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How can knee replacements be a better option than steroids?

Q) I was interested to read in your latest edition of Arthritis Today about the lady from Liverpool who felt ‘cured’ while taking antibiotics. I have had a similar ‘cure’ but with steroids for a gum infection. I was taking prednisolone 5 mg dissolved in 10 ml of water as a mouthwash given to me by my orthodontist. I was amazed to find that after a few weeks of taking prednisolone the pain and stiffness in my knees went and I was able to walk normally, and for once forget all about the two knee replacements I’ve been told I need. Although the prednisolone didn’t cure my gums my GP wouldn’t hear of giving me even a mg of prednisolone to ease my knees. I just don’t understand how well I felt on prednisolone regarding my knees and felt I found ‘my cure’. How can two knee replacements be a better option than a steroid?
Margaret, Devon (Winter 2012)

A) Well, you pose an interesting question! Your doctor will be anxious to avoid giving you steroids because of the known long-term side-effects of the drug. These include weight gain, diabetes and osteoporosis. Knee replacements are not without risks. However, on balance, you would be best to avoid the steroid option as my guess is that they would stop working so well after a while (a phenomenon known as tachyphyllaxis) and you would still be faced with the prospect of knee replacements but with the added risk of thinner bones and more weight.

This answer was provided by Dr Philip Helliwell for the Winter 2012 edition of our magazine, Arthritis Today, and was correct at the time of publication.

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