Dr. Victoria Brander (NorthShore)
First, its important to get a diagnosis. Knee pain can be from arthritis, from inflammation of soft tissues, or even from hip or spine problems. It seems as though you tried the right approach to begin with - ice, rest and an antiinflammatory cream. If you can tolerate these, the next steps are to start an antiinflammatory (such as ibuprofen or naproxen over the counter), see a physician (and probably get an XRay) and then, based on the diagnosis, do physical therapy, start a customized exercise program or try other interventions if needed (like injections). But, since the pain has been going on since October, you should see a physician for an an accurate diagnosis.

Dr. Victoria Brander (NorthShore)
Chronic pain, including fibromyalgia, is very difficult. It usually takes a combination of interventions - medication to restore sleep, some pain medication or intervention, structured exercise/physical therapy, centrally acting medication to reduce brain "hypersensitivity" to pain, pain osychologist for biofeedback, stress management etc. Very important are techniques to foster the patient's trust in the physician and clinicians, which then lead to better patient compliance, lessening of fear and better outcomes. Many of these patients are "kinesthesiophobic" (have fear of movement) -- so need to trust that we are not going to hurt them with exercise and mobility instructions. But the single best predictor of outcome is patient's SELF-EFFICACY - and we train this through verbal persuasion (education, classes); improving "physiology" (eg exercise); having patients see other patients going through the same problems; and activity repetition - 1:1 with a PT who inspires & motivates

Dr. Victoria Brander (NorthShore)
Exercise is the single best treatment for arthritis. Its the only treatment ever shown to change the "natural history" (deterioration) of arthritis. The type of exercise depends on teh joint. For knee arthritis, exercises should focus on strengthening the quadriceps, glut muscles and abdominal muscles; working on flexibility of the hips and the knees and normalize the pattern of walking. A bicycle is a great exercise for hip and knee OA. I strongly believe that Yoga is the best choice for exercise classes for almost all patients with arthritis

Dr. Victoria Brander (NorthShore)
Many people with arthritis of the thumb (including ME!) seem to benefit from getting a customized thumb splint; seeing an occupational therapist for exercises; trying a topical anti-inflammatory (such as diclofenac gel); and if necessary modifying some activities (such as typing) that aggravate the pain. I like to use a paraffin (hot wax bath) unit to heat the joint and tissues and then following that with aggressive stretching and strengthening. The more you stretch out the joints the better they feel. Surgery is a very last resort

Dr. Victoria Brander (NorthShore)
That's a great question. You want to wait until pain is bad enough that it starts to limit your activities, but not so long that you are very disabled. People who are more disabled going into surgery have a more difficult time recovering. It is very important to reduce your joint pain before surgery (medications, injections) so that you can EXERCISE (stationary bike is great) preoperatively. I like to send my pre-operative hip and knee surgery patients to physical therapy for customized exercise. Most people know deep down inside of them when the "time is right" for surgery. Along with Ron Allen (a patient who is a law professor and writer), Dr David Stulberg and I wrote a book for patients/consumers who have arthritis that is bad enough to start considering surgery. We have a whole chapter dedicated to "knowing when the time is right". The book is >10 years old (I think its less than $5 on Amazon now) -- the surgery detail is outdated but the other concepts, such as this one, apply.

Dr. Victoria Brander (NorthShore)
First, if your doctor approves, take full dose anti-inflammatory - such as ibuprofen 600mg (3 Advils) four times a day or naproxen 440mg (2 Aleve) twice a day. Most people don't take the full antiinflammatory dose and so the medications don't work well. There are other medications we often add to the antiinflammatories- such as tramadol (a simple pain killer) or cymbalta (to dampen the nerve component of pain). Exercise is critical -- very important to strengthen the quadriceps, glut muscles, abdominal muscles. Injections include steroids ("cortisone shots"), hyaluronic acid (such as Synvisc or Euflexxa), and fairly soon an injectable stem cell treatment (for early arthritis). Sometimes orthotics (knee "unloader" brace or even foot orthotics) can help unload pressure on the knee and reduce pain. Last, if the diagnosis is advanced arthritis and all the nonsurgical interventions dont work, knee replacement surgery may be indicated

Dr. Victoria Brander (NorthShore)
Unfortunately, it's almost impossible to answer your question accurately without having specific clinical information - about how bad your arthritis is, if you also have arthritis in the hip or back, what else you have tried and what your physical exam and XRay findings are. Because I am not your doctor and have not examined you, I can give you general information about arthritis but not specific recommendations about you...sorry. But, in general, people with arthritis of the knees find that if they exercise 4 days a week (focusing on STRENGTH of the hips, knees and abdominal muscles), take a medication to reduce pain or inflammation consistently, wear supportive shoes, try a knee brace, and intermittently get injections if these help, often find their arthritis can quiet down significantly. Your most important choice is exercise.

Dr. Victoria Brander (NorthShore)
There is no known treatment that slows the "natural history" of arthritis of the hands, unfortunately. (I sympathize with you - I have arthritis in my hands too!). We think the best strategies are: keep your hands strong and knuckles flexible; use a brace for the thumb (especially at night to reduce movement & inflammation); try a topical antiinflammatory cream (such as diclofenac cream up to 4 x a day); take adequate Vitamin D (2000 international units a day); eat an antiinflammatory diet (avoid sugars, alcohol and carbohydrates); keep your hands warm in the winter (I use a paraffin - hot wax - bath for my hands and then follow that with stretching); and, you can use modified/built up handles on your kitchen tools, use a jar opener etc

Dr. Victoria Brander (NorthShore)
For many people, yes. I suggest to my patients that if they are taking an antiinflammatory every day, they need to come in for a visit every 6 months so we can monitor their blood pressure, look for leg edema, question them about heartburn and get blood tests (looking at kidney, liver function and urine for protein). Patients who have diabetes, disorders of the kidney or liver, heart disease, reflux, stomach ulcers, who are very frail or elderly, those on blood thinners, and those on multiple medications are at high risk of complications and need to re-consider taking daily antiinflammatories (I am reluctant to prescribe them in these situations).

Dr. Victoria Brander (NorthShore)
Its hard to answer that question too specifically because I dont know the details of your condition. However, in general, the most important strategy is EXERCISE -- and seeing a very good physical therapist with a specialty in spine is critical. With arthritis of the spine, treadmill or long walking is usually too painful. Instead exercsing in flexion (such as a stationary bike) is better. And, need to work on strength of the abdominal muscles -- pilates, yoga for scoliosis, Tai Chi are all great. Sometimes patients use a corset/abdominal binder when they are active (eg "quick draw corset"). Transcutaneous electrical stimulation (TENS unit) is a topical device that sends very brief light electrical impulses into the muscles/spine, "confusing" the pain nerve endings and in many patients reduces pain. There are a variety of injections into the spine that sometimes help - eg epidural steroid injections, ablation of pain nerves.