Rheumatoid Arthritis In The Knee

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In This Article –

  • Introduction
  • How Likely Is RA To Affect Your Knees?
  • Diagnosis
  • Symptoms

Rheumatoid Arthritis Destroys Lives. It Breaks You Down And It Takes Away Your Life. We Look At What Can Be Done If You Get Rheumatoid Arthritis In The Knee.

Find it quick and take steps to stop it progressing, a good quality of life is still very achieveable…

Introduction

Rheumatoid arthritis is a chronic autoimmune disease, meaning that your bodies own defence system turns against you and attacks your joints instead of protecting you against outside infection. Unlike other common forms of arthritis it is not caused by excessive wear and tear.

Indeed, if you are unlucky enough to have rheumatoid arthritis in the knee, it is very likely that both knees will be affected at the same time as it is a ‘symmetrical’ disease.

Rheumatoid arthritis works in your knees by attacking the synovial fluid around your joints, ultimately reaching your cartilage and without enough fluid to lubricate them, the joints will rub together causing pain, inflammation and ultimately eroding the cartilage until your knee joint is bone on bone.

Pain is typically aggravated by any activity that involves standing as your weight works against you. Knee pain is also particularly prevalent in the reasons why rheumatoid arthritis sufferers struggle to sleep at night.

How Likely Is Rheumatoid Arthritis To Affect Your Knees?

As a major joint in your body, it is quite likely that, once diagnosed with RA, you will develop rheumatoid arthritis in the knee at some point. It isn’t usually the first joint to be attacked – that is normally taken by your hands or feet. However, given the significance to you of your knees for your overall mobility, looking after them is no less important.

Diagnosis Of Rheumatoid Arthritis In The Knee

Diagnosis of rheumatoid arthritis is fairly standard – a full medical check (including history) to establish functional capability and any new restrictions. This will then typically be followed by a full physical examination for deformities, nodules and other potential symptoms followed by blood tests to determine if ‘rheumatoid factor’ is present.

The doctor may then also a series of x-rays, CT scans, MRI scans and maybe even a bone scan to determine how far your arthritis has progressed.

It is also likely that you will be referred to a rheumatologist within 3 months. While there is no cure for rheumatoid arthritis, the sooner treatment is started the better the eventual outcome is likely to be.

Symptoms In Your Knees

The main symptoms with rheumatoid arthritis in the knee are swelling, inflammation and stiffness. This stiffness is likely to be worse in the morning and after getting up, but (unlike with osteoarthritis) the knee is unlikely to ‘free’ itself up straight away and may be stiff for several hours.

Inflammation in your knee joint may also cause a swelling of the bursa (fluid pocket) behind your knee. This is known as a Popliteal Cyst or ‘Baker’s Cyst’. In some people this cyst has been known to rupture and extend half way down your calf.

Unlike with rheumatoid arthritis in the hands or feet though, twisted joints are highly unlikely (the knee is more solid). However, changes in the joint due to the inflammation, can cause the cords that connect the bones together to become ‘lax’. This can then lead to your quadriceps wasting away and becoming very weak (also known as muscle atrophy)

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12 Ways To Manage Your Knee Pain

Aggressive intervention is essential is slowing the onset of rheumatoid arthritis, wherever it strikes. Although it is unusual to affect your knee joints first, it is still important to recognise the swelling/ pain and get a definitive diagnosis from your doctor. From there you have a number of options for managing the pain in your knee and preventing further erosion of your joints –

1. NSAIDs (Non Steroidal Anti-Inflammatory Drugs). As the name suggests, these are designed to reduce the inflammation in your knee and increase its mobility. Common examples include Ibuprofen. This is likely only to be a short-term course, due to considerable side effects, particularly with long-term use.

2. DMARDs (Disease Modifying Anti-Rheumatic Drugs). These are used specifically to prevent further damage to your joints. They work by decreasing the cells that cause inflammation in the blood, therefore reducing the cause of joint damage. Examples include Ciclosporin and Methotrexate.

3. A Range Of Directly Injected Steroids Where Appropriate. Injected straight in to the knee joint, they can be used to reduce the inflammation. It is most likely your doctor will select from a range of corticosteroids to inject directly in to the joint spaces.

4. Physical Therapy. To maintain as much mobility without weight as possible. If the cartilage in your knee has already started to erode, there is not much any exercise can do to stop it, but regular physio and exercise as laid out below may be able to prevent the onset of osteoporosis which can make later treatment even more difficult.

5. Strict following of the RICE technique – Rest, Ice, Compression, Elevation. In other words, plan your days to ensure regular periods of rest, use ice whenever convenient to reduce the inflammation, Compress wherever possible to provide support and elevate when relaxing to rest and strong blood flow.

6. Supportive Devices. Items such as a cane, a walking frame and a long shoehorn may all help avoid putting too much pressure on your knees. If the disease advances further, then a stairlift may help painful ‘jarring’ of your knees, particularly on the way down.

7. Bracing. An actual physical knee brace may be critical to protect the knee joints

8. Exercise. Changing to swimming and other reduced-weight bearing exercises such as cycling on a machine. Some stretching to build up strength. Aqua therapy may also be an option to build up muscle and flexibility without the force of impact.

9. Use of a TENS Machine (Transcutaneous Electrical Nerve Stimulation). This is a special machine that uses electrical pads to stimulate your nervous system around injured joints. To see our full report on how medically to use a TENS machine click here.

10. Further Lifestyle Modifications. In addition to changing your exercise regime, other changes such as losing weight and stopping smoking will both improve your chances of preventing further disease progression.

11. Surgery. As a last option, you could have surgery to either clear out your knee of damaged tissue or replace the knee joint altogether. This is always considered a ‘final option’ as the risk of infection is high and can be very dangerous on an already weakened immune system and also because you will never achieve the same mobility on an artificial knee joint as you have on a real one.

12. Opioids. As your disease progresses and becomes debilitating, doctors may prescribe the use of certain strong opioids such as Morphine to control the pain and allow you to continue getting the most out of life.

The Potential Impact On Your Life

This very much depends on when you catch your rheumatoid arthritis. If you catch it early, your prognosis is relatively good. Remembering that there is no actual cure for rheumatoid arthritis, the ultimate goal is for you to live a full life, relatively unhindered by your symptoms.

With early rheumatoid arthritis in the knee and a good RICE plan (see above), you can control the symptoms fairly well – provided you follow the full guidance for controlling your rheumatoid arthritis overall.

If you are suffering with rheumatoid arthritis in the knee because you’ve had a diagnosis and are at a fairly late stage, particularly if it’s been attacking your knee for some while and the cartilage is badly eroded, then surgery becomes a realistic option. Most doctors will still advocate rest and bracing for as long as possible, but eventually will have to look at replacing your knee joint altogether.

If you do have a complete knee replacement, you will find a dramatic difference. Providing you follow the after-surgery exercises, then you should make a full recovery and, while a replacement will never be as free or flexible as a real one, you  

Knee Surgery For Rheumatoid Arthritis

In the event that everything has been tried, but your disease is still progressing in your knees (or you caught your rheumatoid arthritis very late in the first place), then surgery may be considered to achieve a better quality of life.

Surgeons have one of three basic options –

1. Arthroscopic Surgery. Keyhole surgery can be used to allow a surgeon to repair tissue in the joint or clear out tissue that is too badly damaged.

2. Osteotomy of The Knee. The surgeon aims to improve the alignment of your knee (distorted by the rheumatoid arthritis) by cutting either the shin bone or your thigh bone.

3. Knee Replacement. Either a partial replacement where half the joint is replaced and fused to a prosthetic or a complete knee replacement where your entire joint is removed and replaced with a new knee.

There are a variety of types of prosthesis available depending on the surgeon’s preference of material and style (whether they prefer to use a standard size and bolt your bones in to it or get a personalised joint made that is designed to fit your leg better (‘signature knee’ replacement)

“What If I Don’t Want Surgery?”

If your knees have been sufficiently degraded that surgery is the only realistic option for improvement and you really don’t want to go ahead, then your most hopeful outcome is an improvement of symptoms with limited reduced mobility.

Symptoms may be controlled, at least in the short term with medication, but if you’re at a surgery stage, then your mobility is already pretty poor and likely to deteriorate fast.

If you are unlucky and choose not to have surgery, then you will develop osteoporosis and greatly reduced mobility as well as considerable pain. Choosing surgery after the development of osteoporosis, will result in a much less guaranteed outcome and is not recommended.

The Final Word –

Rheumatoid arthritis in the feet is not normally the first area attacked or the first symptom present when making a diagnosis of RA. However, because of the knee’s absolutely essential role in your mobility, it is one of the most debilitating areas to develop Rheumatoid Arthritis in.

Your knees are not as prone to developing deformities because they are stronger and better supported. What separates treatment of this disease in your knees is that, unlike hands and feet, replacement knee joints are quite common place.

However, replacing your knee joint should only be a last option after various treatment options have been tried. These most commonly include non-weight bearing exercises, bracing of your knee, TENS machine treatment and using supportive devices – as well as strict following of the RICE method of treatment. This will normally yield results, as long as you don’t leave it too long before starting. As with all areas affected by rheumatoid arthritis, time is key.

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