(Focus - Singapore)
Dr. Yoon Kam Hon, one of the leading Rheumatologist based in Singapore, participated in a discussion with decodeMR, wherein he has given a concise description of the disease, which will help our readers to get a better understanding of osteoarthritis.
Dr. Yoon Kam Hoon is a Rheumatologist and Internist, presently serving in El Shaddai Arthritis & Rheumatism Specialist Medical Centre, Singapore.
We use X-ray, ultrasound, and MRI to see the severity and presence of inflammation and other structural lesions and bone marrow edema on MRI. In terms of blood tests, it is done to find if there are any other causes besides Osteoarthritis contributing to the symptoms.
As we all know that pain is one of the most common symptoms for a patient suffering from Osteoarthritis, kindly let us if there are any other distinctive signs that can alert a person about the possibility of developing Osteoarthritis.
Dr. Yoon: I think if the pain is recurrent, accompanied by stiffness, and gets worse on exertion or movement or due to any other activity, then these can be considered as the common symptoms that should be paid attention to.
Are there any specific biomarkers for Osteoarthritis in terms of diagnosis?
Dr. Yoon: No, the diagnosis is mostly dependent on symptoms and signs. Sometimes, the knee can be swollen, or there can be some changes in shape or alignment. In such conditions, we can use X-ray, ultrasound, and MRI to see the severity and presence of inflammation and other structural lesions and bone marrow edema on MRI. In terms of blood tests, it is done to find if there are any other causes besides Osteoarthritis contributing to the symptoms, Gout and Rheumatoid Arthritis
How does a typical Osteoarthritis patient look like in terms of his age and other health parameters?
Dr. Yoon: Osteoarthritis patients can be divided into three groups. The first is the younger age group that includes the patients of younger age who either experience sports-related injuries leading to early Osteoarthritis, or those who have a history of meniscus injury. The second is the older age group that includes patients who are in their 60s. It is more common in females who are obese and have other metabolic conditions like diabetes, hyperlipidemia, or a metabolic type of Osteoarthritis. Then there is an even older age group, people who are in their 80s and 90s and have the degenerative type of Osteoarthritis.
Are there any other health parameters?
Dr. Yoon: Together with OA, vitamin D sufficiency, osteoporosis (bone health), and sarcopenia (muscle health) are also important.
How do you treat or manage a typical Osteoarthritis patient?
Dr. Yoon: Initially, we confirm the diagnosis based on X-rays, ultrasound, and MRI reports. Then we grade the Osteoarthritis stage (whether it is 1, 2, 3, or 4) based on the severity, and accordingly start the treatment. We do a package of treatments. For those who are okay to take injections, we recommend them to take the hyaluronic acid injection, which is usually given in a course of 3 injections when there is joint inflammation, intraarticular steroids and NSAIDs can also be given concurrently. It is applicable for all the stages. For those who do not want injection, we have medication and supplements for the knee to control the inflammation, repair the cartilage, and build up the bone structure. Because the subchondral bone is also important for Osteoarthritis.
We also have magnetic therapy available in our clinic that can help in the regeneration of the cartilage. This regenerative therapy is called the MBST therapy and is a German technology. The MBST stands for Molecular Biophysical Stimulation Therapy. It can stimulate cartilage regeneration for patients suffering from Osteoarthritis and can be done for different joints, knees, hips, ankles, shoulders, and fingers. We have about 3 years of experience in this form of non-invasive therapy with a success rate of 70%.
And then of course, for the more serious patients who fail to respond to the medical treatment or physiotherapy, we recommend them to undergo total knee replacement, also called Knee Arthroplasty.
The recent advancements include the MBST therapy, which is a non-invasive regeneration. There are also new injections available such as Viscosupplementation or hyaluronic acid as a combination. Then, there are also PRP injections, stem cell therapies, and autologous protein solution injections. There are also new biologics treatments for Osteoarthritis in terms of pain
Is physical activity or exercise helpful for Osteoarthritis patients?
Dr. Yoon: Yes, moderate physical exercise can be helpful, but not over-exercising or overstraining of the joints.
So, over-exercising worsens the symptoms?
Dr. Yoon: Yes, therefore, we normally recommend, moderate physical activities.
What are the recent advancements in the diagnosis and treatment of Osteoarthritis?
The recent advancements include the MBST therapy, which is a non-invasive regeneration. There are also new injections available such as Viscosupplementation or hyaluronic acid as a combination. Then, there are also PRP injections, stem cell therapies, and autologous protein solution injections. There are also new biologics treatments for Osteoarthritis in terms of pain. So, these are the different modalities that can be given to patients.
So, by surgery, you mean joint replacement therapy?
Yes, joint replacement, either unilateral or total joint replacement. In terms of Arthroscopic surgery., usage of stem cells and “mesh repair are some of the newer innovations.
In your opinion, who would be the ideal candidate for a joint replacement?
Dr. Yoon: Those who are in the third to the fourth stage, and who fail conservative treatment, and who are without any serious medical contraindication would be the ideal candidate.
Can you let me know what are the complications of this surgery?
Dr. Yoon: Well, there is always an anesthetic risk, and then the infection of the joint, along with post-surgical infection, DVT, stroke, and cardiovascular risk. In the long-term, patients may develop after total knee replacement a condition called post-TKR synovitis in which the knee remains swollen. It is a kind of auto-immune or inflammatory development.
What is the expected prognosis for a typical Osteoarthritis patient?
Dr. Yoon: The prognosis depends on the stage of the disease. Those who are in stage one do very well. After the injection and treatment, they can be cured. In stage two, some patients, after one course of hyaluronic, get well for a couple of years before they return with the same symptoms. But there are cases of better prognosis as well. Once, we gave one course of hyaluronic injection to a patient ten years ago. He came back ten years later for the other knee, which means the right knee which was treated ten years ago was still okay.
When it comes to the third or fourth stage, the prognosis is not so good if they are not keen on surgical treatment. Then, the conservative or medical therapy, in terms of injection and MBST can be applied with a 70% success rate. They may not improve 100% but at least that 70% improvement is possible.
Are there any other ways to improve the patient outcome other than what you have mentioned?
Dr. Yoon: Of course, the general health of the patient is important in terms of muscular-skeletal strength, treating the other bones, and sarcopenia. All these also contribute to joint function and rehabilitation. And as you can see, long-term supplement is also advised for patients, who are not going for surgery.
Thank you so much for giving your valuable input and agreeing to participate in our small discussion. We really enjoyed discussing with you and we are sure that our readers would also find this interview useful.