NSAIDs for the knee, oral NSAIDs and intra-articular glucocorticoid injections for the knee; acupuncture, thermal modalities, radiofrequency ablation, acetaminophen, duloxetine and tramadol are only conditional.

   Kolasinski SL, et al. — 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.. Arthritis Rheumatol, 2020. DOI: 10.1002/art.41142.

2. The Cochrane review of land-based therapeutic exercise for knee osteoarthritis extracted data from 54 studies, with high-quality evidence from 44 trials (3,537 participants) that exercise reduces pain immediately after treatment, and further high-quality evidence that it improves physical function. Benefit attenuates but persists for at least two to six months after the programme ends.

   Fransen M, et al. — Exercise for osteoarthritis of the knee.. Cochrane Database Syst Rev, 2015. DOI: 10.1002/14651858.CD004376.pub3.

3. In the only randomized trial of total knee replacement (100 patients with moderate-to-severe knee OA), the surgery group improved more on the KOOS4 score at 12 months than the non-surgical group (32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) - but had four times the serious adverse events (24 vs 6, P=0.005), and 26% of the non-surgical group chose surgery within the year while 74% did not.

   Skou ST, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. N Engl J Med, 2015. DOI: 10.1056/NEJMoa1505467.

4. A cross-sectional study of 1,703 primary total knee arthroplasties in Ontario found approximately one in five patients (19%) were NOT satisfied with the outcome. Satisfaction with pain relief ranged 72-86% and with function 70-84% depending on the activity. The strongest predictor of dissatisfaction was expectations not being met (10.7x greater risk).

   Bourne RB, et al. — Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res, 2010. DOI: 10.1007/s11999-009-1119-9.

5. The 2010 ACR/EULAR classification criteria define 'definite rheumatoid arthritis' by confirmed synovitis in at least one joint, absence of a better alternative diagnosis, and a total score of 6 or more out of 10 across four domains: number and site of involved joints (0-5), serology (0-3), acute-phase response (0-1) and symptom duration (0-1). This is the formal boundary between inflammatory arthritis and degenerative joint disease.

   Aletaha D, et al. — 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.. Arthritis Rheum, 2010. DOI: 10.1002/art.27584.