Rheumatoid Arthritis of the Knee
How Is Knee RA Diagnosed? continued...
Blood tests for RA may be positive for the following:
- Anemia (low red blood cell count)
- Rheumatoid factor (RF), found in about 70% to 80% of those with RA
- High erythrocyte sedimentation rate (sed rate), which indicates inflammation
- Antibodies to cyclic citrullinated peptides (CCP)
- High levels of C-reactive protein (CRP)
Your doctor may order an X-ray of the joints. An MRI may also be used to detect evidence of joint damage or destruction.
Your doctor may withdraw a sample of joint fluid (synovial fluid) to analyze. People with RA usually have joint fluid that's filled with inflammatory material.
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.
- 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
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.