Effective treatment for rheumatoid arthritis of the knee has several components. A combination of medication, exercise and rest is often used. If symptoms are severe or joint damage occurs, surgery might be the best treatment option.
There are several classes of drugs used to treat rheumatoid arthritis of the knee. The type of drug used will depend on disease progression, severity of pain and level of damage done to the joint. The most common types are anti-inflammatory drugs, corticosteroids, disease-modifying antirheumatic drugs and biologic agents. Sometimes an antimalarial is used, often in conjunction with an antirheumatic.
Anti-inflammatory drugs are effective in treating pain and swelling associated with rheumatoid arthritis (RA). There are two options for anti-inflammatory drugs: non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin; and cyclooxygenase 2 (COX-2) inhibitors, such as celecoxib and valdecoxib. NSAIDs can cause gastrointestinal symptoms, including ulcers. COX-2 inhibitors do not cause gastrointestinal issues, but they increase the risk of heart disease. Anti-inflammatory drugs relieve symptoms but do not affect progression of the disease.
Corticosteroids, such as prednisone, offer anti-inflammatory properties and also slow down joint damage. They provide effective relief for acute symptoms but might have serious side effects. For this reason, corticosteroids are often used to relieve severe symptoms and then are slowly tapered off.
Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, have been the standard for the treatment of rheumatoid arthritis. A DMARD is usually started as soon as the diagnosis of rheumatoid arthritis is confirmed, because they take one to two months to start showing effects. They provide symptom relief and can slow or halt disease progression. NSAIDs and steroids can be used during this time to provide immediate relief. Side effects of DMARDs include gastrointestinal symptoms, fatigue and lung infections.
Biologic agents, such as abatacept, work by reducing the body's immune response. Only certain areas of the immune system are targeted, but patients might be more vulnerable to infection. They are primarily prescribed for patients who have moderate to severe RA that does not respond to DMARDs. Biologics are given as either an injection or intravenous infusion, which is done in a hospital or physician's office. The most common side effects are rash and pain at the injection site and upper respiratory tract infections.
Exercise is important for people who have arthritis, because it helps keep joints strong and preserves flexibility. Those who have rheumatoid arthritis of the knee should avoid riding bicycles, which puts too much strain on the knees. Exercise should never be attempted during a flare-up of RA. A physical therapist can provide individualized tips and advice.
Rest is just as important as exercise to treat rheumatoid arthritis of the knee. During flare-ups, physical activity should be limited. Rest during periods of inflammation can help prevent joint damage.
There are two surgeries possible to treat rheumatoid arthritis of the knee. A total or partial knee replacement might be necessary in the case of severe damage. This replaces the joint with metal and plastic. An osteotomy cuts major bones in the leg to improve alignment at the knee joint.