Mention the word “arthritis” and most people tend to think of osteoarthritis, which is where the cartilage in our joints wears away, exposing the bone endings to painful rubbing.
But there is another type of arthritis, and that’s the rheumatoid kind. Though not as common as osteoarthritis, rheumatoid arthritis (RA) isn’t vanishingly rare either. The NHS estimates that there are more than 400,000 sufferers in the UK. So what exactly is it? And how might it affect your knees?
What is rheumatoid arthritis?
RA is an inflammatory disease. It originates in the synovium, a soft tissue membrane that lines and protects our joints, and which can become swollen, stiff and painful. This can happen in one or several joints around the body – particularly fingers, wrists and ankles, but also the knees.
What’s the big difference with osteoarthritis?
Osteoarthritis happens through wear and tear, which is why it’s more common in people aged 50+. By contrast, RA is a disorder of the immune system, where the body starts to attack its own tissues. This leads to inflammation, which can stretch the knee capsule and degrade the lining cartilage. In some cases, osteoarthritis follows from that.
What actually causes RA in the first place?
We can’t say for certain. We believe the immune system produces antibodies that mistakenly target the synovial membrane. But doctors aren’t sure what triggers this. Could it be the result of an infection, or could it be related to trauma, stress or diet? At this point, we can’t be certain.
Who can get rheumatoid arthritis?
RA can affect anybody, but it usually occurs in middle age, roughly between the ages of 30 and 60. Women are up to three times more likely to suffer from RA than men. It also appears to run in families, and is more common among smokers.
What does RA in a knee feel like?
It often presents as a generalised discomfort throughout the knee, usually described as a throb or ache. The pain tends to be worse in the mornings after rest (rather than after activity, as is more usual with osteoarthritis), normally lessening within 30 minutes or so of getting up. It may be present all the time, or it can suddenly flare up (this is known as palindromic rheumatism).
Does it cause any other symptoms?
It can do. As well as pain, swelling, stiffness and warmth in the knee (or in other joints), RA can cause fatigue, lack of energy, loss of appetite, and even a raised temperature and sweating.
How do you diagnose it?
There’s no single test, so it usually comes down to a combination of physical examinations, talking through the history and symptoms, sometimes requesting an x-ray or MRI scan, and often ‘CRP’ and ‘ESR’ blood tests, to check for raised “inflammatory markers”.
What can you do about it?
The good news is that rheumatology has seen some really significant advances in recent years. So today the focus is much more on monitoring and managing RA rather than reaching for surgery – especially if it’s diagnosed and treated early. There are several lines of treatment, starting with pain medications and physical therapies but now also including disease-modifying drugs (known as DMARDS) and biological treatments (such as infliximab), which can help to prevent the arthritis from getting worse and reduce the risk of further complications.
If you’re experiencing knee pain or problems because of rheumatoid arthritis, we’re here to help. You can find out more about RA in our online Conditions pages. It’s also simple and quick to make an appointment with Mr Bailey: just head to our Bookings page, or give the team a call on 01962 826107.