Boyd W. Haynes III, MD
In this article, I’m going to put on my chef’s hat and take you inside the kitchen for a brief cooking lesson. No, I’m not giving up my day job as an Orthopaedic surgeon, but I want to use a culinary illustration to describe a process that occurs in the human knee joint or really any joint that is inactive for a while. First, most of us are familiar with Jell-O®, that wiggly-jiggly fruit flavored goo. To make it, you add hot water to it, stir, pour into a dish, and then put in the fridge. At first, the gelatin in the mix is very liquid in the hot water and stirs easily. As it cools, it takes on the form of a gel-like, soft, wobbly substance, that isn’t a solid but isn’t a liquid either. The gelatin thickens the mixture as it cools and isn’t stirred anymore. Imagine the same thing happening in your joints when you sleep or are inactive for a period of time.
That is what we call the gelling effect, and it is caused when the fluid leaks from blood vessels surrounding an inactive joint and waterlogs the cartilage in the joint. When the individual decides to move, the cold fluid acts like cold gelatin and is difficult to move through the cartilage and painful. After moving and warming the joint for several minutes, that fluid in the cartilage warms up and the gelatin becomes much more liquid, making movement easier, the joint less stiff and painful.
The gelling effect can be exacerbated in a different way in those with severe osteo-arthritis, or auto-immune disease, such as psoriatic or rheumatoid arthritis, and can be more severe, lasting more than the typical 30 minutes of stiffness in the morning or after prolonged inactivity. Conversely, a period of prolonged activity, like taking a very long walk or doing an increase workout at the gym can also increase the gelling effect for those with auto-immune disease.
So how do we treat the gelling effect? I think it important to become aware of what it is and why it happens. That takes a bit of the scariness away and helps patients to understand that they need to move and warm up their joints when they feel stiff and painful. I tell everyone “Movement is life!” and it couldn’t be truer in this instance. If a patient is experiencing this for the first time, they probably need a work-up for arthritis, which will include x-rays, a thorough physical exam and lots of questions about their lifestyle, work, activity level, pain, etc.
If I do determine that the patient has arthritis, we will educate the patient about osteo-arthritis, its progression, and get the patient on some anti-inflammatory medication. In the early stages, that might be simply some OTC ibuprofen or naproxen sodium, but as arthritis progresses, we may be looking at oral or injectable steroids or other drugs like Celebrex. The patient can use heat, like a heating pad, hot baths, or showers to help warm up their joints. An exercise regimen will be recommended, and I may send the patient to Physical Therapy if they need help getting started building their strength and range of motion. Walking, biking, swimming, yoga, and pickleball, are just a few activities that are great for folks with arthritis to do. Eating a well-balanced, nutritious diet, that is lower in sugar and gluten has been shown to be helpful to arthritis sufferers.
For my patients whom I suspect may have an auto-immune component in their arthritis, I typically refer them to a rheumatologist for a work-up. If the rheumatologist finds that indeed the patient has PSA or RA, the Rheumatologist will prescribe medications to arrest the joint destruction and reduce the pain, inflammation, and joint damage these conditions cause.
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