Is a knee replacement my only option?
Q) I've had arthritis in both knees for nine years. My doctor thinks I'm currently a long way off knee replacement but I'm concerned about the future. The problem in my case is that no painkillers or anti-inflammatories can be prescribed because I have a hiatus hernia but, more seriously, I have a potentially life-threatening allergy to egg and white meat and I also react to paracetamol. Inevitably, as time goes on, things will get worse and I have no means of pain control. Should joint replacement be the only option, I worry about how the anaesthetic and antibiotics will affect me. Are there any other options for people like me?
M Smith, Liverpool, Merseyside (Autumn 2009)
A) Oh dear, what a mess. A hiatus hernia can cause indigestion and this can be made worse by anti-inflammatory drugs such as ibuprofen and diclofenac. Other types of painkiller don't usually have this side-effect. If you can't take paracetamol there are other painkillers your doctor can try, such as codeine and tramadol. It's true that many other painkilling drugs also contain paracetamol but those suggested above don't. In addition, you could try locally applied drugs such as capsaicin, which is an extract of the pepper plant capsicum. Capsaicin works as a counter irritant and can be very effective. However, you have to be careful to wash your hands after using it as it can irritate the eyes and mouth. As to the knee surgery itself, well it sounds as though it may never happen – the disease doesn't always progress to the point of knee replacement. Regular knee muscle strengthening exercises can improve the pain and help you walk better. If it does come to an operation I'm sure that appropriate precautions about your potential allergies will be taken – this is one of the first questions asked when you're admitted to hospital.