DEAR DR. ROACH: How do I know if I have arthritis? My left leg makes a slight cracking noise in my knee when I walk down the stairs, but no pain. However, when I go for a long drive, I limp when getting out of the car, which kind of goes away and does not hurt my knee. Long walks also bother me. When I went to a specialist, he said I needed therapy. I went to some sessions, but it did not help! When I told my doctor, he said, “Oh, that’s just arthritis.” (Note: This is the leg that was broken when a drunk driver hit me at age 22. I’m now in my mid-60s.) Also, my family has no history of arthritis. I also don’t know how someone can give me therapy if they don’t know what’s wrong? — Anon.

ANSWER: I don’t know for sure whether you have arthritis. Many people in their 60s do have some arthritis, usually osteoarthritis, the most common type. The noises joints make when they bend, especially under pressure, might or might not indicate arthritis. The fact that you are stiff after being immobile in a car for a while does suggest osteoarthritis. Severe injury to a joint can cause osteoarthritis: When we see osteoarthritis in just one joint (the one with a history of trauma), that’s likely the underlying reason. Osteoarthritis does not necessarily run in families.

So, even with the diagnosis being fairly likely, I personally get an X-ray done at least once on my patients who I think have osteoarthritis. There are many less-common conditions that can mimic osteoarthritis, which may have different treatments. Joint diseases due to deposition of crystals into the joint, like gout and especially pseudogout, can sometimes look like ordinary osteoarthritis, even though they usually have distinct flares. A chunk of cartilage that hardens in the joint can look like osteoarthritis. Psoriasis has a particular arthritis, normally in smaller joints, that can be mistaken for osteoarthritis. This is very dangerous because, like rheumatoid arthritis, psoriatic arthritis can be very destructive to a joint. I do think it makes sense to know what exactly you are treating before treating it, and X-rays are very, very good at making the diagnosis.

Exercise and physical therapy are first-line treatments for osteoarthritis, but may take a while to start working. Many medications are also used.

DEAR DR. ROACH: Please consider writing about Lipoprotein (a), or Lp(a). Should we have this checked with our cholesterol panel? — V.J.

ANSWER: Lp(a), called “LP little a”), is a type of low-density lipoprotein that is an independent risk factor for heart disease from traditional cholesterol measurements. Although it is not recommended to be checked in everybody, there are some situations where checking Lp(a) makes sense. These situations include people with a strong family history of coronary disease; people with some risk factors but are unclear whether to start medications; and people with a family history of very abnormal cholesterol.

There is no specific treatment currently available that both lowers Lp(a) and reduces risk; however, the usual treatments for high cholesterol, such as statins, ezetimibe and PCSK-9 inhibitors, do reduce the risk of a heart attack in people with high Lp(a) levels. There are ongoing studies for new drugs in development, called antisense oligonucleotides, which greatly reduce Lp(a). If these prove useful at preventing heart attacks, that will not only be a new treatment, but may change recommendations about checking Lp(a) levels on people of average risk.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

(c) 2022 North America Syndicate Inc.

All Rights Reserved