When to get checked before arthritis treatment Surprise

When to go now

A hot, swollen joint with fever needs urgent care. Sudden trouble standing after an injury also needs urgent care. You can't wait if the joint looks bent or swells quickly.

New weakness, numbness, or lost bladder control needs prompt help. These signs aren't a normal part of gradual joint wear. Go where you can get a full medical exam.

Sudden swelling is like a warning light on your car. It doesn't identify the cause by itself. It tells you to get help without waiting.

Which visit to arrange

Start with primary care for a slowly aching large joint. A physical therapist can help rebuild strength and motion. Your doctor may order an X-ray after examining the joint.

Call your doctor when small joints swell on both sides. Long morning stiffness, rash, or eye trouble also needs attention. A rheumatologist is a doctor for joints harmed by immune attacks or crystals.

QC Kinetix is a non-surgical joint clinic. Its medical providers are clinic staff who examine joints and carry out treatment. They can discuss regenerative care made from prepared parts of your blood.

What to bring to the appointment

Bring your medicine list, including pills bought without a prescription. Add any old X-ray report and notes from prior care. You'll need clothes that let the provider move the joint.

Describe when the soreness began and what makes it worse. Say whether it wakes you or changes your walking. Name the daily task you want to do again.

Ask what the exam found and what remains uncertain. Then ask how waiting could affect the joint. You'll leave knowing which care to consider next.

Sources

1. The PRECISION trial randomized 24,081 patients who required NSAIDs for osteoarthritis or rheumatoid arthritis and were at increased cardiovascular risk to celecoxib, ibuprofen or naproxen. A primary cardiovascular outcome event occurred in 2.3%, 2.7% and 2.5% respectively, meeting non-inferiority for celecoxib - but 68.8% of patients stopped taking the study drug and 27.4% discontinued follow-up.

   Nissen SE, et al. — Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis.. N Engl J Med, 2016. DOI: 10.1056/NEJMoa1611593.

2. The SPACE pragmatic randomized trial (240 patients) compared 12 months of opioid versus non-opioid medication therapy for chronic back pain or hip or knee osteoarthritis pain, using a treat-to-target strategy in both arms, with pain-related function as the primary outcome and medication-related symptoms as the primary adverse outcome.

   Krebs EE, et al. — Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial.. JAMA, 2018. DOI: 10.1001/jama.2018.0899.

3. In a two-year double-blind randomized trial of 140 patients with symptomatic knee OA and ultrasonic synovitis, intra-articular triamcinolone 40 mg every 12 weeks produced significantly greater cartilage volume loss than saline (index compartment cartilage thickness change -0.21 mm vs -0.10 mm; between-group difference -0.11 mm, 95% CI -0.20 to -0.03) with NO significant difference in pain.

   McAlindon TE, et al. — Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.. JAMA, 2017. DOI: 10.1001/jama.2017.5283.

4. 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.

5. 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.