Arthritis is a commonly-used and broad term that encompasses a range of degenerative conditions affecting the joints, leading to pain, swelling, and reduced mobility. The most common form of arthritis is known as osteoarthritis, often referred to as “wear and tear”. This is the type of arthritis that causes gradual and slow erosion of the cartilage and bones. The terms “wear and tear” are often frowned upon by some on X (formerly Twitter), but my experience is that wear and tear is a perfectly reasonable term to use. Although some do not like the use of the “tear”. Erosion may be a little alarmist to use too, however, cartilage can and does become injured, torn, damaged, and degenerate.
One common issue associated with arthritis is the accumulation of fluid in the knee, known as knee effusion or “having a swollen knee”. Understanding the relationship between arthritis and fluid on the knee is pivotal for effective management and treatment of the condition. This article explores the different types of arthritis, how they impact the knee, and the various strategies for dealing with fluid accumulation.
Types of Arthritis
Osteoarthritis
Osteoarthritis is the most common form of arthritis, often referred to as degenerative joint disease or “wear and tear”. It occurs when the cartilage that forms on the ends of the bones deteriorates and reduces. This wear and tear can lead to significant knee effusion, as inflammation is created causing excessive fluid formation.
Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disorder that primarily affects the joints. It causes chronic inflammation, which can lead to the destruction of cartilage and bone within the joint. This inflammation often results in significant swelling and fluid accumulation in the knee, contributing to arthritis knee swelling fluid. I often see cases of rheumatoid arthritis when aspirating the knee, and I’ll notice the fluid is cloudy or sometimes slightly flaky.
Psoriatic Arthritis
Psoriatic arthritis is a type of inflammatory arthritis that occurs in some people with psoriasis. This condition can cause joint pain, stiffness, and swelling, including in the knees. Psoriatic arthritis fluid on the knee is a common symptom, making movement painful and difficult. Again, the fluid that we aspirate or take out can be flaky or cloudy.
Gout
Gout is a form of arthritis characterised by sudden, severe attacks of pain, redness, and tenderness in the joints. It is caused by the buildup of urate crystals in the joint, leading to intense inflammation and swelling. Gout can cause fluid on the knee, resulting in very considerable discomfort and mobility issues. We can often work out if it could be gout because of lifestyle factors. Alcohol, poor diet, obesity, and lack of exercise can be contributing factors, as well as underlying medical conditions such as kidney disease. They can all affect the accumulation of uric acid. A blood test will often help us to establish if uric acid is the issue.
How Arthritis Affects the Knee
Joint Structure and Function
Arthritis causes many issues in the joint. In the first stage, you’ll often have debris along the joint where the cartilage has become worn. As the arthritis progresses, the knee will get larger, and the joint swells. You’ll also notice the knee becoming gradually stiffer, and often is accompanied with pain. As arthritis develops, you can get excess calcium deposits laid down and they are known as osteophytes, and they further irritate the joint.
Inflammatory Response
Inflammation is a hallmark of arthritis, causing the body to produce excess fluid. Inflammation can often become chronic. The relief that people have when the fluid is drained is remarkable.
Stiffness
In osteoarthritis, the joint becomes stiff. In most cases, really stiff. We often measure the knee bend and can relate the loss of degrees to potential joint degeneration. If the knee drops below 100 degrees, we usually assume the degenerative changes are moderate. Below 90 degrees of flexion and we can usually assume the degeneration is severe.
Diagnosing Arthritis and Fluid on the Knee
Medical History and Physical Examination
A thorough medical history and physical examination are the first steps in diagnosing arthritis and fluid on the knee. In the UK, on the NHS, this will often be performed by the GP or a First Contact Practitioner (Physiotherapist) at the surgery. If you want to bypass the NHS, simply go privately to your local physiotherapist or osteopath for an assessment. They’ll give you a very good idea how bad the arthritis is and what can be done.
Imaging Tests
X-rays
X-rays are the first-line of imaging that usually occurs, especially on the NHS. It can reveal changes in the bone structure, and we typically look for a loss of joint space, indicating the classic “bone on bone” that many patients are advised about.
MRI
MRI scans provide far-more detailed images of the knee’s soft tissues, including cartilage, ligaments, and they are also very helpful at showing fluid accumulation. MRI’s are my absolute go-to, and they give our team a clear indication of the amount of fluid in the knee, and any underlying processes occurring.
Ultrasound Scans
Ultrasound scanning (USS) can be used to visualize fluid buildup in the knee and guide procedures like joint aspiration. We often use USS for checking for fluid on the knee joint, and at the back of the knee joint (Baker’s cyst).
Laboratory Tests
Blood Tests
Blood tests are routinely performed from your GP surgery. They can help diagnose specific types of arthritis by detecting markers of inflammation and autoimmunity, such as rheumatoid factor or elevated uric acid levels.
Synovial Fluid Analysis
Less commonly done, but synovial fluid analysis involves extracting a sample of fluid from the knee joint for laboratory examination. This test can help determine the cause of fluid accumulation, such as infection or crystal-induced arthritis like gout.
Treatment Options
Depending on the severity and cause of the symptoms, treatment can include physical therapy, supportive devices, medication, injection, aspiration and surgical options.
NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation associated with arthritis and knee effusion. This is the go-to by the GP. Our advice is use it short-term, but long-term use is not recommended, even with a stomach protecting drug. NSAIDs have terrible effects on the stomach when used long-term. Always take with or after a meal. Look for other alternatives if NSAID use is becoming excessive.
Steroid Injections
Corticosteroids and steroid injections are potent anti-inflammatory medications that can be injected directly into the knee joint to reduce swelling and fluid accumulation. You don’t want too many of them, so keep them “in the back pocket” until you’ve tried other things first.
Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
DMARDs are used to treat autoimmune forms of arthritis, such as rheumatoid arthritis, by slowing the progression of the disease and reducing inflammation. This is prescribed from a rheumatologist. I’m not a huge fan of DMARDs, but they do seem to have their place. I always try to encourage patients to look for holistic options for RA.
Physical or Manual Therapy
Physiotherapy and osteopathy can help improve mobility and reduce inflammation. Physios and rehab can also help strengthen the muscles around the knee, improve joint function, and reduce symptoms of arthritis.
Braces
Knee braces can provide support and stability and provide compression. They can also limit range of movement, so use them following advice from your physio.
Joint Aspiration
Joint aspiration involves removing excess fluid from the knee joint to relieve pain and swelling. This is something we do on a daily-basis, and patients travel from all over the UK to see us. For pricing, go to our pricing page on the top menu.
Hyaluronic Acid Injections
Hyaluronic acid injections can lubricate the knee joint, improving mobility and reducing pain associated with osteoarthritis.
The most commonly used is called Ostenil Plus.
Arthroscopy
Arthroscopy is a “minimally invasive” surgical procedure used to diagnose and treat joint problems. In reality, arthroscopies can be more than minimally invasive, and they do need rehab afterwards. But they can certainly help. Bear in mind, getting one on the NHS is becoming increasingly difficult.
Knee Replacement Surgery
This is the last step in the chain. Knee replacement surgery involves replacing the damaged knee joint with an artificial implant. This procedure is typically reserved for severe cases of arthritis that do not respond to other treatments. Don’t jump on to this step before first trying the other steps.
Final Thoughts on Arthritis and Fluid on the Knee
Arthritis and fluid on the knee are common issues that can significantly impact quality of life. It is important to get a clear diagnosis of the type of arthritis (most commonly osteoarthritis, or rheumatoid arthritis). The best thing you can do for arthritis if you have a swollen knee is get the fluid drained and get to therapy. We’ve rehabbed thousands of knees and prevented hundreds of patients needing knee surgery.