Definition: Arthritis is the medical term for inflammation of a joint. There are different types of arthritis that can develop in the knee.
Osteoarthritis: This is the most common form. It is a progressive condition also known as degenerative joint disease. The knee joint is formed where the femur (thighbone), the tibia (shinbone) and the patella (kneecap) meet. The bone surfaces that come into contact with each other are covered with a protective smooth cartilage that cushions the bones and enables them to slide across each other without friction. With age and use this articular cartilage deteriorates, leaving bone surfaces exposed and the joint space narrowed. Bones often respond by growing more bone, further decreasing the distance between them. Eventually movement of the knee joint causes the bones to rub directly against each other, triggering inflammation, pain and deformity.
Juvenile rheumatoid arthritis (JRA): This is an autoimmune disease that commonly affects the knees, destroying articular cartilage. The term autoimmune means that for unknown reasons the body attacks its own healthy tissues.
Lupus arthritis: This is a symptom of Systemic Lupus Erythematosus, another autoimmune disease.
Causes: A number of factors can contribute to the development of arthritis and it is often difficult to isolate one main cause, but some risk factors are:
Age: Cartilage degenerates over time and with use, becoming thinner and more brittle, and therefore more vulnerable.
Weight: As the knees bear most body weight, they are more susceptible to damage if a person is overweight.
Heredity: A family history of arthritis increases the risk of developing the disease.
Injury: A previous injury to the knee can lead to arthritis later in life.
Infection or illness: Inflammation caused by an infection can result in arthritis.
Occupation: Some occupations that involve repetitive movements of the knee, or extended periods of time squatting, are more likely to cause injuries that may lead to arthritis.
Gender: Women over the age of 50 are more likely than men to develop osteoarthritis.
Gouty arthritis is caused by the accumulation of urate crystals in the joint.
Pseudogout arthritis is similar to gouty arthritis, but is caused by the accumulation of calcium deposits.
Symptoms: Arthritis is a progressive disease, and symptoms usually appear gradually. The most common symptoms are:
Stiffness that often lasts for longer than an hour
Swelling of the knee, which may be red and tender
Symptoms tend to be worse in the morning, or after sitting still for a length of time. Any activity that involves bending the knee is likely to increase the pain, and there may be a feeling of weakness in the knee. The weather can also affect the level of pain for some people, with cold and damp weather making it worse.
Other symptoms might include:
Obvious deformity of the knee
Loss of range of motion
Fatigue or a vague sense of feeling unwell
Crepitus, or a grinding sensation on bending the knee
Diagnosis: Your doctor will ask about your medical history, including any previous knee injuries. You will be asked to describe your symptoms and what makes them better or worse. You will have a physical examination that will include testing for range of motion of the knee joint. You will probably be asked to stand and walk so that the doctor can evaluate your posture and how you distribute weight on the knees. Any swelling, tenderness, or deformity of the joint will be noted.
You may have some blood or synovial fluid taken for testing, and it is likely that you will have x-rays, which can clearly show structural changes in the joint.
Treatment: Treatment for arthritis of the knee is primarily aimed at relieving symptoms and increasing function. The precise plan of treatment will depend on the cause of your disease and its stage of advancement.
The two most effective treatments for osteoarthritis are weight loss and low impact, aerobic exercise. The use of Tylenol (acetaminophen) and NSAIDs can also be helpful, as can cortisone injections, although the cumulative side-effects of these mean that only a few injections may be given each year. Using a knee brace may alleviate symptoms. Some research has shown that using custom orthotics for shoes, taking supplements such as glucosamine and chondroitin, and receiving saline injections into the knee are not effective treatments. That being said, if these measures provide relief and if your doctor agrees, you should use them.
Treatment for juvenile rheumatoid arthritis includes medications such as anti-inflammatory drugs, disease modifying anti-rheumatic drugs and corticosteroids, as well as biologic agents. When taking medication for JRA you will need to be very carefully monitored by your doctor.
Gouty arthritis is treated with diet modification and medication such as colchicine.
Treatment of infectious arthritis will depend on the cause, but will almost certainly require surgery to clear the joint.
If conservative treatment for arthritis fails, surgery might be indicated. Surgery can be used to repair torn cartilage, graft new cartilage onto the bones, replace severely damaged cartilage with other materials such as metal and plastic, or trim part of the bones to improve joint alignment. Arthroscopy (camera-guided knee surgery) is the preferred technique as it minimizes trauma to the knee, but open knee surgery is sometimes required.
Your doctor or physiotherapist will develop an exercise program specifically for you, tailored to increase flexibility and mobility of the knees, and strength of the leg muscles. Swimming and cycling are excellent ways to exercise aerobically without putting weight on the knees. Tai chi, yoga and Pilates are safe ways to develop flexibility and core body strength.
What to look for in a brace for arthritis of the knee: Research on the benefits of wearing a knee brace for arthritis is mixed but your doctor may feel that it would be beneficial for you. There are two types commonly used: an ‘unloader’ brace, which diverts weight away from the damaged part of the knee, and a ‘support’ brace which spreads the load across the whole knee. Which type would be best for you will depend on your particular situation. Take professional advice and ensure that it is properly fitted.
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