Knee Pain
Knee Rheumatoid Arthritis
Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) in the affected parts of the body.
RA mainly attacks the joints, usually many joints at once. RA commonly affects joints in the hands, wrists, and knees. In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness (lack of balance), and deformity (misshapenness).
RA can also affect other tissues throughout the body and cause problems in organs such as the lungs, heart, and eyes.
In rheumatoid arthritis (RA) of the knees, the immune system mistakenly attacks the tissue that line the knee joints, causing pain, inflammation, and swelling. It can severely affect a person’s mobility.
RA is the result of an immune response in which the body’s immune system attacks its own healthy cells. The specific causes of RA are unknown, but some factors can increase the risk of developing the disease.
Researchers have studied a number of genetic and environmental factors to determine if they change person’s risk of developing RA.
Characteristics that increase risk
Age. RA can begin at any age, but the likelihood increases with age. The onset of RA is highest among adults in their sixties.
Sex. New cases of RA are typically two-to-three times higher in women than men.
Genetics/inherited traits. People born with specific genes are more likely to develop RA. These genes, called HLA (human leukocyte antigen) class II genotypes, can also make your arthritis worse. The risk of RA may be highest when people with these genes are exposed to environmental factors like smoking or when a person is obese.
Smoking. Multiple studies show that cigarette smoking increases a person’s risk of developing RA and can make the disease worse.
History of live births. Women who have never given birth may be at greater risk of developing RA.
Early Life Exposures. Some early life exposures may increase risk of developing RA in adulthood. For example, one study found that children whose mothers smoked had double the risk of developing RA as adults. Children of lower income parents are at increased risk of developing RA as adults.
Obesity. Being obese can increase the risk of developing RA. Studies examining the role of obesity also found that the more overweight a person was, the higher his or her risk of developing RA became.
A knee joint affected by arthritis may be painful and inflamed. Generally, the pain develops gradually over time, although sudden onset is also possible. There are other symptoms, as well:
The joint may become stiff and swollen, making it difficult to bend and straighten the knee.
Pain and swelling may be worse in the morning, or after sitting or resting.
Vigorous activity may cause pain to flare up.
Loose fragments of cartilage and other tissue can interfere with the smooth motion of joints. The knee may lock or stick during movement. It may creak, click, snap, or make a grinding noise (crepitus).
Pain may cause a feeling of weakness or buckling in the knee.
Many people with arthritis note increased joint pain with changes in the weather.
When you see your doctor, you’ll get a physical exam and talk about your personal and family medical histories. You may also get blood tests to help see if you have RA. Those check for:
Anemia (low red blood cell count)
Rheumatoid factor (RF), found in about 70% to 80% of people with RA
“Sed” rate (erythrocyte sedimentation rate). High levels are a sign of inflammation.
Antibodies to a chemical called CCP
High levels of CRP (C-reactive protein)
You may also get an X-ray or, less frequently, an MRI to check on possible joint damage. And your doctor may take a sample of your synovial fluid, which comes from your joints.
OA can't be cured, but therapies are available to ease symptoms and to slow down the degeneration. Recent information shows that mild cases of knee OA may be maintained and in some cases improved without surgery.
Taking pain relievers: Your healthcare provider may recommend taking pain relievers (non-steroidal anti-inflammatory medications, or NSAIDs) to help reduce pain and swelling in your knee. Acetaminophen can be used as an alternative if you cannot tolerate NSAIDs or are allergic.
Glucosamine and chondroitin sulfate: These supplements seem to have nearly the same benefits as anti-inflammatory medicine with fewer side affects. Many doctors feel the research supports these supplements and are encouraging their patients to use them.
Cortison injection: Cortisone is a powerful anti-inflammatory medication, but it has secondary effects that limit its usefulness in the treatment of OA. Multiple injections of cortisone may actually speed up the process of degeneration. Repeated injections also increase the risk of developing a knee joint infection, called septic arthritis. Any time a joint is entered with a needle, there is the possibility of an infection. Most physicians use cortisone sparingly, and avoid multiple injections unless the joint is already in the end stages of degeneration, and the next step is an artificial knee replacement.
Hyaluronic acid injection: Doctors inject three to five doses into the joint over a one-month period. The medicine helps lubricate the joint, ease pain, and improve people's ability to get back to some of the activities they enjoy. These injections are less effective for older adults and severe OA.
Physical therapy: You will learn ways to calm pain and symptoms, which might include the use of rest, heat, or topical rubs. You will also be taught how to protect the arthritic knee joint by modifying your activities. Range-of-motion and stretching exercises will be used to improve knee motion.
Walking aids: This may include shock-absorbing insoles, a cane or walker, a knee unloading brace, or a heel wedge
In some cases, surgical treatment of OA may be appropriate.
In cases of advanced OA where surgery is called for, patients may also see a physical therapist before surgery to discuss exercises that will be used just after surgery and to begin practicing using crutches or a walker.
Click on the tabs below to learn about the various surgical procedures for knee OA.
Arthroscopy
Surgeons can use an arthroscope to check the condition of the articular cartilage. They can also clean the joint by removing loose fragments of cartilage. People have reported relief when doctors simply flush the joint with saline solution. A burring tool may be used to roughen spots on the cartilage that are badly worn. This promotes growth of new cartilage called fibrocartilage, which is like scar tissue. This procedure is often helpful for temporary relief of symptoms for up to two years.
Proximal Tibial Osteotomy
Surgery to realign the angles in the lower leg can help shift pressure to the other, healthier side of the knee. The goal is to reduce the pain and delay further degeneration of the medial compartment. In a proximal tibial osteotomy, the upper (proximal) part of the shinbone (tibia) is cut, and the angle of the joint is changed. This converts the extremity from being bowlegged to straight or slightly knock-kneed. By correcting the joint deformity, pressure is taken off the cartilage. A proper joint angle actually allows the cartilage to regrow, a process called regeneration.
This surgical procedure is not always successful. Generally, it will reduce your pain but not eliminate it altogether. The advantage to this approach is that very active people still have their own knee joint, and once the bone heals there are no restrictions on activities.
A proximal tibial osteotomy in the best of circumstances is probably only temporary. It is thought that this operation buys some time before a total knee replacement becomes necessary. The benefits of the operation usually last for five to seven years if successful.
Artificial Knee Replacement
An artificial knee replacement is the ultimate solution for advanced knee OA.
Surgeons prefer not to put a new knee joint in patients younger than 60. This is because younger patients are generally more active and might put too much stress on the joint, causing it to loosen or even crack. A revision surgery to replace a damaged prosthesis is harder to do, has more possible complications, and is usually less successful than a first-time joint replacement surgery.
Physical therapy treatments after surgery depend on the type of surgery performed. Rehabilitation is generally slower and more cautious after knee replacement procedures and certain types of tibial osteotomies. After simple procedures such as arthroscopy, you may begin fairly aggressive exercise therapy immediately.
Therapy treatments usually begin the next day after surgery. Your first few rehabilitation sessions are used to ease pain and swelling, help you begin gentle knee motion and thigh tightening exercises, and get you up and walking safely. You may need to use either a walker or crutches after surgery. Some patients may be instructed to limit how much weight they place on the knee for four to six weeks.
After going home from the hospital, some patients may be seen for a short period of home therapy before beginning outpatient physical therapy. Outpatient treatments are designed to improve knee range of motion and strength and to safely progress your ability to walk and do daily activities.
The therapist's goal is to help you keep your pain under control, maximize knee mobility, and improve muscle strength and control. When you are well under way, regular visits to your therapist's office will end. The therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.
How using the HeatPulse
and Thermosleeve can help
The Thermosleeve and HeatPulse are great hot and cold therapy tools to help you treat knee osteoarthritis.
Thermosleeve uses cold compression to relieve pain and inflammation
HeatPulse provides a heated massage to boost blood flow to your knee, encouraging healing and improving range of motion
You can use Thermosleeve to bring down initial pain and swelling in your knee. Once pain and swelling have calmed, or after the first 72 hours, switch to the HeatPulse to improve flexibility and range of motion, as well as encourage healing.
You can also use the HeatPulse to warm up and loosen your muscles before doing strengthening and stretching exercises. When you have completed the exercises, use the Thermosleeve to calm flare ups of pain and swelling.
Swelling after knee surgery can last for three to six months after surgery. To help reduce inflammation and pain, you can use the Thermosleeve three to four times a day for about 10-20 minutes during the first few days after surgery. After the initial swelling has gone down, you can alternate between the Thermosleeve and the HeatPulse to relax the muscles and ease stiffness.
The Thermosleeve and HeatPulse are great hot and cold therapy tools to help you treat knee osteoarthritis.
Thermosleeve uses cold compression to relieve pain and inflammation
HeatPulse provides a heated massage to boost blood flow to your knee, encouraging healing and improving range of motion
You can use Thermosleeve to bring down initial pain and swelling in your knee. Once pain and swelling have calmed, or after the first 72 hours, switch to the HeatPulse to improve flexibility and range of motion, as well as encourage healing.
You can also use the HeatPulse to warm up and loosen your muscles before doing strengthening and stretching exercises. When you have completed the exercises, use the Thermosleeve to calm flare ups of pain and swelling.
Swelling after knee surgery can last for three to six months after surgery. To help reduce inflammation and pain, you can use the Thermosleeve three to four times a day for about 10-20 minutes during the first few days after surgery. After the initial swelling has gone down, you can alternate between the Thermosleeve and the HeatPulse to relax the muscles and ease stiffness.
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