New data though shows that osteoarthritis probably begins earlier, probably in the second decade, in many patients.

Dr. Ewa Roos, professor in the Institute of Sports Science and Clinical Biomechanics of the University of Southern Denmark, presented an intriguing paper outlining her research. In it she described two populations of patients who suffer from osteoarthritis of the knee. The first group was comprised mainly of older women. The other group, though, consisted of men in their 30's and 40's (Roos EM, et al. Arthritis Rheum 2005; 52: 3507-3514).

A major hurdle to early diagnosis is that many younger patients with symptoms will have negative imaging studies… in other words, x-rays and magnetic resonance imaging (MRI) tests will be normal.

To complicate matters, patients who have x-ray evidence of osteoarthritis don't necessarily have symptoms.

Risk factors that are common to people with osteoarthritis are genetic predisposition and excessive weight.

In addition, patients who have suffered knee injuries to the anterior cruciate ligament (ACL) and menisci- the cartilage cushions in the knee- are also at increased risk for developing OA (Englund M, et al. Arthritis Rheum 2007; 56:4048-4054).

In related studies, it has been shown that regular exercise is both protective and preventative as far as osteoarthritis of the kb nee is concerned.

In other words, exercise appears to strengthen joint cartilage in patients with OA of the knee. Measurements of glycosaminoglycans, a measure of strength and elastricity in the joint, showed significant improvements in the knees of patients with OA who regularly exercised compared to control subjects who did not.

Many patients with OA of the knees are resistant to the idea of exercise since they feel it may cause the joints to wear down even faster. The results of the above studies clearly indicate that exercise should be encouraged.

For symptomatic relief, strengthening and stretching exercises accompanied by the judicious use of ice and anti-inflammatory medications may be quite helpful.

In the past, corticosteroid (“cortisone”) injections were routinely prescribed for patients with moderate to severe pain from OA. However, evidence indicating that corticosteroids ultimately cause cartilage to wear away faster than it should, has concerned physicians to the point where these injections are used less.

Viscosupplements, lubricants that help the knee to glide better, and which may help slow down the process of wear and tear are helpful for some patients.

More recently, the use of autologous stem cell therapy (stem cells harvested from the patient himself) has shown great promise, not only for symptomatic relief but for actual reversal of cartilage wear and tear with possible re-growth of cartilage. For more information about this procedure, contact the Arthritis and Osteoporosis Center of Maryland at (301) 694-5800.

Total joint replacement is reserved for those patients in whom conservative measures have failed.