Your knee: Rheumatoid arthritis or osteoarthritis?

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1 Your knee: Rheumatoid arthritis or osteoarthritis? Age Rheumatoid arthritis can come on at any age while osteoarthritis usually starts later in life. How does it start? Rheumatoid arthritis comes on rapidly with a stiff, painful swollen knee. Osteoarthritis can start with a sudden swelling but symptoms usually appear gradually. The main features of rheumatoid arthritis are swelling and stiffness. The main feature of osteoarthritis is pain - swelling flares up and can last from a few days to several months. Restricted movement People with rheumatoid arthritis often suffer from knock knees, where legs curve inwards. With osteoarthritis, movement is restricted further down the line and usually starts with a bit of a struggle to fully straighten the knee. Later on, the leg can become bandy (curving outwards) or, in some cases, knockkneed. In the morning With rheumatoid arthritis, the knee is usually at its most restricted first thing in the morning and stiffness can last for hours. With osteoarthritis, however, any stiffness goes away quite quickly in the first hour and often comes back when resting after activity. Other joints? Rheumatoid arthritis can affect a number of different joints at the same time but this is unusual with osteoarthritis. If you re unsure about your condition, it s best to get a diagnosis as soon as you can - medication can limit damage from rheumatoid arthritis.

2 What is osteoarthritis of the knee? Osteoarthritis is when the joint cartilage - and the bone underneath - wears down, which means your knee can feel painful, warm and swollen. Joints are constantly being worn down but the body usually repairs the damage itself. With osteoarthritis, the damage is not properly repaired so the cartilage breaks up and tiny pieces are shredded into the knee. The problem is that when the cartilage thins it s not as good at absorbing shocks and eventually the overloaded bone underneath can become bruised and sore. A lot of the time with osteoarthritis, it s the bone that s painful, which is why things like losing weight, using a stick, wearing well-cushioned shoes and building up your shock absorbing muscles can help. The knee is usually worn down in one or two places rather than evenly all over the knee. So when just one side of the knee wears down, the leg can become bandy (curving outwards) or, in some cases, knock-kneed (curving inwards). As things progress, a small lip of new bone can form, which can be tender, can make the knee look bigger and can make movement harder. Eventually, it also means patients might not be able to properly straighten their knee and, unfortunately, stretching exercises can t put this right. In some cases, doctors can operate to remove the bone. Curiously though, some osteoarthritic knees don t hurt and even when they re quite worn down you might still be able to exercise. The 4 major causes of osteoarthritis of the knee We don t always know why you ve developed osteoarthritis but it s likely to be a combination of things. It can run in the family so maybe you know of relatives who ve had osteoarthritis of the knee or other joints. If you do heavy manual work, like farming for example, you re more at risk because of heavy or repeated pressure on your knee. Obesity can also put a strain on your knee so losing a bit of weight can mean you re less likely to develop osteoarthritis. Things like fractures or major ligament damage around the knee can lead to osteoarthritis in later life - but the risk can be reduced if these injuries are treated well.

3 How do I know if I ve got osteoarthritis in my knee? 10 typical symptoms 1. Your knee is painful and swollen and the swelling often feels warm. 2. In the early stages, you might only feel pain when you re playing sport. 3. Symptoms usually come on gradually although occasionally osteoarthritis starts with a flare-up, which could be caused by a minor injury or overdoing things. 4. Movement is often restricted, particularly when your knee s swollen, and you might not be able to extend it. Further down the line, the leg can become bandy (curving outwards) or, in some cases, knock-kneed (curving inwards). 5. Strenuous activities make the pain worse and using the stairs can be painful. 6. The knee will often stiffen up when you sit at the table and getting up can be uncomfortable. 7. A limp is common, especially for the first few steps. 8. The pain is usually felt in the knee joint itself but sometimes there can be a painful swelling behind the knee - a Baker s cyst is a small sac full of fluid. 9. As the arthritis gets worse, you might have to give up simple activities like going on a day trip. 10. If you have torn bits of bone or cartilage in your knee you might feel your knee catching or clicking and it could even lock into a jammed position. It s best to talk to your doctor about keyhole surgery if this happens Get to know your knee Many patients say their osteoarthritic knee has a threshold and that, if they go past that, it becomes more painful and swollen. Your knee might be able to deal with some of your regular activities but if you do them for longer than usual - or at a greater intensity - there could be problems.

4 For example, if you hike for a few miles instead of your usual one mile, your knee could swell up and become painful. The same thing could happen if you play golf two days in a row rather than your usual Monday and Friday rounds. The good news is there are steps you can take to try to avoid flare-ups. And if you get to know your tipping point, you can learn to stay on the right side of trouble. So if you re planning on going skiing, you can do exercises to build your strength to help protect your knee. You can also make your day s skiing a bit shorter, take days off and rest when you feel tired. Or if you fancy playing tennis for the first time in a while, start with short periods on the court, building things up slowly to make sure your knee will tolerate it. The important thing is to pace yourself and to understand how important it is to rest. Osteoarthritis of the knee: How to manage flare-ups Most people with osteoarthritis know all about flare-ups - the knee suddenly gets worse with more pain and swelling making it harder to move around. Some flare-ups are worse than others but getting on with day-to-day activities can be hard. Patients get to know things that can trigger flare-ups as well as learning how to manage them quickly and stop them from lasting a long time. We encourage you to exercise but please also remember that overdoing it can trigger a flare-up. Here are some of the best ways to manage flare-ups: 1. Try to avoid them in the first place Exercising for longer than usual or exercising harder than usual can both be triggers so nine-hole rounds of golf on two different days could be more sensible than 18 holes in one day. 2. Ice your knee for minutes with frozen peas in a damp tea towel or use a simple device that applies ice-cold water. This can be a big help but please don t put ice directly on the skin as it can burn. 3. Take anti-inflammatories

5 the moment you notice a flare-up and keep taking them until the flare-up is over. However, please don t take over-the-counter anti-inflammatories for longer than indicated on the packet and, if you get indigestion or other side effects, stop taking them and make an appointment to see your GP. 4. Use a bandage or a knee sleeve to help to reduce the swelling and to make you feel more confident about your knee. 5. Slow down Please take it easy when you re having a flare-up and if that means staying in the house then so be it. It s best to wait until the flare-up is under control before you slowly start getting back to your regular activities. 6. Start your leg-strengthening exercises again as soon as the pain and swelling start to settle. Your physiotherapist will tell you all about the best exercises to do. Injections for osteoarthritis of the knee: An essential guide Steroid injections and hyaluronic acid injections can help people with mild to moderate osteoarthritis. The injections, given at an outpatient clinic, are always used alongside things like exercise programmes, physiotherapy and taking medication. Wearing a knee brace can make the injections more effective because it takes the load off the knee. Steroid injections are effective when used occasionally, they act quickly - usually within hours - and they generally give two to six weeks of relief. They can be used to: Quieten down swelling that comes with a significant flare-up of the knee Take down swelling before a programme of knee-strengthening exercises Provide relief ahead of a holiday

6 Hyaluronic acid injections take longer to act but can give six months to two years of pain relief and, while they don t always work, about 60% of patients see big improvements. The injections can be carried out a maximum of twice a year. Side effects Because there s a small risk of infection, we don t usually give injections three months before knee replacements. Some people will get a small flare-up after the injection and steroid injections can leave a small depression where the needle entered. Allergic reactions are rare.