knee arthritis

It is not always certain why arthritis of the knee develops.{{Citation needed|date=June 2013}} The knee may become affected by almost any form of arthritis, including those related to mechanical damage of the structures of the knee (osteoarthritis, and post-traumatic arthritis), various autoimmune forms of arthritis (including; rheumatoid arthritis, juvenile arthritis, and SLE-related arthritis, psoriatic arthritis, and ankylosing spondylitis), arthritis due to infectious causes (including Lyme disease-related arthritis), gouty arthritis, or reactive arthritis.

The knee is one of the joints most commonly affected by osteoarthritis. Cartilage in the knee may begin to break down after sustained stress, leaving the bones of the knee rubbing against each other and resulting in osteoarthritis.{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925|title=Osteoarthritis - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2018-12-23}} Nearly a third of US citizens are affected by osteoarthritis of the knee by age 70.{{Cite web|url=https://www.health.harvard.edu/blog/insoles-no-help-for-knee-osteoarthritis-201308216629|title=Insoles no help for knee osteoarthritis|last=Watson|first=Stephanie | name-list-style = vanc |date=2013-08-21|website=Harvard Health Blog|language=en-US|access-date=2018-12-23}}

Obesity is a known and very significant risk factor for the development of osteoarthritis.{{Cite web|url=https://www.hopkinsarthritis.org/patient-corner/disease-management/role-of-body-weight-in-osteoarthritis/|title=Osteoarthritis : Role of Body Weight in Osteoarthritis - Weight Management|website=Arthritis Information|language=en-US|access-date=2018-12-23}} Risk increases proportionally to body weight. Obesity contributes to OA development, not only by increasing the mechanical stress exerted upon the knees when standing, but also leads to increased production of compounds that may cause joint inflammation.

Parity is associated with an increased risk of knee OA and likelihood of knee replacement. The risk increases in proportion to the number of children the woman has birthed. This may be due to weight gain after pregnancy, or increased body weight and consequent joint stress during pregnancy.{{cite journal | vauthors = Wise BL, Niu J, Zhang Y, Felson DT, Bradley LA, Segal N, Keysor J, Nevitt M, Lane NE | title = The association of parity with osteoarthritis and knee replacement in the multicenter osteoarthritis study | journal = Osteoarthritis and Cartilage | volume = 21 | issue = 12 | pages = 1849–54 | date = December 2013 | pmid = 24029601 | pmc = 3855897 | doi = 10.1016/j.joca.2013.08.025 }}

Flat feet are a significant risk factor for the development of osteoarthritis.{{cite journal | vauthors = Gross KD, Felson DT, Niu J, Hunter DJ, Guermazi A, Roemer FW, Dufour AB, Gensure RH, Hannan MT | title = Association of flat feet with knee pain and cartilage damage in older adults | journal = Arthritis Care & Research | volume = 63 | issue = 7 | pages = 937–44 | date = July 2011 | pmid = 21717597 | pmc = 3087845 | doi = 10.1002/acr.20431 }} Additionally, structural deformities, advanced age, female sex, past joint trauma, genetic predisposition, and certain at-risk occupations may all contribute to the development of osteoarthritis in general.

The knee is often the first joint affected in Lyme disease.

Arthritis is a common symptom of SLE. Arthritis is often symmetric and more often involves small joints. Though almost any joint may be affected, the knees and joints of the hands are most often involved in SLE. In larger joints (including the knee), avascular necrosis is a possible complication, leading to further pain and disability.{{cite journal | vauthors = Grossman JM | title = Lupus arthritis | journal = Best Practice & Research. Clinical Rheumatology | volume = 23 | issue = 4 | pages = 495–506 | date = August 2009 | pmid = 19591780 | doi = 10.1016/j.berh.2009.04.003 }}

Reactive arthritis often presents with lower limb oligoarthritis, including that of the knee.{{cite journal | vauthors = Hamdulay SS, Glynne SJ, Keat A | title = When is arthritis reactive? | journal = Postgraduate Medical Journal | volume = 82 | issue = 969 | pages = 446–53 | date = July 2006 | pmid = 16822921 | pmc = 2563769 | doi = 10.1136/pgmj.2005.044057 }}

Arthritis of a single joint of the lower extremities with rapid onset is highly suggestive of gouty arthritis.{{cite journal | vauthors = Tausche AK, Aringer M | title = [Gouty arthritis] | journal = Zeitschrift für Rheumatologie | volume = 75 | issue = 9 | pages = 885–898 | date = November 2016 | pmid = 27730304 | doi = 10.1007/s00393-016-0206-z }} The knee may sometimes be affected. In cases of gouty arthritis of the knee, skin symptoms occur less often, however pain and swelling may be particularly intense.{{cite journal | vauthors = Ragab G, Elshahaly M, Bardin T | title = Gout: An old disease in new perspective - A review | journal = Journal of Advanced Research | volume = 8 | issue = 5 | pages = 495–511 | date = September 2017 | pmid = 28748116 | pmc = 5512152 | doi = 10.1016/j.jare.2017.04.008 }}

RA most often first manifests as inflammation of particular finger or toe joints, however, pain and swelling of larger joints, including the knees, may also be the first sign.{{cite book|chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK384455/| chapter =Rheumatoid arthritis: Overview | title = Informed Health Online |publisher=Institute for Quality and Efficiency in Health Care (IQWiG) | location = Cologne, Germany | date =2016-08-11 }}

Diagnosis of knee osteoarthritis often entails a physical examination, assessment of symptoms and the patient's medical history, but may also involve medical imaging and blood tests. Persistent knee pain, limited morning stiffness and reduced function, crepitus, restricted movement, and bony enlargement appear to be the most useful indications of knee osteoarthritis for diagnosis.{{cite journal| vauthors=Zhang W, Doherty M, Peat G, Bierma-Zeinstra MA, Arden NK, Bresnihan B |display-authors=etal| title=EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. | journal=Ann Rheum Dis | year= 2010 | volume= 69 | issue= 3 | pages= 483–9 | pmid=19762361 | doi=10.1136/ard.2009.113100 |s2cid=12319076|url=http://ard.bmj.com/cgi/content/short/ard.2009.113100v1}}

Standardized medical questionnaires like the Knee injury and Osteoarthritis Outcome Score (KOOS){{cite web |url=https://orthotoolkit.com/koos/ |title=KOOS survey score description and calculator|publisher=OrthoToolKit|date=2024 |access-date=January 1, 2018}} or the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC){{cite journal | vauthors = McConnell S, Kolopack P, Davis AM | title = The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties | journal = Arthritis and Rheumatism | volume = 45 | issue = 5 | pages = 453–61 | date = October 2001 | pmid = 11642645 | doi = 10.1002/1529-0131(200110)45:5<453::AID-ART365>3.0.CO;2-W| doi-access = free }}{{cite journal |vauthors=Stratford PW, Kennedy DM, Woodhouse LJ, Spadoni GF |title=Measurement properties of the WOMAC LK 3.1 pain scale |journal=Osteoarthritis and Cartilage |volume=15 |issue=3 |pages=266–72 |date=March 2007 |pmid=17046290 |doi=10.1016/j.joca.2006.09.005 |url=https://www.oarsijournal.com/article/S1063-4584(06)00270-6/fulltext}} can also be used to diagnose and monitor progression of knee osteoarthritis.

A physician will recommend a treatment regimen based upon the severity of symptoms. General recommendations for the management of knee arthritis may include avoiding activities that aggravate the condition, and applying cold or warm packs and using ointments and creams to relieve symptoms.

Pharmaceutical management is usually dependent upon the nature of the underlying condition causing arthritis. Over-the-counter medications like acetaminophen (paracetamol), and ibuprofen, naproxen, and other NSAIDs are often used as first-line medical treatments for pain relief and/or managing inflammation. Corticosteroids may be injected directly into the joint cavity to provide more significant relief from inflammation, swelling, and pain. Other medications used in management of arthritis of the knee include; disease-modifying antirheumatic drugs, biopharmaceuticals, viscosupplementation (including hyaluronic acid injections), and glucosamine and chondroitin sulphate.

Hyaluronic acid is normally present in joints (including the knee), acting as lubricant and providing shock absorption, among other functions. In osteoarthritis, there is a loss of articular hyaluronic acid activity, likely contributing to pain and stiffness associated with the condition. Hyaluronic acid injections are an FDA-approved treatment for osteoarthritis of the knee, and are sometimes also used for other joints. However, the merits of HA injections are still disputed. HA injections are indicated when other medications fail to offer adequate symptom relief. Symptom relief associated with HA injections may last up to 2 years after an injection. HA injections appear to offer significant pain relief to some patients, while others may see no benefits at all.{{Cite web|url=http://www.arthritis.org/living-with-arthritis/treatments/medication/drug-types/other/hyaluronic-acid-injections.php|title=Hyaluronic Acid Injections for Osteoarthritis|website=arthritis.org|access-date=2018-12-23}}{{Cite web|url=https://www.mayoclinic.org/drugs-supplements/hyaluronic-acid-injection-route/description/drg-20074557|title=Hyaluronic Acid (Injection Route) Description and Brand Names - Mayo Clinic|website=www.mayoclinic.org|access-date=2018-12-23}}{{cite journal | vauthors = Bowman S, Awad ME, Hamrick MW, Hunter M, Fulzele S | title = Recent advances in hyaluronic acid based therapy for osteoarthritis | journal = Clinical and Translational Medicine | volume = 7 | issue = 1 | pages = 6 | date = February 2018 | pmid = 29450666 | pmc = 5814393 | doi = 10.1186/s40169-017-0180-3 | doi-access = free }}{{cite journal | vauthors = Bowman EN, Hallock JD, Throckmorton TW, Azar FM | title = Hyaluronic acid injections for osteoarthritis of the knee: predictors of successful treatment | journal = International Orthopaedics | volume = 42 | issue = 4 | pages = 733–740 | date = April 2018 | doi = 10.1007/s00264-017-3731-8 | pmid = 29299652 | s2cid = 4379086 }} In severe osteoarthritis without much cartilage, the benefits of hyaluronic are not observed.

Supportive devices like knee braces can be used for symptom relief in osteoarthritis of the knee.{{cite journal | vauthors = Phillips S, Li CS, Phillips M, Bischoff M, Ali P, Chahal J, Snider M, Bhandari M | title = Treatment of Osteoarthritis of the Knee with Bracing: A Scoping Review | journal = Orthopedic Reviews | volume = 8 | issue = 2 | pages = 6256 | date = June 2016 | pmid = 27433297 | pmc = 4933815 | doi = 10.4081/or.2016.6256 }}{{Cite web|url=https://www.mayoclinic.org/tests-procedures/knee-braces/about/pac-20384791|title=Knee braces for osteoarthritis - Mayo Clinic|website=www.mayoclinic.org|language=en|access-date=2018-12-23}} Knee braces may however result in discomfort, skin irritation, swelling, and may not provide benefits to all. Using a cane, shock-absorbent footwear and inserts, elastic bandages, and knee sleeves may also be helpful for managing arthritis symptoms. Braces may be especially effective when only one knee is affected. Shoe insoles that are fitted to correct flat feet provide significant relief to those with severely flat feet.{{Cite web|url=https://www.medicalnewstoday.com/kc/best-walking-running-shoes-osteoarthritis-knee-310586|title=Athletic shoes for knee osteoarthritis: The best walking and running options|website=Medical News Today|language=en|access-date=2018-12-23|archive-date=2018-12-24|archive-url=https://web.archive.org/web/20181224074249/https://www.medicalnewstoday.com/kc/best-walking-running-shoes-osteoarthritis-knee-310586|url-status=dead}} However, it has been found that insoles used to correct medial knee osteoarthritis (the more common form) may not offer much pain relief.{{Cite web|url=https://www.health.harvard.edu/blog/insoles-no-help-for-knee-osteoarthritis-201308216629|title=Insoles no help for knee osteoarthritis|last=Watson|first=Stephanie| name-list-style = vanc |date=2013-08-21|website=Harvard Health Blog|language=en-US|access-date=2018-12-23}}{{cite journal | vauthors = Parkes MJ, Maricar N, Lunt M, LaValley MP, Jones RK, Segal NA, Takahashi-Narita K, Felson DT | title = Lateral wedge insoles as a conservative treatment for pain in patients with medial knee osteoarthritis: a meta-analysis | journal = JAMA | volume = 310 | issue = 7 | pages = 722–30 | date = August 2013 | pmid = 23989797 | pmc = 4458141 | doi = 10.1001/jama.2013.243229 }}

Obesity is a known and very significant risk factor for the development of osteoarthritis. Furthermore, losing weight reduces mechanical stress acting upon the knees when standing, possibly reducing pain and improving function in knee osteoarthritis. However, it is necessary to ascertain whether the patient is actually overweight before committing to weight loss as a management technique.

Exercises can help increase range of motion and flexibility as well as help strengthen the muscles in the leg.[http://orthoinfo.aaos.org/topic.cfm?topic=a00212 Arthritis of the Knee - American Academy of Orthopaetic Surgeons], Retrieved on 2010-01-22. Physical therapy and exercise are often effective in reducing pain and improving function. Compared to the patient-education program, pain and function showed improvement after eight weeks of aquatic exercise, and after twelve weeks it showed improvement in the function actiites.{{Cite journal|last1=Taglietti|first1=Marcelo|last2=Facci|first2=Ligia Maria|last3=Trelha|first3=Celita Salmaso|last4=de Melo|first4=Fernanda Cristiane|last5=da Silva|first5=Daniela Wosiack|last6=Sawczuk|first6=Geovane|last7=Ruivo|first7=Thamires Marques|last8=de Souza|first8=Thaisley Barbosa|last9=Sforza|first9=Chiarella|last10=Cardoso|first10=Jefferson Rosa|date=June 2018|title=Effectiveness of aquatic exercises compared to patient-education on health status in individuals with knee osteoarthritis: a randomized controlled trial|journal=Clinical Rehabilitation|volume=32|issue=6|pages=766–776|doi=10.1177/0269215517754240|issn=1477-0873|pmid=29417831|hdl=2434/548022|s2cid=3431729|hdl-access=free}} Inclusion of isokinetic quadriceps and hamstring strengthening exercises into the rehabilitation packages for the patients with knee osteoarthritis may also enhance the high-quality of life and make a contribution to the decreased hazard of fall.{{Cite journal|last1=Gezginaslan|first1=Ömer|last2=Öztürk|first2=Erhan Arif|last3=Cengiz|first3=Mustafa|last4=Mirzaoğlu|first4=Tacettin|last5=Çakcı|first5=Fatma Aytül|date=December 2018|title=Effects of isokinetic muscle strengthening on balance, proprioception, and physical function in bilateral knee osteoarthritis patients with moderate fall risk|journal=Turkish Journal of Physical Medicine and Rehabilitation|volume=64|issue=4|pages=353–361|doi=10.5606/tftrd.2018.2422|issn=2587-1250|pmc=6648029|pmid=31453533}} land-based exercises that focus on hip abductor shows improvement related to performance and function in women with symptomatic knee osteoarthritis.{{Cite journal|last1=Wang|first1=Jianxiong|last2=Xie|first2=Yujie|last3=Wang|first3=Li|last4=Lei|first4=Lei|last5=Liao|first5=Peng|last6=Wang|first6=ShiQi|last7=Gao|first7=YaQian|last8=Chen|first8=Yu|last9=Xu|first9=Fangyuan|last10=Zhang|first10=Chi|title=Hip abductor strength-based exercise therapy in treating women with moderate-to-severe knee osteoarthritis: a randomized controlled trial|journal=Clinical Rehabilitation|volume=34|issue=2|pages=160–169|doi=10.1177/0269215519875328|issn=1477-0873|pmid=31505954|year=2020|s2cid=202557153}} A Cochrane review could not conclude whether high-intensity exercises provide better results than low-intensity exercises.{{cite journal | vauthors = Regnaux JP, Lefevre-Colau MM, Trinquart L, Nguyen C, Boutron I, Brosseau L, Ravaud P | title = High-intensity versus low-intensity physical activity or exercise in people with hip or knee osteoarthritis | journal = The Cochrane Database of Systematic Reviews | issue = 10 | pages = CD010203 | date = October 2015 | volume = 2015 | pmid = 26513223 | doi = 10.1002/14651858.CD010203.pub2 | pmc = 9270723 }}

Surgical intervention may be undertaken if no other management technique yields adequate relief. Surgical procedures may entail an arthroscopy (seldom used for sole osteoarthritis), osteotomy (performed only for unilateral early-stage osteoarthritis), or arthroplasty.

Knee replacement is the most definitive treatment for osteoarthritis-related symptoms and disability. It is a type of arthroplasty, and may involve either a partial or total replacement with a prosthesis.

Alternative medicine interventions undertaken for pain relief in arthritis of the knee include acupuncture, and magnetic pulse therapy.

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{{Diseases of the musculoskeletal system and connective tissue}}

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Category:Aging-associated diseases

Category:Inflammations

Category:Rheumatology

Category:Skeletal disorders

Category:Knee injuries and disorders