Rheumatoid Arthritis in the Knee: What to Expect

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Rheumatoid arthritis (RA) is a condition that causes inflammation throughout the body. This condition occurs when your body's own immune system attacks healthy cells. RA often affects many different joints, including the knees, causing pain and difficulty with daily tasks.

This article discusses rheumatoid arthritis in the knees, including affected structures, symptoms, disease progression, and treatment.

woman holding knee

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How Does RA Affect the Knees?

Inflammation caused by rheumatoid arthritis attacks many different structures in your knees, such as the cartilage that provides padding between the bones, the ligaments that attach bone to bone, and the joint capsule that surrounds the entire joint. As RA progresses, it can also break down your bones.

Symptoms caused by RA in the knees are similar to other conditions that affect the knees, such as osteoarthritis. However, RA attacks joints on both sides of the body at the same time—a hallmark sign of this condition—while other conditions typically affect one side of the body.

In addition, stiffness caused by RA is worse in the mornings and improves with activity. With other conditions, joint mobility can get worse as the day goes on.

RA in the knee (and other joints) progresses through four stages.

Stage 1

In stage 1 of your condition, rheumatoid arthritis causes swelling in the knees and inflammation in the capsule that surrounds the joint. This leads to pain and stiffness.

Stage 2

In stage 2, inflammation causes damage to the cartilage that provides padding between the bones in your knee joints. You'll likely notice more stiffness and begin to lose some range of motion of your knees in this phase.

Stage 3

Stage 3 RA is considered severe. At this stage, inflammation continues to attack the soft tissues in your knees and now extends into your bones. Your mobility will be further impacted, and your bones might begin to shift out of place, causing your knees to look deformed.

Stage 4

In the final stage of RA, the inflammatory process is over. Function and mobility are significantly impacted, and your knees will continue to be swollen and very painful.

Other Symptoms of RA

Rheumatoid arthritis affects the entire body. In addition to joint issues, RA symptoms often include:

  • Rheumatoid nodules (painless lumps under the skin near joints)
  • Fatigue/low energy
  • Decreased appetite
  • Low-grade fever

How Is RA in the Knees Diagnosed?

RA is first diagnosed through a medical examination and blood tests. Symptoms of RA typically follow a certain pattern:

  • Symptoms lasting at least six weeks
  • Stiffness that is worst first thing in the morning
  • Rheumatoid nodules at your joints
  • Pain and swelling in the hands and fingers
  • Symptoms in four or more joints
  • Symptoms in both sides of the body

Blood tests for rheumatoid arthritis look for elevated levels of inflammation and specific markers that are common with autoimmune disorders. These tests include:

Imaging is used to assess the amount of damage RA has caused to your knees. X-rays show bone position and inflammation that is present in the joint. Magnetic resonance imaging (MRI) provides a picture of the soft tissues in your knees, such as cartilage and ligaments. Computed tomography (CT scan) can be used to provide more information about the extent of damage caused to your bones.

How Is RA in the Knees Treated?

Rheumatoid arthritis in the knees is treated with medications, home remedies, and sometimes surgery.

Medications

Rheumatoid arthritis is commonly treated with medications that suppress your immune system to decrease excess inflammation in the body. However, these medications, called disease-modifying antirheumatic drugs (DMARDs), can take several months to show improvements.

Knee symptoms can also be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aleve (naproxen) and Advil (ibuprofen). If these over-the-counter (OTC) medications aren't effective, your healthcare provider might prescribe short-term steroids.

Almost all patients with RA will need DMARD therapy. NSAIDs and steroids are only indicated for short-term use (less than three months) in the treatment of RA. Sometimes for the knee, intra-articular steroid injections are helpful for short-term treatment.

Home Remedies

Home remedies can help decrease knee symptoms from RA when you're having a flare-up, including:

  • Apply ice or heat: Either heat or ice can be applied to the knee for 10–20 minutes at a time, multiple times a day, depending on the underlying cause of pain. Ice can help reduce swelling and inflammation, while heat can improve blood flow and relax the muscles. Typically, RA in the knee causes fluid buildup with associated warmth; therefore, ice is better at reducing local inflammation.
  • Unload your joints: Consider using a cane or walker to reduce some pressure on your knees when you walk. If using a cane, hold it in the hand opposite your more painful knee. If you choose a walker, use one with wheels and push it like a shopping cart while you walk.
  • Keep moving: Stiffness is common with RA. Keep your knees moving within a pain-free range with gentle exercise. Weight-bearing activities such as walking put more pressure on your joints. Try walking in a pool or riding a stationary bike instead.

Surgery

Over time, RA can cause knee damage that requires surgery. Knee arthroscopy uses a tiny camera and tools that are inserted through several tiny incisions. These tools are used to clean up frayed tissues and remove scar tissue to help decrease pain and improve mobility.

Severe RA can require total joint replacement surgery. Knee replacement surgery involves removing the damaged ends of your bones and replacing them with metal prostheses. After surgery, physical therapy is provided for six to eight weeks to help you regain movement and function.

Summary

Rheumatoid arthritis is a chronic inflammatory condition that causes your body to attack its own cells. RA commonly affects the joints, including the knees. RA is diagnosed with a medical exam, blood work, and imaging to assess the extent of your joint damage. Treatment includes medications, home remedies, and sometimes surgery.

A Word From Verywell

Living with rheumatoid arthritis can be stressful. RA in the knees can make it difficult to walk, climb stairs, and stand for long periods of time. However, being proactive with your treatment can improve your quality of life. See a physical therapist for ideas on unloading your painful joints and maintaining your movement and strength. Talk to your healthcare provider about medication options.

Frequently Asked Questions

  • What does rheumatoid arthritis in the knee feel like?

    RA causes pain that often increases with weight-bearing activities, such as walking or climbing stairs. You might also feel "locking" or "clicking" in your knees.

  • How is rheumatoid arthritis diagnosed?

    RA is diagnosed through a medical exam, blood work, and imaging to assess damage to your joints or internal organs.

  • What helps relieve rheumatoid arthritis knee pain?

    Anti-inflammatory medications can decrease knee pain during an RA flare-up. Home remedies such as hot packs, gentle exercise, and the use of an assistive device (such as a cane) can also help.

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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. American College of Rheumatology. Rheumatoid arthritis.

  3. Rheumatoid Arthritis Support Network. RA diagnosis: What criteria are used to diagnose rheumatoid arthritis?

  4. Arthritis Foundation. DMARDs.

  5. University of Washington Medicine. Knee surgery for rheumatoid arthritis.