My swollen collapsing knee ... is it OA or RA?

During my visit to the RA clinic this week I explained to the Nurse Practitioner that my knee has decided that it no longer wishes to support me, especially when I need to walk down stairs or steps. It is hot, swollen and crunchy!

She says that it won't be RA related, as RA does not affect the knees. So it must be OA.

I find this curious as one of my biggest problems in the early stage of my disease was a swollen hot knee that had to be drained and injected with steroids. At that time I was told it was my RA running out of control.

So who is right? Can RA get to your knees?

And if it is OA (I have had it X rayed and am waiting for the results) then is that one of those problems that we are told we must just learn to live with?

In the meantime, I have started walking downstairs backwards, which helps enormously.

19 Replies

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  • Hi Phoebe, amazing how we are often told so many different things. I have Inflammatory Arthritis which did start in both knees breaking down which I read was a sign of RA. This was confirmed by my consultant. Either way it is very painful& debilitating. I leant to put good leg up the stairs & the bad one down the stairs, still you take care of yourself& hope the x ray shows you what is going on.

    Love Alison x

  • Thanks Alison, I have put your stairs technique into practice today. It's better than walking backwards!

  • Hi Phoebe,

    I think you have my knees! Hot, swollen, crunchy, needing drained, steroid injections and I've been confirmed as RA and am now on DMARDS to control the disease. I use baby steps on stairs but everyone knows when I'm coming because of the crunch!

    Strange that your NP said RA does not affect the knees - that's definitely a new one on me. The worst bit is when one of the knees suddenly gives way as you never know when it's going to happen, most unsettling. Good luck with the xray and hope it tells you something, mine showed normal wear and tear (for a woman my age!!) so no real indicator of what was going on. All the very best to you and good luck.

    Fi x

  • It is so very scary when my knee suddenly gives way, and the pain can be excrutiating. In a way it is reassuring to know others have the same problems, isn't it?

  • It might help you and others to know that (at least in my experience) you can go through periods of a lot of pain, having to go backwards, one stop at a time, then after losing a bit of weight I started to find I could do steps normally again. I don't think its a straight line down!

  • hi phoebe, i got told i had oa 13 years ago and it stayed silent for a few years then started to go like yours and they still tell me its oa and have operated on it a few times (general clean out and look around) and now after 2 and half years of hurting going up stairs etc and lots of physio they say they will do a knee replacement but while they have made me wait my left knee and my hip have gone!!! and more recently my hands and elbows have been swelling and hurting so they think i have ra too!!! and all this started because i had a thyroid condition,so good luck with yours hope you get the treatment you deserve xxx

  • Hi Phoebe - that stuff about RA not affecting knees has got to be a load of rubbish?! - as far as I know it can affect any joints at all but is more common in hands and feet in the early stages perhaps. Mine started in both wrists and both knees simultaneously with feet being terribly painful first thing in the mornings too. By the time I was diagnosed it was only affecting my upper body but it definitely kicked off in knees to start with and has caused infrequent bouts of pain in the inside of my knees ever since. Perhaps what actually she meant was it looks and sounds like your case is OA from examining you. Either way we need our knees to hold us so I hope you get some relief from it soon - physio might help you a lot? Tilda x

  • Hi there,

    I agree with the others - of course RA affects the knees. I have inflammatory arthritis, most likely Psoriatic Arthritis but maybe RA. The doubt about the diagnosis has nothing to do with the fact that my both my knees are the worst affected joints - the 2 Rheumys I've seen, the Rheumy nurse and the GPs all consider that the inflammation of my knees is symptomatic of both conditions.

    My new Rheumy's take on the OA that x-rays show in my knees is that it is caused by the inflammatory arthritis, - he refers to it as 'secondary OA.'

    In 'ordinary' OA the cartilage wears away over time - 'wear & tear arthritis'. In RA & other forms of inflammatory arthritis the disease activity can destroy cartilage thereby producing exactly the same effect.

    I was reading about how Psoriatic Arthritis often goes undiagnosed. The author of the report made a wry comment about dermatologists noticing that their patients with the skin condition Psoriasis 'very often have OA'. The point being made was that these Psoriasis patients had actually gone on to develop Psoriatic Arthritis and that was what was damaging their joints, not 'wear and tear'.

    I dare say I'm over-simplifying but I'm pretty sure that's basically how it is: RA causes damage that looks and feels like ordinary wear & tear OA. However, I've heard that the more sophisticated the image, the more likely the doctor is to be able to tell what's causing the problem. For that reason I'm going to ask for an MRI scan when I next see the Rheumy.

    Did you find that the steroid injections helped with pain & mobility? I had them too and then immediately started on oral steroids - the result has been fairly miraculous. My money's on the oral steroids being mainly responsible for the improvement, but can't tell for sure of course. I do have a lot of damage - mechanical damage - so how the steroids can help me move around so easily is beyond me! And I wonder what life will be like when I come off them in a month? Back to using a stick & needing help to have a bath? So your question about whether knee damage / OA is just one of those problems we must learn to live with is constantly on my mind, too.

    I also wonder whether, If the OA damage is caused by the inflammatory arthritis, will MTX and other DMARDs help? I've not been taking MTX long enough yet to know what effect it is or isn't having.

    Are you having physio? The more I look into the role of the quads, the more seriously I take my physio exercises as well as swimming etc. My Physiotherapist has given me very clear guidelines about exactly how to come down stairs etc. so that I can move as normally as possible while avoiding the twisting movements that are bad for the knees.

    Hope I have not gone on too much, the moment anyone mentions knees, off I go!

    Christina x

  • I think it is total rubbish to say you can't have RA in your knees! But sadly you can have BOTH! My RA does sometimes inflame my knees, and like others then needs draining and so on. But I also have OA in my knees, and things like sudden locking or collapsing of the knee especially as you go up or downstairs is classic OA. In my case the RA didn't cause damage that is mimicking OA, as my knees have been bad for many many years. I put that all down to stupid sporting activity as a kid, when I used to damage myself and then just strap up by knees and keep going! Like Christina tho' I really believe that exercise (done properly, not how I used to) can be an amazing help especially for knees. If I don't follow my routine I soon feel a lot worse. Pollyx

  • It's a minefield isn't it. The consultant I see told me I have OA in my knee,I had a x-Ray my gp told me it was definitely not OA, I asked her if I could have a MRI scan as it is constantly hot swollen & painful,MRI came back cartilage damage. Back to the gp,I asked could this be due to RA,she didn't know,ask the consultant,could she have been wrong,could it after all be OA,she thought not,but ask the consultant,what can be done about it,will it get worse,should I be having treatment,again ask the consultant. I've learnt more on this site than I have from any of the doctors I've seen. So what do I think,I think it's RA but what can be done about it I don't have a clue. I don't suppose this is of any help at all except to say your not alone x

  • Seems to me that RA and OA go hand in hand. You'd think that once the RA has had a bit of a nibble at cartilage, then the damage would be likely to be exacerbated by normal wear and tear, especially on a weight-bearing joint. And vice versa, i.e. pre-existing but unnoticed OA damage might make the effect of RA seem more dramatic than it actually has been.

    Also, OA occurs more easily where muscles are weakened and therefore not supporting joints as they should, so if there's a bit of muscle wasting from RA-linked immobility that could easily contribute to OA. It all seems a bit chicken & egg.

    The compartmentalisation of medicine doesn't seem to help much - if you've got OA you get sent to Orthopaedics, RA: Rheumatology. Great that there is this specialisation of knowledge and expertise but they don't always communicate well, or at all & seem terrified of stepping on each others' toes. The way they refer to each other in hospital letters makes me laugh: 'awaiting the expert opinion of my esteemed colleagues in (another dept.)' etc.

    Anyway esteemed colleagues, hope the sun comes out for you today, there is a monsoon here.

    Christina x

  • My rheumy tells me that I have a combination of both OA & inflammaotory arthritis.

    I have had a resurfacing on one knee & the other knee is swollen, crunchy & doesn;t work very well!

    I have had fluid removed & steroids put in. I was due to have an arthroscopy last week (orthopod wanted to do it) however my rheumy has started me back on Sulpha as he says that works on the lining in a similar way as the arthroscopy. He also gave me a steroid inj to help - not that it has yet! :(

  • Thank you all for your replies. The support I get on here beats anything I get from the NHS. I suppose I probably have OA as well as RA in my knee. I am doing my quads exercises as much as I can and I bought a rather splendid knee support this morning in the hope it might hold things together on really bad days.

    There seem to be some interesting treatments around you all, wash-outs and resurfacings, etc.

    Hope I get my results soon and some idea of what can be done for me.

    Feeling really happy this evening as our local girl did rather well in the Olympics tonight. She is Jessica Ennis. Brilliant performance.

  • Hiya,does the knee support work? I hadn't thought about that. Didn't know you could have RA &OA in the same joint,that makes sense,so much to learn. I'm waiting for an orthopaedics appointment. Started taking meds for the RA last week so hoping that will sort my knee out but I guess it's not that easy. X

  • Yes, the support was really helpful. It seemed to put my knee hinge back in the right place. I have only worn it a bit, just for bad patches. And I am getting my quads back to their old selves with my exercises.

    Still doing my funny stairclimbing though!

  • i aggree with feather

    i had mri done showed some midial wear but mris dont show everything in the joint so he told me somtimes we go in and do find a mechanical problem.

    be verry weary of using a support for more than 3 hrs at a time

    also the main mussel to work which everyone forgets is the VMO to keep your pattela tracking better

    none mussle use even though it hurts a bit can lead to other things as ive learned even though im not diagnosed yet so dont just exersise the quad you need the vmo also which is the same exersise as the quad but foot at 45 degrees look on youtube for it.

    the mri on my knee i thought they where taking the mick cos it was swelled under the knee cap now it feels like some dead grissel.

    and if you start walking or compensating on the leg other things will come into play which the knee is joined to like ankles hips back.

    if it only one knee the hip on the opposite side will be sore cos you dont know it but you are compensating to the best leg even if they are both bad you will tend to put more pressure on the better leg.

  • Hi, I have replied twice here, and it keeps disappearing!!

    Hope this reply works...

    Thanks Minka, I have looked up VMO and it is very interesting.

    I had no idea about the hip issues.

  • I'm having horrible pain in my knees at the moment (usually one at a time which is weird). Its got worse since i've stopped treatment for RA (won't go into all that its a bit complicated). I think that the RA treatment does help the knees, but what diagnosis that implies, I don't know. I've been told that knees are OA, but also that RA can affect any joint in our bodies (probably not all at the same time though!

  • It sounds like oa to me that's what I have and I can understand about the stairs I have problems getting up and down xxx

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