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Rheumatoid Arthritis of the Knee

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What's the Treatment for Knee RA?

The best treatment for knee RA is early and aggressive medical care. Medical treatments include the use of disease-modifying anti-rheumatic drugs (DMARDs), which are used with NSAIDs (non steroidal anti-inflammatory drugs) and/or steroids in low doses.

DMARDs include:

  • methotrexate (Rheumatrex, Folex)
  • leflunomide (Arava)
  • hydroxychloroquine (Plaquenil)
  • sulfasalazine (Azulfidine)
  • gold (Myochrisine injected into muscles; Auranofin -- given orally)
  • minocycline (Minocin, Vectrin, Dynacin)
  • azathiaprine (Imuran)
  • cyclosporine (Neoral, Sandimmune)
  • tofacitinib (Xeljanz)

Another category of DMARDs are biologic modifiers -- usually used with methotrexate. Biologic agents include:

  • adalimumab (Humira)
  • anakinra (Kineret)
  • etanercept (Enbrel)
  • infliximab (Remicade)
  • abatacept (Orencia)
  • rituximab (Rituxan)
  • golimumab (Simponi)
  • Certolizumab (Cimzia)
  • tocilizumab (Actemra)

Other treatments are:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) -- over-the-counter and prescription strength
  • Steroids

Along with early and aggressive medical therapy, regular exercise is important. Exercise helps strengthen the muscles around the knee and helps support the joint. Sometimes physical therapy and occupational therapy are recommended.

Is Surgery Necessary for Knee RA?

At some point, total joint replacement may be performed. This surgery is usually a "last resort" instead of the first treatment option for knee RA. Today's advances in total joint replacement give a successful outcome in most cases.

Synovectomy is another procedure that's performed with rheumatoid arthritis. With synovectomy, the surgeon removes the inflamed synovium or joint lining. Synovectomy can be done as an open procedure or by arthroscopy. In general, arthroscopic procedures are associated with fewer complications and faster recovery than a more invasive surgery. The relief in knee pain with synovectomy in RA may last up to five years.

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WebMD Medical Reference

Reviewed by David Zelman, MD on February 11, 2014
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