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Rheumatoid Arthritis in the Knee: Symptoms and Treatments

Posted on February 18, 2021

Article written by
Laurie Berger

Medically reviewed by
Iris Navarro-Millán, M.D.

More than 1.3 million people in the U.S. have rheumatoid arthritis (RA), which typically starts in the hands and fingers and can later progress to the knees. The resulting joint stiffness, pain, and swelling affecting the knees can restrict movement, potentially impacting quality of life.

To learn more about knee RA, myRAteam spoke with rheumatologist Dr. Iris Navarro-Millán, assistant professor of medicine at Weill Cornell Medicine and the Hospital for Special Surgery in New York City, and a National Institutes of Health (NIH)-funded rheumatology researcher specializing in knee RA.

Because knee RA shares some symptoms with knee osteoarthritis (OA), another form of arthritis, making a diagnosis can be challenging, Dr. Navarro-Millán said. “When people with RA start experiencing knee pain, we (as rheumatologists) tend to jump quickly to say, ‘You probably also have osteoarthritis.’ But it's very common for [people] with RA to have both.”

Many members of myRAteam report late-stage knee pain. “I’ve had RA for 10 years, but only experienced pain in my knees in the last one or two years,” explained one member.

Getting a correct diagnosis, however, has been frustrating for some. “My doctor said I don’t have RA because it’s in my knees, yet everything I've read said that RA can attack the knees,” one member said. Another member added, “My rheumatologist was way too quick to assume my knee pain was fibromyalgia and OA, not RA. I’m getting a second opinion.”

What Does RA of the Knee Feel Like?

Knee RA feels quite different from knee OA. Members of myRAteam who have inflammatory knee arthritis described their experiences:

  • “Inflamed, swollen, hot, red, stiff, painful joints that cause imbalance and limping.”
  • “Swollen, knife-like pain and tightness when trying to bend my knee.”
  • “Both knees (under the kneecap) pound and feel hot.”
  • “Pain behind the kneecap and where bone is resting on bone.”
  • “Loud, popping noise.”
  • “Pain started in my right knee before exploding to every other joint.”

When RA affects the knees, it damages both the synovial membrane protecting the knee joint and the synovial fluid that lubricates it. Over time, inflammation and swelling limit movements and can damage cartilage, ligaments, and bone. Bones start to grind on each other and erode, causing more pain and swelling.

Common symptoms of knee arthritis that can be related to RA, OA, or both include:

  • Joint stiffness
  • Pain
  • Swelling
  • Joint locking, clicking, or popping
  • Warmth around the knee
  • Difficulty bending or straightening the knee
  • Joint instability and pain when weight is placed on it
  • Increased pain during rainy weather
  • Involvement of other joints

Daily Activities

The inability to walk without pain or discomfort has had a major impact on quality of life for members of myRAteam. “My knees are swollen today, but I’ve still got to clean the house and do laundry,” said one member.

Work

Knee pain can lead to disability, which is common among people with RA. An estimated 60 percent of people living with the condition are unable to work 10 years after disease onset. “My job involves standing and walking for eight hours a day, and I’m really struggling now,” said one myRAteam member. Another was “forced into early retirement” as a result of severe knee pain. “I have to use a walker now,” she said.

Injuries

Chronic knee pain and swelling can affect balance, leading to falls and injuries. “I stumble and fall at times, resulting in a broken shoulder four months ago,” said one member. “Stiffness and pain make walking difficult. I've had to use a cane for better stability,” explained another.

Socializing

Painful movement makes it hard to gather with family and friends, play with grandchildren, take vacations, or simply enjoy long walks. “Sore knees hold me back from doing the things I like to do,” shared one myRAteam member. Another noted, “I can’t bend down, jump, or run anymore.”

Sleep

Many members of myRAteam report sleepless nights due to knee pain, which can subsequently lead to more pain and depression. “I don't sleep most nights. The pain is bad. I use pillows, but can't get comfortable,” said one member.

Mental Health

Lack of sleep, inability to move or enjoy life, and the stigma of using assistive devices to get around can increase the risk of depression in people with knee RA. “The depression that comes with this disease sucks,” lamented one member. “Getting dressed up and looking great, then seeing yourself walking with a cane makes me feel so old.”

Differences Between RA and OA

Although symptoms of knee RA may be similar to those of osteoarthritis, there are several distinct differences.

Osteoarthritis is a degenerative disease caused by wear and tear, and is usually localized to a specific joint. Over time, knee cartilage wears away, causing bone-on-bone rubbing and pain.

RA, on the other hand, is a chronic autoimmune disease that typically impacts multiple joints. It may eventually attack the knee joint, causing pain and swelling.

There are several additional differences that are important to know. OA typically arises in one side of the body. With RA, however, both knees would typically be swollen symmetrically.

In addition, OA pain is usually sharp and worsens later in the day after periods of prolonged activity. But with RA, pain and stiffness are often worse in the morning, triggered by lack of movement.

One myRAteam member with both conditions summed up her experience: “OA pain feels like my joint is on fire, achy, and makes snap, crackle, pop sounds. The pain comes and goes, and is worse when I do too much. RA pain, on the other hand, feels like my joint is literally going to explode from a buildup of pressure. It’s a sharp, nonstop pain inside the joint that sometimes freezes it [and it won’t bend].”

Diagnosis

Rheumatologists use several methods to diagnose and confirm knee RA:

  • Physical examination — The doctor will examine your knee for range of motion, grinding sounds, and level of pain.
  • Imaging tests — X-rays are typically ordered to detect bone or joint damage, and help differentiate forms of arthritis. New bone formation may be common to both types of arthritis, but RA will also show erosion, according to Dr. Navarro-Millán.
  • Blood tests — Rheumatoid factor and cyclic citrullinated peptide (CCP) antibody tests are often used to confirm RA. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) tests may also be ordered to measure the level of inflammation in the body.

“If someone comes into my office with a swollen knee, I’ll usually drain it and analyze the fluid to see if it's highly inflamed, or if there is an infection, which is important to rule out in these cases,” said Dr. Navarro-Millán. “In some instances, I may order an MRI to determine if there’s a torn ligament or torn meniscus [which could be related to OA inflammation or trauma].”

How Is RA of the Knee Treated?

Although there is currently no cure for RA or OA of the knee, the conditions can be managed if diagnosed and treated early. Ask your doctor or rheumatologist about the treatment options best suited for your situation.

Medications

Disease-modifying antirheumatic drugs (DMARDs), such as Trexall (methotrexate), Azulfidine (sulfasalazine), and Plaquenil (hydroxychloroquine), are commonly prescribed to slow the progression of RA.

The option of biologic DMARDs (bDMARDs), such as Enbrel (etanercept) and Humira (adalimumab), can also be used to reduce an immune system response, decreasing inflammation and relieving pain. “bDMARDs are not giving individuals a new joint; they’re preserving the joint from getting permanently damaged,” said Dr. Navarro-Millán.

For short-term pain relief, over-the-counter (OTC) pain relievers and anti-inflammatory medications are usually the first line of treatment for both OA and RA. For stiffness and swelling, Dr. Navarro-Millan often prescribes nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) and Aleve (naproxen), as well as administering corticosteroid injections into knee joints.

Other short-term relief measures include draining fluid that builds up in the joint and injecting medication into the knee. “I had injections in both knees for seven years and lived pain-free for three months after each injection, no limitations,” said one member.

Surgery

If RA or OA progresses to bone-on-bone pain and causes disability that’s not relieved with medication, surgery may be prescribed.

Osteotomy is one option, during which knee bones and joint tissue are cut and reshaped to relieve pressure on the joint from cartilage loss and bone erosion.

If the physician instead performs synovectomy, the damaged joint lining is removed to reduce pain and swelling. The synovium in the affected joint may grow back, however, requiring additional surgeries.

Arthroplasty (total or partial knee joint replacement) may also be an option. During this procedure, damaged cartilage and bone are removed and replaced with metal, ceramic, or plastic joints to restore knee function.

As with all surgeries, there are risks and possible complications with knee procedures. “[Surgery] is not [recommended] for someone who’s having pain for the first time,” Dr. Navarro-Millán explained. When mobility, independence, and quality of life have been compromised or worsened, “that’s when I’ll encourage someone to discuss the pros and cons of knee surgery with an orthopedic surgeon,” she explained. It has to be “something that’s really debilitating.”

While knee replacement may seem drastic to some, many members of myRAteam report success with the procedure. “It was the best thing I could have done,” shared one member, echoing the comments of others. Another said, “It took four months before I could walk without a cane after the first one. Seven weeks after the second one, I was at spring training.”

After any type of knee surgery, there’s a period of rehabilitation during which you may be prescribed a variety of techniques to help you regain mobility. Physical therapy can help strengthen muscles surrounding the knee joint to improve range of motion and flexibility. Assistive devices, such as a knee brace, crutches, or cane, can help you move and get around.

Alternative Therapies

Some complementary therapies have been shown to relieve pain stemming from knee RA:

  • Exercise — A key part of treatment, exercise can alleviate stiffness and pain. Most physical therapists will recommend low-impact exercises such as walking, cycling, or swimming, which put less stress on your knees and help you maintain a healthy weight.
  • Lifestyle changes — A proper diet, weight loss, and getting plenty of sleep can help alleviate some of the physical pain and emotional distress around knee RA.
  • Acupuncture — Fine needles stimulate specific energy points on the body to relieve pain or temporarily numb an area. There’s some evidence that acupuncture can ease RA knee pain by regulating the immune system to reduce inflammation. Ask your rheumatologist to recommend a licensed and certified acupuncturist.

Tips From myRAteam Members

Many myRAteam members share home and natural remedies that have helped their knee pain:

  • “Ice is your best friend. Try a polar ice unit — it's a little cooler with a host and cuff attached,” one member said. “Fill with ice and a little water, wrap around your knee, elevate, and relax for about a half hour. The ice water circulates all around your knee, it's heaven.”
  • “Biofreeze is great,” another member noted. “You can buy large tubs of it from Amazon for much cheaper than the drug stores.”
  • “A warm compress really helps,” one member said. “I use a heating pad.”

Talk With Others Who Understand

On myRAteam, you’ll meet other people living with rheumatoid arthritis. More than 142,000 myRAteam members come together to ask questions, give advice, and share their stories with others who understand life with RA.

Have you been diagnosed with RA of the knee? Have you found effective ways to treat this condition? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References

  1. Rheumatoid Arthritis — American College of Rheumatology
  2. Arthritis of the Knee — American Academy of Orthopaedic Surgeons
  3. Osteoarthritis — Mayo Clinic
  4. Rheumatoid Arthritis Signs and Symptoms — Johns Hopkins Arthritis Center
  5. Acupuncture for Arthritis — Arthritis Foundation

Laurie has been a health care writer, reporter, and editor for the past 14 years. Learn more about her here.

Dr. Navarro-Millán is an assistant professor of medicine at Weill Cornell Medicine and the Hospital for Special Surgery in New York City. Learn more about her here.

A myRAteam Member said:

Yes I have and it felt my appliance shifted and unable to move then finally got better my doctor request X-ray now waiting on my results I didn’t think… read more

posted about 3 hours ago

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