Causes of Arthritis of the Knee
There are many conditions that can result in degeneration of the knee joint. Osteoarthritis is the most common reason that patients need to undergo knee replacement surgery. This condition is commonly referred to as “wear and tear arthritis.” Osteoarthritis can occur with no previous history of injury to the knee joint – the knee simply “wears out.” There may be a genetic tendency in some people that increases their chances of developing osteoarthritis.
The major problem in osteoarthritis is that the cartilage (the articular cartilage) on the surface of the bone inside the joint wears away. This results in bone rubbing against bone since the slick protective surface of the articular cartilage is absent. This causes pain. Abnormalities of knee joint function resulting from fractures of the knee, torn cartilage and torn ligaments can lead to degeneration many years after the injury. The mechanical abnormality leads to excessive wear and tear – just like the out-of-balance tire that wears out too soon on your car.
Diagnosis of Arthritis of the Knee
The diagnosis of a degenerative knee starts with a complete history and physical examination by your doctor. He will ask about any other medical conditions and surgical conditions. X-rays will be required to determine the extent of the degenerative process and may suggest a cause for the degeneration. Other tests may be required if there is reason to believe that other conditions are contributing to the degenerative process. Blood tests may be required to rule out systemic arthritis (such as rheumatoid arthritis) or infection in the knee.
Is Knee Arthritis Affecting Your Mobility?
The osteoarthritis (OA) in your knees may have affected your ability to move freely more than you realize. To check your mobility, try the movements below that demonstrate everyday activities. Pay close attention to how easy or difficult they are for you today compared to a time before you had OA.
Non-Surgical Options
Injections to Treat Knee Pain Caused by Arthritis
If your knee pain is severe, your physician may elect to inject preparations for the treatment of knee pain directly into your arthritic knee. Knee injections may take several forms:
Corticosteroid Injection
Corticosteroids, also known as glucocorticoids, refer to a group of naturally occurring human hormones. These hormones, commonly referred to as “cortisone”, can be artificially produced in the laboratory and purified for injection into inflamed or arthritic joints, due to rheumatoid arthritis, osteoarthritis, or trauma. For knee arthritis, cortisone injections into the joint can often help reduce the inflammation for two to three months. Before administering the cortisone injection, your doctor may insert a needle into the knee joint and remove or pull excess fluid from the joint. Doctors normally give less than three cortisone injections a year because of the possibility that excessive steroid injections may actually speed the process of joint deterioration.
Viscosupplementation
Hyaluronic acid (HA) injections are designed to replenish the acid in your knee joint. These injections were recently approved for use in the United States. Used for years in Canada and Europe, this jelly-like medication reduces knee pain by deadening nerve endings in the knees. It also acts like natural cartilage by creating a shock absorber between the bones and easing the pain associated with weight bearing and joint movement. Hyaluronic acid is injected directly into the knee with a needle. It can produce relief for varying periods, but can be beneficial for at least three months.
Possible Complications of Knee Injections
Following the injection of cortisone or hyaluronic acid into the knee, there may occasionally be increased pain or an inflammatory reaction to the injected medication. These reactions usually occur within the first 24 to 48 hours after the injection and ice, elevation, and medications such as analgesic can help.
Injections into a joint must always be done under sterile conditions to minimize the possibility of infection. If an infection does occur after the knee has been injected, it must be dealt with promptly to avoid irreversible destruction of the joint cartilage. Pain greater than expected, swelling and/or redness of the knee joint or the development of a fever should raise concerns about an infection and be reported immediately to your doctor. Rapid diagnosis, intravenous antibiotic therapy, followed by surgical drainage of pus, removal of any infected debris, and washing the joint with sterile fluids is essential to the effective management of an infected knee.
Knee Arthritis: Assistive Devices to Help Patients with Arthritis Pain
If you suffer from knee arthritis, everyday activities such as getting dressed in the morning, going up stairs and even using the shower can be difficult. There are many assistive devices available that may make your life easier and more productive. Your doctor or occupational therapist can identify specific assistive devices that will help you in your daily life.
Bathrooms
If you have stiff joints from knee arthritis, a raised toilet seat may be helpful. You may also wish to install rails by the side of the toilet to make it easier for you to move on and off of it. Showering is easier if you have a shower seat and grab bars. There are companies that focus on creating showers for people with disabilities. You may also find these devices useful:
- Non-skid safety mats
- long-handled brush or sponge
- hand-held shower head
Dressing
If you have stiff joints from knee arthritis, a raised toilet seat may be helpful. You may also wish to install rails by the side of the toilet to make it easier for you to move on and off of it. Showering is easier if you have a shower seat and grab bars. There are companies that focus on creating showers for people with disabilities. You may also find these devices useful:
Climbing Stairs
If you can, avoid stairs. If you must climb stairs, always use the handrail and take your time. Use your best leg first when going up and lead with the bad leg on the way down. If you are unable to climb stairs in your home, you may want to explore installing a stair lift that will allow you to move easily up and down the stairs.
Walking
A cane is the best assistive aid for problems with walking. There are many different types of canes. A popular choice for many people is a quad cane that has four tips at the end to give stability. With knee arthritis, use the hand on the same side as the problem knee. Walkers or crutches may also help people who are unable to use a cane.
You can buy most of these assistive devices in department stores, medical supply stores, through specialized mail-order catalogs, or through medical assistance web sites.
Viscosupplementation for the Knee
Introduction
The human knee will bend an average of 1 million times in one year. To aid in all that movement, the knee is filled with a substance called synovial fluid. Synovial fluid acts as a lubricant and shock absorber to cushion the knee joint.
Viscosupplementation is becoming a popular treatment to relieve pain caused by osteoarthritis of the knee. The process involves a series of injections into the knee joint designed to reduce pain caused by arthritic changes in the joint’s surfaces and fluid.
Sometimes, either through the effects of aging, accident or a disease, such as arthritis, components of the synovial fluid may begin to break down. One such component is hyaluronic acid or HA. In patients with osteoarthritis, the concentration of HA in the synovial fluid is reduced resulting in smaller and less effective molecules. The HA loses some of the lubricating and shock absorbing properties that protect the knee. Researchers believe this can result in joint pain, stiffness and perhaps an onset or worsening of osteoarthritis.
Sometimes, either through the effects of aging, accident or a disease, such as arthritis, components of the synovial fluid may begin to break down. One such component is hyaluronic acid or HA. In patients with osteoarthritis, the concentration of HA in the synovial fluid is reduced resulting in smaller and less effective molecules. The HA loses some of the lubricating and shock absorbing properties that protect the knee. Researchers believe this can result in joint pain, stiffness and perhaps an onset or worsening of osteoarthritis.
How Does Viscosupplementation Work?
Viscosupplementation is a type of therapy in which the hyaluronic acid in the knee can be augmented through a series of injections. Viscosupplementation will not cure arthritis or repair damaged cartilage in your knee, but it may relieve joint pain for a period of time.
Researchers are not exactly sure how HA injections relieve pain. Theories suggest that the injection of supplemental HA may induce the body to produce its own HA in the knee. Researchers also believe HA may have anti-inflammatory properties, or that the new “lubricant” in the knee protects and soothes the nerve endings exposed by the degraded cartilage of the arthritic knee.
Hyaluronic acid is a naturally occurring substance that is present in not only synovial fluid, but also in the eyeballs, skin and cartilage. When isolated, it is a thick viscous fluid having a consistency similar to an egg white. Viscosupplements use purified HA that is derived from either rooster combs or genetically engineered cells to augment the natural HA in the knee joint.
How is it Administered?
The enzymes of the stomach break down HA, so there is no pill form of viscosupplementation. Therapy is available only through injection into the knee. The injection is directly into the knee joint from a point on the side and under the kneecap. The injections usually take no longer than 15 seconds. Three viscosupplements are approved for use in the United States: Hyalgan®, Synvisc® and SupartzTM . Depending on which product your physician prescribes, the administration is either through three or five injections, one each week. According to the manufacturers, it can take up to 12 weeks for the injections to take full effect.
Who Can Benefit?
Viscosupplementation is recommended for people with osteoarthritis who are not responding to traditional therapies, such as pain-relief medications or exercise. It also is an option for people who have arthritis and are not candidates for a knee replacement. People in this category would include those whose knee is not completely impaired or those who may be considered too young for a knee replacement.
What are the Side Effects?
You should not receive HA viscosupplementation if you ever had an allergic reaction to any other hyaluronate preparations or are allergic to poultry products. You should not receive the injections if you have an infection or skin disease around the injection area. As with any injection, mild pain may occur at the injection site. You may also have swelling, heat and/or redness, rash, itching, or bruising around the joint. These reactions are generally mild and usually do not last long.
How Effective Is It?
A number of clinical studies have been conducted regarding HA viscosupplementation.
A multi-centered study from Canada published in the journal of the Osteoarthritis Research Society, Osteoarthritis and Cartilage, December 1995, concluded that HA viscosupplementation is a safe and effective treatment. One group of patients was treated with hyaluronic acid. The other received non-steroidal anti-inflamatory drugs (NSAIDs). The researchers found that after six months, the group receiving HA had better pain relief than those receiving NSAIDs.
Conclusion
There are a wide range of options to treat osteoarthritis of the knee. Although researchers aren’t sure why viscosupplements can reduce pain, more and more doctors are using these injections to help treat their patients’ knee pain.
Symptoms
Rheumatoid Arthritis: Symptoms of Rheumatoid Arthritis of the Knee
If you are showing symptoms of rheumatoid arthritis in the knee, you may first notice a swelling around and below the knee joint. The knee joint may be stiff in the morning due to lack of movement when sleeping, but may get better with activity throughout the day. It also may be tender to the touch. Some people say that their knee joint feels like it may snap and is really hot inside. In addition, since rheumatoid arthritis is usually a symmetrical disease, both of your knees will most likely be affected.
If there is significant damage to the knee joint, the knee may appear malaligned or crooked to the naked eye. Also, if you have rheumatoid arthritis in the knee, you will most likely have one or more of the other symptoms that are prevalent in rheumatoid arthritis:
- Swelling and pain in one or more joints, lasting six weeks or more
- fatigue and/or weakness
- Stiffness following periods of immobility which gradually improves with movement
- general sickness, mild fevers, anemia and weight loss
- fluid accumulation, especially around the ankles
Symptoms of Arthritis of the Knee
The symptoms of a degenerative knee joint usually begin as pain while bearing weight on the affected knee. You may limp and the knee may become swollen with fluid. The degeneration can lead to a reduction in the range of motion of the affected knee as the knee bends less than normal and may lose the ability to completely straighten out. Bone spurs will usually develop and can be seen on an x-ray. Finally, as the condition becomes worse, the pain may be present all the time and may even keep you awake at night.
