Inflammatory Arthritis of the Knee: Rheumatoid, Psoriatic and Spondyloarthritis

What is inflammatory arthritis?

In osteoarthritis, the cartilage wears gradually. In inflammatory arthritis, the problem starts in the synovium, the thin lining of the joint. The immune system wrongly targets it, so it thickens, makes excess fluid and releases substances that can erode cartilage and bone if the disease is not controlled.

The main types that affect the knee are rheumatoid arthritis, psoriatic arthritis and the spondyloarthritis family, which includes ankylosing spondylitis, reactive arthritis after an infection and arthritis linked to inflammatory bowel disease.

Symptoms in patients' own words

• "My knees are stiff for a long time when I wake up and loosen as I move"
• "My knee swells up for no reason, I never injured it"
• "It feels warm and puffy and I can't straighten it"
• "My fingers and wrists hurt too"
• "My lower back is stiff at night and better with exercise"
• "I feel tired all the time"

Clues that point to inflammation rather than wear include morning stiffness lasting longer than about half an hour, swelling in several joints, both sides affected, a skin rash such as psoriasis, nail changes, a red painful eye, or bowel symptoms.

Who gets it

Rheumatoid arthritis is more common in women and often starts in midlife, usually affecting the small joints of the hands and feet as well as the knees. Psoriatic arthritis affects some people with psoriasis, and the arthritis can appear before the skin rash. Spondyloarthritis often begins in younger adults, more commonly men, with back stiffness and sometimes a single swollen knee.

In Qatar, patients sometimes put a swollen knee down to football, padel or kneeling for prayer and wait for months. If the knee swells repeatedly without a clear injury, it is worth having it assessed.

Diagnosis and the knee surgeon's role

Many patients first see a knee surgeon because their main complaint is a swollen knee. Dr. Gelber's first job is to work out why it is swollen. That means a careful history and examination of the knee and other joints, and usually drawing fluid from the knee. The fluid is tested to rule out infection and crystals such as gout, and its features can suggest inflammatory arthritis.

Blood tests check inflammation markers and antibodies linked to rheumatoid arthritis, and sometimes a genetic marker linked to spondyloarthritis. X-rays show any joint damage, while ultrasound or MRI shows a thickened lining and fluid.

When the picture suggests inflammatory arthritis, Dr. Gelber refers you to a rheumatologist, the specialist who diagnoses and treats these diseases with long-term medicines. Early treatment by a rheumatologist is the most effective way to protect the joint.

Non-surgical treatment

Rheumatologists use disease-modifying medicines, and when needed biologic medicines, to calm the immune system and stop joint damage. These are the foundation of treatment.

For the knee itself, a steroid injection into the joint after draining the fluid often settles a flare quickly while the medicines take effect. Physiotherapy keeps the knee moving, rebuilds thigh strength lost during flares and protects the joint. Weight management, regular low-impact exercise such as swimming or cycling, and not smoking all help.

Surgical treatment

Surgery is not the first answer, but it has a role. If one knee keeps swelling despite good medical treatment and injections, an arthroscopic synovectomy removes much of the inflamed lining through small incisions, and can reduce swelling in selected patients.

When the cartilage has already been destroyed, knee replacement can relieve pain and restore function. Surgery is planned together with your rheumatologist, because some medicines affect healing and infection risk and may need to be paused and restarted at the right time.

Recovery and when to see a specialist in Doha

After arthroscopic synovectomy most patients walk within a day or two and work with a physiotherapist on movement for several weeks. Recovery from knee replacement takes longer, usually a few months. With good disease control many people stay active.

See a specialist if your knee swells without an injury, swells repeatedly, or is stiff every morning. Seek urgent care for a hot, swollen knee with fever, especially if you take medicines that lower immunity. Dr. Gelber sees patients at Aman Hospital in Doha.