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Rheumatoid Arthritis (RA) of the Knee
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, including the knees. This condition occurs when the body’s immune system mistakenly attacks the synovium, the lining of the membranes that surround the joints. RA in the knee can lead to pain, swelling, stiffness, and eventually joint damage and deformity. It is a progressive disease that can significantly impact a person’s mobility and quality of life.
Symptoms
The symptoms of rheumatoid arthritis in the knee include persistent pain and swelling in the joint, stiffness (especially in the morning or after periods of inactivity), and a feeling of warmth around the knee. As the disease progresses, the joint may become deformed, and movement can become increasingly restricted. Other symptoms include fatigue, fever, and weight loss. Flares of increased disease activity may alternate with periods of relative remission.
Treatments
Medications:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These can help reduce pain and inflammation.
- Disease-Modifying Antirheumatic Drugs (DMARDs): Medications such as methotrexate can slow the progression of RA and save the joints and other tissues from permanent damage.
- Biologic Agents: These are a newer class of DMARDs that target specific parts of the immune system. Examples include TNF inhibitors like etanercept (Enbrel) and adalimumab (Humira).
- Corticosteroids: These can be used to control acute flares and severe symptoms but are generally used for short periods due to potential side effects.
Physical Therapy: A physical therapist can design an exercise program to maintain joint flexibility and muscle strength. Low-impact aerobic exercises, such as swimming or cycling, can be particularly beneficial.
Lifestyle Modifications: Weight management, a healthy diet, and avoiding activities that stress the knees can help manage symptoms. Assistive devices, such as braces or orthotics, can provide additional support.
Surgery: In severe cases, surgical options such as synovectomy (removal of the inflamed synovium), joint fusion, or total knee replacement may be considered to alleviate pain and restore function.
Causes
The exact cause of rheumatoid arthritis is unknown, but it is believed to involve a combination of genetic and environmental factors. A family history of RA, smoking, and certain infections may increase the risk of developing the disease. In RA, the immune system mistakenly attacks the synovium, leading to inflammation that can damage the cartilage and bones within the joint. Over time, the joint can lose its shape and alignment, resulting in chronic pain and disability.
Diagnosis and Management
Diagnosing rheumatoid arthritis involves a combination of physical examinations, blood tests (such as rheumatoid factor and anti-CCP antibodies), and imaging studies like X-rays, ultrasound, or MRI to assess joint damage. Early diagnosis and treatment are crucial to managing the disease and preventing joint damage. A rheumatologist typically coordinates care, often working with a team of healthcare providers to optimize treatment and improve patient outcomes. Regular monitoring and adjustments in therapy are necessary to control the disease effectively and maintain joint function.