My aching knees! X-post

I have severe psoriatic arthritis in both knees. This has come up rather fast--I've never had trouble with my knees until last fall. Most of my arthritis in my feet and hands, but now my knees are just so painful. They get tired quickly and my right knee is quite swollen.It wakes me up at night.

I am just starting my WLS journey and I'm worried about getting the walking in. I can barely walk my dog, other than a quick run to the backyard. Grocery shopping is getting harder--I get so fatigued. Back in May my ortho did an MRI and found torn meniscus in each knee, plus a ruptured bakers cyst and severe swelling on the right knee. I had a series of Supartz injections to both knees in May.  It was great for about 3-4 weeks, but in the last 3 weeks I'm going downhill. I've been doing PT for 3 weeks and my therapist is very concerned with the deterioration. I see the ortho on MOnday and I'm worried about what he's going to say. The whole point of the Supartz was to postpone double knee replacements.

I just don't know what to do. I had hoped to get through WLS first, to see if that would improve the knees. But what if I can't do the walking? Would you start the knee replacements and postpone the WLS? Or just grin and bear it and know that you won't be able to do as much walking as is required? 

I have end stage arthritis in both knees (I need a TKR in both knees).  I was using a walker before surgery.  I'm 11 months out and have lost 145 pounds.  I walk everywhere now.  Everyone is different but just taking all that weight off my knees feels so much better.  My pain was so bad before I was considering going out on disability.  Life is great now.  

Sonja

I'm not an expert on psoriatic arthritis & I'm not a doctor. I have 2 friends who have psoriasis. One of them was discouraged from having WLS because the doctor was unfamiliar with results with patients with psoriasis as a systemic auto-immune disease. Her doctor said something about being concerned about the psoriasis making it difficult for her surgical site to heal (excess bleeding). Remember, I'm getting this from my friend, & I'm not a health care practitioner.

If you haven't chosen a surgeon yet, or been approved yet, perhaps you should scour OH for physicians who have done WLS on psoriatic patients before.

I don't have psoriatic arthritis, but before my WLS, my knees hurt every morning & every night (so did my feet). I forced myself to walk about 2 miles every few days. When I got back from that 2-mile walk, it would take me an hour to recover. I would sit down in my living room. Just SIT there for an hour before I could get up, my knees, back, feet, everything ached so much. 

Now I can walk for 5 miles I feel like I could walk for (maybe) another mile! I do still have some aching in my right ankle (Achilles?) & my right knee after exertion. But I'm positively light on my feet now after losing 124 pounds (I went from 257 to 133).

My hairdresser (who is also a dear friend) had WLS in 2007. She lost over 150 pounds. She went swimming religiously & did aqua aerobics as she lost weight. She just couldn't do the walking because of joint pain. She did have a hip replacement 2 years ago & came through it with flying colors. She feels like she's 20 (she's 51). She said even after the anesthesia wore off in the hospital after her hip replacement she felt a thousand times better.

Everyone's situation is different, of course. I would definitely do my research & find a surgeon who's knowledgeable & comfortable with psoriatic patients.

Warmest wishes & the best of luck to you as you begin your journey!

Love, gg

I would have the WLS first, and I'll explain why.  I have osteoarthritis in both knees, and also had no trouble until recently.  I injured my right knee, and when there were doing images for it found I had grade three arthritis (my ortho grades on a scale of 1-4, with four being no cartilage left). He wants me to have WLS because he feels if I don't lose a significant amount of weight I'll need knee replacement by 40.  My PCP agrees.  They told me to get an exercise bike to get my activity in.

This also worked for my father.  He was told he needed both knees replaced.  They did the first one, but he put the second off because he was afraid recovering from that would interfere with pre-op requirements.  He's now down almost 200 lbs from his highest weight, and has no pain in either knee, even though he never had the second replacement.  He went swimming for exercise, after waiting for the incisions to heal, of course.  The only walking you'll need to do is up and down the halls to help move the gas along and prevent clots.  All your other exercise can come from other, more knee friendly forms of activity.

Good idea! I hadn't thought about swimming or aqua aerobics. I'm a lightweight at 220-lbs so I'm hoping that I'll be able to lose all the weight.

Make sure you work with your surgeon as to your arthritis issues...the RNY is the single WORST option for arthritis. Sleeve or DS is the best.

Liz

Curious as to why you say RNY is the worst option.....I had RNY and my arthritis is almost nonexistent pain wise now.

It is worst from the standpoint of not being ale to take NSAIDs for pain and inflammation.  Some surgeons discourage NSAID use with sleeve and DS as well, but it is more of an issue with RNY because (unlike sleeve and DS) we have the remnant stomach to worry about.  An ulcer in the blind remnant stomach (which can only be accessed via surgery) can be very difficult to treat.

Not everyone gets relief from knee pain after losing the weight. It reallly depends on how severe the arthritis damage is before the RNY.  If the arthritis is severe or there are lots of bone spurs, losing weight may not decrease the pain much (as was my case... I for some relief from the pain in my right knee, but NO relief from the pain in my left knee (which I finally broke down and had replaced in March)),

Lora

Not everyone sees relief from arthritis by losing weight. My arthritis is in my back and hands and knees...thank GOODNESS I do not have to worry about a blind stomach. Cause I NEED NSAIDS even after losing my weight. According to my surgeon, my options for pain relief with a RNY were very limited...mostly opiate type meds or tramadol (already using that in combination with the maximum allowed dosage of celebrex which IS an NSAID so tramadol by itself wasn't gonna cut it).

I'm glad getting the weight off helped yours but at some point in time Mother Nature will decide to give you arthritis in spite of your weight. Remember, arthritis is a disease that affects normal size people too.

Liz

DUH!! I didn't even think about the NSAIDS, they have not been a part of my life for so long now I forget about them. So from that standpoint I totally understand.