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For more information, go to www.arthritisresearchuk.org

Your ten minute knee consultation starts here

Published on 01 January 2009
Source: Arthritis Today

Dr Mallen in clinic with patients

Do you come out your GP surgery feeling that you haven’t really got anywhere? Dr Christian Mallen offers expert advice on people with knee osteoarthritis can get the most from their GP consultation.

If you are reading this and you are suffering with knee pain, don’t be alarmed - you are not alone. Around one in four people over the age of 50 experience knee pain yet only half of these people will seek medical advice about their pain. The commonest diagnosis given to older people with knee pain is osteoarthritis. For many people getting a diagnosis of osteoarthritis from their doctor is worrying, yet there is much that can be done for people suffering from this very common condition.

When you visit your doctor for the first time they will take a history from you (talk to you about what has been going on) and usually examine your knees.

There are certain questions about your knees that can provide the GP with useful information that will help him/her make a diagnosis, guide your treatment and make a plan for the future. These might include:

  • How long have you had the pain?
  • How severe is the pain (you may be asked to rate your pain on a scale of 0-10)?
  • Do you have pain anywhere else?
  • Is your knee stiff in the mornings? How long is it stiff for?
  • Did your pain start after an accident?
  • Does your knee swell up?
  • Does your knee get red or hot?
  • Do you have problems going up or down stairs?
  • Do you wake at night with pain?

As well as asking about your joints, your doctor will also ask questions about how you are feeling in general and how the knee pain impacts on your day to day ability to do things. Don’t be surprised (or offended) if they also ask you about your mood, as depression and anxiety are both very common in people with knee pain (about one in three older people with pain in their joints or muscles also have a low mood). Treating your low mood can also be beneficial to your knee pain. If you feel low, or need extra help doing your usual activities, do let your doctor know. They can’t help you with what they don’t know about!

They will also want to know about other conditions you may suffer with, such as diabetes and high blood pressure, as this will affect which treatments you will be offered. If they don’t ask directly about this, don’t worry, as they may have this information about you already.

It is often possible to make the diagnosis of osteoarthritis without looking at the knee, although it is good practice to perform an examination. This doesn’t hurt and only takes a few minutes to do. Typically the doctor will start by looking at your knee. In particular they look for any swelling, deformity, or any redness, and at the muscles surrounding the joint. They will then go on to do more specific tests which involve moving the joint around and testing how stable your knee is.

The diagnosis of osteoarthritis can usually be made on the history you tell your doctor and on the results of the physical examination. X-rays are seldom needed and usually do not change the management of your problem. Likewise, for osteoarthritis, which tends to be related to ‘wear and tear’, blood tests do not provide any additional useful information.

Most people with osteoarthritis can be successfully managed by their GP, with the help of the primary care team. Other professionals that can provide useful information and support include the practice nurse, local pharmacist and physiotherapist. Make use of this team, as everyone contributes different skills and have different areas of expertise. Referral to a specialist, such as a rheumatologist or orthopaedic surgeon, is not necessary for the majority of people with knee pain, although some people with more severe and longer lasting problems may benefit from a visit to the hospital.

There is a range of core treatments that are recommended for everyone, the most important of which is exercise. This troubles many people, as it may not make sense to exercise when it causes pain. However, joints like to be used and long periods of rest may cause worsening of your pain and disability. Your GP or physiotherapist can offer advice on doing the right sorts of exercise, but try to keep as active as you can. Arthritis Research UK provides useful information on doing the right kind of exercises for your knee.

Weight loss is also important as it takes pressure off the knee joint. Most people find losing weight difficult, particularly if they find exercising difficult. Ask your doctor or practice nurse about this. Many surgeries provide weight loss clinics and can refer you to a range of exercise programmes, including water-based activities that make exercising easier and more enjoyable.

GPs also frequently prescribe medication that you can also buy from the pharmacist or supermarket. These include simple painkillers such as paracetamol and topical applications that you rub into your knee (such as ibuprofen gel). If your doctor recommends using these, give them a try, even if you have used them before. They are very effective for many people with knee pain but may need to be taken regularly to notice a real benefit. If these treatments don’t help, go back to your doctor, as there are still lots of alternatives you can try, such as a steroid injection and other types of pain relief.

Many people now buy preparations such as cod liver oil, glucosamine and chondroitin sulphate from their pharmacist or herbal shop. Whilst the National Institute of Health and Clinical Excellence (NICE - the organisation that advises doctors on what treatments to use) does not specifically recommend using these treatments, some people do notice a benefit from them and they are unlikely to cause you any harm.

Successfully managing knee pain requires an ongoing partnership between you and your doctor. There are some things that a GP can do for you, but many successful treatments, such as exercise and weight loss, can only be done by you. Below I have listed a few tips to help you get the most out of your visit to the GP.

Top tips to get the most out of your consultation

  • Prioritise your knee pain. Doctors only get 10 minutes to spend with you, and if you ask about your blood pressure or asthma first there will be no time left for your joints.
  • Ask questions. Your doctor won’t mind and it will help you clarify what you have been told.
  • Ask the doctor to provide you with some written information, as much of what you discuss will be forgotten by the time you get home. Very good patient information sheets are now available that can easily be accessed through the Arthritis Research UK website during the consultation.
  • We all have our own ideas and concerns about what is, or may be, wrong with us and also what could be done to help. If your doctor does not ask about this, and many do, tell him. It will mean that he is more on your wavelength and so in a better position to help you.
  • Arrange a follow-up appointment if things don’t improve. There are usually other options that can be tried if your first treatment is not successful so don’t assume nothing more can be done.
  • If your doctor prescribes painkillers (such as paracetamol or co-codamol) or rubs (such as ibuprofen gel) use them. This sounds obvious but many people worry about taking tablets and only use them when their pain is severe. Sometimes planning in advance is useful, for example taking painkiller before you go shopping to prevent the pain coming on.
  • Remember that there are some things that only you can do. Your doctor can provide you with information about exercise or weight loss, but cannot make you do it.
  • Make use of the full primary care team. Physiotherapists can provide useful advice on a wide range of topics including exercise, using appliances and knee taping and pharmacists are experts on the safe use of medication.

Dr Christian Mallen is a GP and holds an Arthritis Research UK career progression fellowship at Keele University.

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