5 October: Q&A with Dr Mike Martin

I'm a 47-year-old man and have been having problems with my knees, particularly my right one, which is often swollen and very painful when I bend it. My GP said I have arthritis. He prescribe painkillers and recommended that I see a specialist. Would surgery be the answer or are there any non-surgical options that might help me?

Dr Mike Martin Consultant Rheumatologist, Spire Leeds Hospital

In answer to your question, problems in a middle aged man, affecting both knees suggests one of a number of conditions, not all of which require surgery.

Episodic swelling with pain may indicate a crystal deposition disease, the most common example of which would be gout. This may occasionally present in this way but more often will be associated with an acute, short duration attack that affects the foot or ankle.

Inflammatory conditions such as rheumatoid arthritis or psoriatic associated arthropathy should also be considered. If you or a close family member has psoriasis involving the skin this will aid in diagnosis. In each of these above conditions medical treatment may be required with tablets and possibly joint injections.

Surgery would in general only be considered for degenerate conditions affecting the joint, examples of which are osteoarthritis, usually seen in older people, and arthritis that develops following trauma to the cartilage, in this case a tear.  Detailed imaging with scans and possibly arthroscopy may help to determine the cause, and after considering all these possible diagnoses, only then will surgery be performed.

May I suggest asking your doctor to make a referral to a specialist Rheumatologist for an initial assessment. 

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