Q: My 58-year-old mother is suffering from a problem in her knees. When she sits for more than 15 minutes and gets up, she cannot stand straight. Her knees remain bent and stiff for another 10-15 minutes. This problem has been troubling her for quite a while now. She has sought the opinion of many medical practitioners, but could not be cured. Kindly advise.

A:The features that you have described strongly suggest that your mother has osteoarthritis. Osteoarthritis is a degenerative process of the cartilage of the joints, mostly knee joints. It has strong genetic background. In addition, those who have diabetes also get it early and its more severe form. It is also partly a lifestyle disease. Extensive studies done in China by the Beijing Osteoarthritis Study Group, and extensively published Arthritis Rheumatism in the last several years, have shown that sitting cross-legged, squatting (as in using Indian style WC since childhood, or while doing certain Yogic asanas requiring sitting in padmasana posture, etc.), doing push-ups, going up-and-down the stairs, etc. cause increasing damage to the knee cartilage. Finally, not doing regular exercise (the simplest and the best exercise is to walk 5-6 km on a daily basis) can also lead to this problem. If exercise is not done daily, the person gains weight causing further deterioration of osteoarthritis. Several recent scientific researches have again proven that walking on a regular basis and keeping weight down to achieve body mass-index of 23 or below can stave off osteoarthritis. Regarding treatment, it is of utmost importance that a dietician is consulted for weight-reducing diet, a qualified occupational therapist is consulted for changing lifestyle, so that further knee damage is prevented and for performing appropriate exercises, and, consulting a rheumatologist for some medicines to give pain relief so that it becomes easier to walk and do exercises. Any of the many non-steroidal anti-inflammatory medicines (so-called painkillers) are used temporarily for pain relief so that walking becomes less painful. But weight reduction (even as slowly as 1 kg every month till a body mass index of 23 is reached) and building up stamina by slowly increasing the distance of daily walk till she can walk 5-6 km every day, are the two most important components of treatment. If walking is slowly increased on a daily basis, symptoms slowly abate. Other medicines, including Synvix (Hyal NG) injections, and their use is surrounded in controversies. Probably these things do give temporary relief and help the patient in increasing regular appropriate exercises (quadriceps exercises) and regular walking. Those who cannot do any of the above things may ultimately require joint replacement surgery.