Understanding Knee Pain

Osteoarthritis :: Rheumatoid Arthritis :: Post-Traumatic Arthritis


Osteoarthritis (OA) is sometimes called degenerative arthritis because it comes from inflammation of the joint due to "wear and tear". Joint cartilage is a smooth covering of the bone ends where they come into contact within the joint. When cartilage wears away, the bones rub against each other, causing pain and stiffness. OA usually occurs in people over age 50 and often in people with a family history of the disease.

Osteoarthritis is the most common form of arthritis in the United States. When OA begins to affect a joint, a series of reactions take place that actually begin to degrade your once-healthy cartilage. Once the cartilage that normally cushions the joint breaks down, the bones of your joint eventually grind directly against each other. Your body reacts to this by creating bone spurs and the joint capsule itself may thicken and become inflamed.

There are two kinds of OA. Primary OA often refers to “everyday wear”. Secondary OA is considered the result of a maligned joint, being overweight, injury or overuse.

Who suffers from OA?

Twenty-seven million people are affected by OA in the United States alone. Although OA can affect anyone at any age, it has been linked to the aging process. More than 50% of everyone over 65 has OA symptoms in one or both knees. By 75, virtually everyone suffers with OA in one or more joints. In fact, OA of the knee and hips continues to be the most common cause of arthritis-related disability for Americans.

What are the Symptoms?

Although some people who have OA say they feel no pain, most people who have OA experience pain, stiffness (especially in the morning), swelling, grinding and tenderness in one or more joints. For some people, OA can become completely debilitating. In order to diagnose you properly, Dr. Fischer will consider your symptoms, medical history, examine your joint(s) and order diagnostic tests. Dr. Fischer may order blood work, X-rays, a CT scan or an MRI to get a better understanding of your painful joint and its condition.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s natural immune response attacks the lining of the joints (called the synovium), causing chronic inflammation and pain. The inflammation may eventually damage the joint’s cartilage and bone, weaken the soft tissue around the joint (cartilage, ligaments and tendons) and prevent the joint from working properly.

Left untreated, RA can greatly reduce your quality of life. You may have already decreased your activity level to avoid the pain caused by a joint affected by RA. It’s not uncommon for the joint damage caused by RA to lead to a loss of movement, an inability to work, and even the need for surgery to repair the damage.

What Are The Symptoms of RA?

RA is a chronic, persistent disease that can take a variable course over an affected person’s lifetime. It may progress slowly, sometimes produce “flare ups”, and then at times go into “remission” during which the symptoms may greatly diminish or disappear. There are 3 stages of RA identified by specific symptoms. In the first stage, RA causes pain, warmth, redness and swelling in affected joints. In the second stage, it causes thickening of the synovium. In the third stage, permanent joint damage begins to occur as bone and cartilage are attacked by the enzymes released by the inflamed cells in the once-healthy synovial fluid.

In addition to joint pain, swelling and stiffness, the symptoms of RA commonly include fatigue, weakness, flu-like symptoms accompanied by a low-grade fever, loss of appetite, depression, chronic dry eye or dry mouth and, in people with more advanced RA, bumps (called rheumatoid nodules) under the skin.

How is RA Treated?

Your primary doctor will refer you to a rheumatologist, a doctor who specializes in inflammatory diseases like RA. Your rheumatologist may recommend different treatment options depending on the severity of your RA and its impact on your joint(s) and your body as a whole. And while there is no cure, RA can be controlled through the use of new drugs, exercise, and self-management techniques.

If your RA is so severe that conservative treatment options are no longer managing your symptoms to meet your activity goals, joint replacement may be an option. Some treatment options, such as partial knee replacement, are not indicated for patients with RA because the underlying disorder will inevitably affect the other native parts of the knee. Dr. Fischer will work with you and your other physicians to develop an individual treatment plan

Post-Traumatic Arthritis

What Are The Symptoms of Post-Traumatic Arthritis?

The symptoms of post-traumatic arthritis include joint pain, swelling, fluid accumulation in the joint, and decreased tolerance for walking, sports, stairs and other activities which stress the joint.

How is Post-Traumatic Arthritis Treated?

Post-traumatic arthritis is treated similarly to osteoarthritis. Treatment starts with weight loss, low impact exercise and strengthening of the muscles surrounding the joint, non-steroidal anti-inflammatory medicines (NSAIDs such as Advil, Aleve, Celebrex or one of many others) are often recommended if you can take them. Arthritic joints can also be injected with cortisone or substances called Hylamers which act like artificial joint fluid. All of these measures are aimed at making the joint more comfortable and functional. They do not cure the arthritis.When the arthritis progresses to the point that these measures are not effective in treating pain and maintaining function, then surgical treatment will be discussed.

Surgical treatment may include debriding ("cleaning out"), reconstructing or replacing the worn out joint surfaces. Post-traumatic arthritis progresses as time goes on, the joint surface wearing out further with more use over the years. Fortunately, when the nonsurgical treatments are no longer effective, surgical treatment can offer lasting relief. Deformity through or around the joint may necessitate the use of computer assisted navigation to restore the joints normal alignment.