Rheumatoid arthritis of the knee: symptoms and treatment

An inflammatory process that affects one or more joints is called arthritis.
It has several varieties, differing in causes, symptoms and treatment. The rheumatoid form of the disease can appear at any age, but most often affects people over 30 years of age. It has been noted that the proportion of women among the sick is over 70%. The disease causes destruction of the synovial membrane of the joint, cartilage, and bone. In its chronic form, the disease causes pain for many years and interferes with leading a full life. Over time, the degree of damage to the knee joint will only increase, so treatment should begin as early as possible.

Symptoms of rheumatoid arthritis of the knee joint

Characteristic manifestations of the disease can be detected without the use of special diagnostic equipment:

• decreased mobility of the knee, which manifests itself at the initial stage of the disease only after an overnight rest;
• sharp or aching pain that intensifies with movement; may spread to the entire leg;
• inflammation, signs of which are swelling of the knee, local changes in body temperature;
• effusion in the affected area;
• fever;
• increased fatigue.

As the disease progresses, the symptoms of rheumatoid arthrosis of the knee joint will intensify, and its deformation will be visible even to a non-specialist. Start treatment without waiting for the problem to become disabling! At the initial stage, the destruction of the knee can still be stopped.

The main symptoms of the disease are:

• Acute joint pain;
• Increased body temperature;
• Rapid heartbeat and chest pain (usually these symptoms are caused by carditis, that is, inflammation of the heart);
• Small subcutaneous nodules;
• Muscle twitching that cannot be controlled;
• Skin rash.

The most common signs of this disease are acute pain in the joints and a significant increase in body temperature. With the development of rheumatism, the joints suddenly begin to ache, and they become unusually red and swollen, and very hot to the touch. The tendency of the disease is as follows: as soon as the pain in one joint or area subsides, painful sensations arise in another. This is especially noticeable if the patient is not immediately prescribed bed rest and a course of anti-inflammatory drugs.

It should be noted that there are cases when pain in the joints is quite weak and not clearly expressed. In this case, the temperature in the presence of the disease appears suddenly, then sharply increasing, then decreasing. These symptoms usually last for about two weeks.

Inflammation of the heart occurs almost simultaneously with the above signs of rheumatism. At the beginning of the disease, carditis does not manifest itself in any way. In the complete absence of symptoms, the disease can only be detected by the attending physician by listening to the heart, detecting its rapid beating. As the disease progresses, the outer lining of the heart becomes inflamed, causing pain in the chest area. Carditis can also be accompanied by heart failure, which appears along with shortness of breath, abdominal pain and vomiting, nausea and cough. These symptoms especially appear in children, but they are expressed so weakly that parents do not consider it necessary to show the baby to the doctor.

Inflammation of the heart can be very serious and in most cases causes damage to the mitral valves. It leads to rheumatic damage to this organ. It can be detected by the appearance of characteristic heart murmurs, allowing the doctor to diagnose rheumatism.

As for uncontrollable muscle twitching, such symptoms of rheumatism appear gradually. It may take more than a month before the symptoms become noticeable and intense enough to require immediate medical attention. This occurs during a period of time when muscle twitching turns into fast and chaotic movements that disappear during sleep. At the same time, rheumatism is characterized by twitching of any muscle group. The only exceptions are the eyes. It is very difficult to identify such a symptom in children: parents attribute muscle twitching on the face to pampering and grimaces, and uncontrolled movements of the arms and legs and frequent self-injury to clumsiness. Such signs may be present for four to six months.

When all of the above symptoms disappear, a skin rash may occur: flat spots with wavy edges appear on the surface of the epidermis, which are painless and do not cause itching. The rash does not last long and usually disappears in one to two days.

It is worth noting that with rheumatism, abdominal pain often occurs, the child develops nausea, and loses appetite. Against the background of such manifestations in young patients, appendicitis is often falsely diagnosed, delaying treatment of the underlying disease.

Causes of rheumatoid arthritis of the knee joint

Absolutely anyone can get sick, regardless of gender, age, or lifestyle. Rheumatoid arthritis is caused by a combination of several factors:

• hormonal disorders - this is why women of puberty usually become ill;
• injuries, as well as unsuccessful operations or incorrect rehabilitation after them;
• hypothermia of the body;
• smoking;
• infectious diseases;
• allergy.

The bulk of officially registered patients are men and women aged 25 to 55 years.

Stages of rheumatoid arthritis of the knee joint

The disease develops gradually, so at first a person does not attach much importance to minor health problems. The course of the disease can be divided into 2 stages:

• Initial, when the victim is plagued by minor pain, and in the morning the knee joint is inactive. After a few hours, the victim forgets about the illness - exactly until its new manifestations.
• Transition to the stage of rheumatoid polyarthritis, which usually manifests itself symmetrically on the left and right limbs. The pain does not stop, and difficulties with movement appear.

Arthritis in severe cases is no longer just mild pain or inflammation. Destruction can affect muscles, affect the liver, heart, lungs and other internal organs. In this case, the patient’s life is at risk. The risk of disability increases.

Diagnosis of rheumatoid arthritis of the knee joint

The doctor, in addition to visually examining the patient and interviewing him, uses hardware diagnostic tools for rheumatoid arthritis. First of all, a blood test is performed to help detect signs of the disease, which include:

• increase in ESR;
• low hemoglobin levels and a decrease in the number of red blood cells (anemia);
• The level of C-reactive protein in the blood is higher than normal.

In addition to blood composition, the following are examined:

• X-ray of the knee, as well as the results of an ultrasound examination (ultrasound).
• Intra-articular fluid. If the diagnosis is confirmed, it has a reduced density, low transparency, and a high number of individual blood cells - neutrophils, leukocytes and others.
• Urine for the presence of protein.
• Test for the presence of antibodies to immunoglobulins. With a 70% chance of rheumatism it will be positive.
• Serum creatinine and urea levels.

If several symptoms of the disease have been identified, the doctor may prescribe an additional examination, based on the results of which treatment is prescribed. The first signs that attract attention are:

• nodules characteristic of rheumatism;
• positive result of rheumatoid testing;
• manifestation of arthritis in other joints (hands, etc.);
• joint deformation - visible visually or using x-ray examination;
• stiffness of movements.

Treatment of rheumatoid arthritis of the knee joint

The methods used to combat the disease are divided into non-drug and drug-based. Surgery (surgery) is used in extreme cases.

Non-drug treatments for rheumatoid arthritis of the knee:

• Pharmacopuncture. Designed to relieve inflammation and provide nutrition to the damaged joint.
• Shock wave therapy, which serves to restore normal blood supply. Returns the ability to bend the leg at the knee.
• Vacuum therapy is a type of massage based on the organization of low pressure zones in a certain area.
• Magnetotherapy. It has an analgesic and anti-inflammatory effect on affected joints.
• Laser therapy. Increases local immunity, has anti-inflammatory and sedative effects, improves blood circulation.

In contrast, some medications, in addition to the obvious effect (relieving pain, inflammation, etc.), may also have side effects:

• non-steroidal anti-inflammatory drugs;
• basic medications, the use of which begins immediately after diagnosis and can continue throughout life;
• hormonal agents.

How to treat rheumatoid arthritis of the knee joint and in what ratio to use Eastern and Western methods, the doctor must determine individually.

Treatment

All patients suffering from RA should be observed and treated only by a rheumatologist. Delaying therapy for 12 months significantly reduces the likelihood of a favorable prognosis for this disease. If the diagnosis of RA is beyond doubt, basic antirheumatological drugs (DMARDs) are prescribed. Methotrexate is the drug of choice worldwide. This therapy controls the disease, prevents bone deformities, improves the quality of life of patients and the prognosis of the disease. Drugs such as leflunomide (Arava), sulfasalazine, and hydroxychloroquine are also used. The choice of drug is determined only by a rheumatologist individually for each patient, taking into account the degree of disease activity, concomitant pathology, tolerability and effectiveness of previous therapy. Treatment with DMARDs is carried out indefinitely, sometimes for life, in order to prevent progression and control the disease, maintain remission or low disease activity. In some cases, with high disease activity, severe disease, and the impossibility, for a number of reasons, of taking high adequate doses of DMARDs, a rheumatologist may prescribe glucocorticosteroid drugs (GCS), which have a powerful and rapid anti-inflammatory effect. In case of ineffectiveness, poor tolerability of DMARDs, or the presence of risk factors for poor prognosis of RA, a decision is made to prescribe genetically engineered biological drugs (GEBD) to the patient. The effectiveness and tolerability of this therapy is assessed by a rheumatologist, who also determines its duration. In addition to drug therapy, patients suffering from RA are required to perform daily physical therapy (PT), which is not contraindicated even with high disease activity. The patient can begin performing exercise therapy in a group or individually with an instructor, and then continue independently at home. For patients with RA without disease activity, various methods of physiotherapy, massage of the affected limbs, hydrotherapy - baths, showers, etc. are also indicated.

In the later stages of the disease, with inadequate or late therapy, or with an aggressive course of the disease, surgical treatment methods that restore the function of the limbs are sometimes necessary. Types of surgical correction for RA are synovectomy (removal of the synovial membrane of the affected joint), reconstructive surgery on bones, ligaments, tendons of large and small joints (plasty), as well as endoprosthetics.

At the Clinic of High Medical Technologies named after. N.I. Pirogov, if RA is suspected, patients, after examination by a rheumatologist, can undergo a full examination, including all laboratory tests, Rg of joints, if necessary, MRI of joints and other methods of examining internal organs if indicated. The rheumatologist will prescribe adequate therapy and will subsequently evaluate the effectiveness and tolerability of treatment and dynamic monitoring of the patient. Also in our institution, patients can get advice from a physiotherapist and exercise therapy doctor, and, if there are indications and no contraindications, undergo various types of physical therapy, massage, etc. After a qualified consultation with an orthopedist-traumatologist, together with a rheumatologist and doctors of other specialties, patients, taking into account the indications for surgical treatment of joints, various types of surgical interventions are performed.

Proper nutrition for rheumatoid arthritis of the knee joint

The diet for rheumatoid arthritis is based on several principles:

• you need to eat in small portions, at least 4 times a day;
• You should avoid cold dishes and limit the consumption of highly heated foods;
• it is necessary to reduce salt intake to the amount indicated by the doctor;
• drink about 2 liters of liquid per day.

Healthy foods that should form the basis of your diet:

• fruits and vegetables;
• bread - rye or bran;
• cereals;
• fresh greens are a source of vitamin C, iron, calcium;
• lean meat;
• sea ​​fish;
• dairy products;
• green tea, natural juices.

You should limit yourself to sour, salty, spicy foods, coffee and alcohol, and avoid fatty foods.

Causes

In modern medical practice, the name “rheumatism” has been replaced by the term “acute rheumatic fever.” This name of the disease more accurately characterizes the etiology of the disease - it is caused by a previous infection with streptococcus A. As a rule, infection with streptococcus is associated with a previous sore throat, scarlet fever, and the presence of chronic inflammatory diseases of the ENT organs.

The cause of rheumatic joint damage when infected with streptococcus A is not only the toxic effect of its enzymes on connective tissue, but also the similarity in the structure of proteins of some strains of streptococcus and body tissues, which is more important. When an immune response to streptococcal infection occurs, the body begins to produce antibodies that attack the person’s own tissues. First of all, as we wrote above, the membranes of the heart are affected, then the pathological changes “spread” to the rest of the body, affecting the connective tissues. By the way, it was this method of spread that gave the name to the disease - “rheuma” is translated as “flow/flow”.

No matter how strange it may seem, most often it is not only elderly people who suffer from rheumatism, including the limbs, but also schoolchildren. The reason is a weak immune system and the infectious nature of the pathology. According to statistics, this disease affects schoolgirl girls 3-4 times more often than boys.

Gymnastics for rheumatoid arthritis of the knee

Physical exercise will help keep muscles toned and maintain joint mobility. The intensity of the exercises is determined by the doctor, who can supplement the list of basic exercises:

• lying on your back, bend your leg at the knee joint, without lifting the sole off the floor;
• bending your knees, make rotational movements, as when riding a bicycle;
• bending your knees, spread them apart and bring them back;
• swing your legs without bending them at the knee (lying and standing);
• make circular movements with the leg bent at the knee;
• spreading straight legs to the sides in a lying position.

When prescribing gymnastics for rheumatoid arthritis of the knee, the doctor takes into account the presence of concomitant diseases and the degree of damage to the joint.

Pathogenesis

Normally, the human immune system produces antibodies (proteins) that help the body fight, destroy viruses, bacteria and other foreign substances. In rheumatoid arthritis, the immune system produces antibodies against healthy cells and tissues of its own body, these are called autoantibodies (“auto” - its own). With arthritis, inflammation occurs inside the joint: the synovium thickens, which can lead to swelling of the joint. The swollen synovium turns into a dense mass called “pannus”. As the pannus grows, the articular cartilage begins to be damaged, leading to weakening of the muscles, ligaments and tendons. Against the background of persistent inflammation, the bones that form the joint are destroyed. In severe RA, the distal bones may come into contact and partially fuse, causing what is called ankylosis, in which the joint begins to lose its function. Persistent deformities can form (the so-called “boutonniere”, “swan neck”), and the patient’s functional ability and quality of life decrease.