Knee Effusion (Water on Knee) from PMR?

[OakOwl]

My knees started feeling quite painful shortly after the PMR started. I assumed it was part of PMR until my Rheumatologist said a few months ago she didn't think it was. The knee pain has increased more than the PMR pains as prednisone has been tapered. (I'm on the "75% less pain than untreated is fine" tapering plan due to existing comorbidities of osteoporosis and heart disease.) Now down to 4mg / day Prednisone, plus 15mg Methotrexate.

My primary care provider confirmed the swelling in the knees (it's not visible -- I can feel the stiffness and painfulness when bending though, and it shows up in scans & doctors can feel it from the crease in the leg behind the knee). But the primary care provider has now ruled out a number of causes, including Osteoarthritis. Her best guess is that it is immune-system related, and thinks that the Rheumatologist should consider other possibilities if it is not PMR related.

Very occasionally I've seen knees in lists describing PMR, but mostly not. The Rheumatologist has ruled out Rheumatoid Arthritis. So I'm curious -- has anyone else experienced Knee Effusion (Water on the Knee) along with their PMR?

Thanks!

[marionofnorwich]

Yes I am in almost the exactly the same situation. 4 years into PMR and I honestly can't tell if it is still active or not. On 4.5 at the moment but I was on 4mg but have been through a hip op lately so on slightly higher before starting to try and get down further a to again. From the start I had that tightness behind the knees and my right knee and calf was visible 'fatter' although it sometimes seemed only I could see that. In April 2022 when just reduced from 5mg to 4mg I got COVID and although the COVID was ok everything went a bit wild as I didn't know about sick day rules. I increase eventually to 10mg and worked back down but two weeks after the COVID my knee was suddenly unbearably painful like toothache or CC someone had got it with a hammer. Took a few weeks to settle down. Eventually (Sept 22) it was x-rayed and I had an insufficiency fracture plus water in the bone. And a degree of osteo arthritis. There was no specific treatment. The consultant orthopaedic surgeon doesn't think a knee replacement will help and RA had been ruled out and so I am left with very stiff knees on both sides and the right one is painful as well as stiff. There seen to be no solutions. Exercise makes them worse but now I am trying to strengthen them but slowly. Vitamin D ( which I was low on) seems to have helped the intermittent calf muscle pain. And I have stopped all other medication, statins and BP. But my story and situation is very similar with out the comorbidities you have. Sadly I have the same situation but no answers for you!

[OakOwl in reply to marionofnorwich]

Thanks for your reply - so may be related! But sorry you are struggling with the same and more. I do hope some answers are eventually found for you too.

[Carrollee]

morning

Yes I have effusion on my left knee. Both knees have osteoarthritis but the left knee has extra bone (can’t remember the proper word 🤔) so it can lock on occasion. It also has a small bakers cyst and synovitis. I was given physio but it was too much and the bakers cyst leaked 😵‍💫 and I ended up with DOMS 🤷🏼‍♀️. So I just keep up with my walking each day to keep it moving as best I can.

Sorry you are going thru this. 🤗

[OakOwl in reply to Carrollee]

Thanks for your reply. Sorry to hear physio made your knee worse! Good to know you are walking anyway to keep moving (me too).

[S4ndy]

Hi there, yes I have had fluid on my knee. I have osteoarthritis in both knees. I had back surgery last year and during the recovery period my right knee got really painful. I had an MRI and saw a Orthopedic surgeon recommended by my Neurosurgeon. He was able to see that my osteoarthritis had not deteriorated and was a long way off needing replacement thankfully. However he did point out fluid around the joint which he said was caused by inflammation. He didn't think it was PMR he though it was mechanical. I had been doing more exercise after the back surgery and my gait had changed i.e I was walking differently and the knee was not used to it. He suggested scaling back the walking and using a short course of Diclofenac until it settled down. My rheumatologist agreed although he is if the opinion I have some sort of inflammatory arthritis as well as osteoarthritis and PMR. Anyway, the treatment plan worked and the knee is back to it's usual slightly grumbling self.

[OakOwl in reply to S4ndy]

Glad your knees have improved. Interesting that your rheumatologist considered the possibility it was caused by inflammatory arthritis.

[pegpowell]

During my first year of PMR in 2016, my knees had to be drained by an osteo surgeon a couple of times. He also gave me cortizone shots. Early 2017, my right knee was replaced. I was always very active before PMR. Coming down Humbug mountain in 2015 triggered my knee problems. During my last years taking pred, I had left hip replacement 2022 and left knee meniscus repair 2023. 2024 finds me PMR/pred free. I walk miles every day with my dog and climb stairs very carefully.

[OakOwl in reply to pegpowell]

You've been through a lot! Hopeful to hear you are PMR/pred free and able to walk miles.

[PMRpro Ambassador]

I have had swelling around my knees and pain - right at the start and it eased with pred. I would say it isn't uncommon - people with PMR often complain about knees.

[OakOwl in reply to PMRpro]

Good to know pred took care of yours. Mine were better too on the higher dose. Thanks for letting me know this isn't uncommon -- something I'll bring up at my next rheumatologist appt.

[Sharitone]

Yes, not initially, but I did with with the first flare. Swollen and hot, even though XR did not show very much OA. However, I was given a cortisone injection in the worse knee, which did very little. When I finally went back on pred - hey presto! knees calmed down.

[OakOwl in reply to Sharitone]

Thanks -- more evidence not just OA. Good to know your knees calmed down & good to know pred was effective treatment.

[Holidaytime89]

Yes! - painful knees - particularly the left knee were my first symptoms in oct 23. It progressed within weeks to hips, hands, shoulders. By this time GP was only focused on the left knee which they said X-ray had shown was osteoarthritis. I’d been fit and active until about a month before this - and the knee pain at night was really bad. I knew it wasn’t osteoarthritis but not being believed about the level of pain and difficulties i had was one of the worst parts. Many of the appts were phone calls. I was really desperate by January and got a face to face appt with another GP who could see I could hardly walk and agreed it could be PMR (though he said it doesn’t affect hands or knees) but he prescribed prednisolone. I felt 90% better by the next morning so it must have all been caused by PMR.

My left knee pain took a few weeks longer to fade - and now that I’ve reduced the Pred to 5mg it’s starting to feel a bit more sore again.

Thank goodness for this site - it has been such a good source of information for me. It’s sad that some GPs seem to be so ill informed about PMR and I think that osteoarthritis is a convenient excuse for anything particularly if you are 60+

[PMRpro Ambassador in reply to Holidaytime89]

They'll label you with OA and fibro at the drop of a hat - covers pretty much all symptoms and can claim there is sod all they can do about them!!!!!

[piglette in reply to Holidaytime89]

I am glad you are now improved. I have just been watching the skateboarding in the Olympics. My knees aching just watching!

[Holidaytime89 in reply to piglette]

Me too! They just bounce up when they fall over- amazing!

[DorsetLady PMRGCAuk volunteer in reply to Holidaytime89]

Yes but we probably did at their age too!

[piglette in reply to DorsetLady]

Never in a million years was I able to do what those young girls are doing.

[piglette in reply to Holidaytime89]

It makes your knees hurt watching them!

[OakOwl in reply to Holidaytime89]

Helpful to hear your experience and glad the pain faded with treatment. Your knee experience sounds similar to mine (though my PMR started in the shoulders, then hips. Then knees started shortly after) It is so difficult not being believed by doctors! But seems to happen so often.

Everyone's responses have helped improve my confidence for explaining my knees to the rheumatologist this week. Thanks!