Rheumatoid arthritis (RA) is a systemic disease of the immune system. It affects multiple joints in the upper and lower extremities. Knees are one of the common joints affected by RA. RA can occur at any age and can affect both knees. In this article, we will consider the treatment of rheumatoid arthritis of the knee.
When RA affects the knee joint, the synovial membrane, which connects the ends of the bones in the joints, thickens and creates an excess of joint fluid.
This excess fluid, along with inflammatory chemicals, releases the immune system, leading to swelling and damage to the cartilage, which acts as a cushion in the joint, leading to pain and joint erosion.
Treatment of rheumatoid arthritis of the knee
The goal of the treatment is twofold: to alleviate the symptoms of the disease and prevent the progression of the disease and damage to the joints.
Painkillers and anti-inflammatory drugs.
To relieve symptoms, the main treatment options are painkillers and anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs commonly used to combat the symptoms of rheumatoid arthritis. However, they are notorious for their side effects, because of which they can only be used on a short-term basis.
Medicines against rheumatic diseases.
Modifying antirheumatic drugs are widely used to prevent the progression of joint damage. These agents have a diverse mechanism of action, and they act by reducing swelling and joint pain, reducing markers of acute inflammation in the blood, and stop the progressive damage to the joints.
They include methotrexate, sulfasalazine, leflunomide, gold salts, and cyclosporine. However, basic drugs are also associated with varying degrees of side effects.
Corticosteroids are anti-inflammatory drugs. They can be prescribed as medications or injections directly into the joints to reduce joint inflammation.
A newer approach is the use of biological agents. Inhibitors were the first licensed biological agents, including etanercept, infliximab. This was followed by monoclonal antibodies, such as abatacept, rituximab.
The adjunctive treatment for rheumatoid arthritis of the knee includes exercises, joint protection, psychological support to help deal with related symptoms and disabilities.
Lifestyle changes include weight loss and exercise changes from running or jumping exercises to swimming or cycling, which do not carry a risk of knee damage. Weight loss can reduce stress on support joints such as the knee.
Physiotherapy is an integral part of the treatment of relieving arthritis. This helps maintain optimal flexibility and bond strength.
Assistive devices, such as a cane, walker, shoes, etc., can help deal with disabilities associated with rheumatoid arthritis of the knee.
Treatment of rheumatoid arthritis of the knee with surgery. Surgery can be performed to maintain joint function or to prevent loss of joint function. Joint replacement therapy may be chosen. This is important when the joints are not working.
There are various types of surgery to eliminate joint problems. For patients with rheumatoid arthritis, full or partial knee replacement is often recommended.
Symptoms most often include pain and stiffness of the affected joints. The pain is more often in the morning and stronger, associated with severe stiffness. The joint may become stiff and swollen, making it difficult to bend or align the knee.
Pain and stiffness are also worse off after a period of inactivity. The knee may feel weak or “fixed” or “tightened” as a result of this disease.
The diagnosis of RA affecting the knees is based on the same principles as the diagnosis of rheumatoid arthritis of other joints.
The diagnosis is initiated with a detailed history of the onset and severity of symptoms, as well as a family history of RA or other autoimmune disorders.
The next step involves a physical examination when other joints are examined for swelling, pain, and signs of inflammation. The range of motion of the knees, pain, soreness, and stiffness is noted.
There are a set of tests that can be used in the diagnosis, but none of them is final.
Due to inflammation, blood tests such as C – reactive protein and erythrocyte sedimentation rate may be raised. These, however, are non-specific markers of inflammation.
Rheumatoid factor is a relatively specific test. The presence of this significant factor is observed in almost 80% of all people with RA. The presence of rheumatoid factor cannot be detected in the early stages of the disease. In addition, about 1 out of 20 healthy people may experience a positive result for the rheumatoid factor. Thus, the presence of the rheumatoid factor is not an absolute indicator of rheumatoid arthritis.
Several imaging studies, such as X-rays, MRI scans, and computed tomography, can be ordered to examine the degree of joint damage caused by this disease. X-rays usually show a loss of joint space in the affected knee.