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Dear Dr. Donohue: Will you provide information on osteoarthritis of the knee? Please include steps to take if you have it. Does it hurt a lot after surgery? Do vitamins or calcium help? - W.J.

Dear W.J.: Osteoarthritis is the most common kind of arthritis. One-third of the population age 65 and older has it.

It's cracking and crumbling of the cartilage inside the joint, allowing bone to rub against bone, causing pain and stiffness.

Age, being overweight, heredity, misalignment of the joint bones and previous injury all contribute to causing osteoarthritis.

Climbing stairs, getting out of a chair and walking become challenges.

There is no cure, but there are steps to take to manage it. Weight loss, if you are overweight, makes a huge difference. Loss of only 5 percent of current weight increases joint mobility and lessens pain. Exercise helps. Walk to the point of pain, rest and then continue. Strengthening the thigh and hamstring muscles protects the knees. A warm shower or bath decreases stiffness.

Tylenol is a safe and effective pain reliever. Nonsteroidal anti-inflammatory drugs - Aleve, Advil, Motrin and others - work well, but they can cause stomach irritation and possibly promote an ulcer. Simultaneously taking medicines that blunt stomach-acid production protects against those side effects. Prilosec and Zantac are two examples of protective drugs. Voltaren gel, a nonsteroidal anti-inflammatory drug applied directly to the skin on the knees, reduces the threat of stomach irritation and eases joint pain.

A doctor can inject the knee with cortisone, which often provides three or more months of relief.

Calcium and vitamins don't work. People often ask about chondroitin and glucosamine, but there is little evidence they help.

The ultimate treatment is replacement of the joint. Pain after the surgery is not great and doesn't last long.

Dr. Paul Donohue's address is P.O. Box 536475, Orlando, FL 32853-6475.

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