Is knee pain at night a sign of arthritis?

How arthritis night pain usually feels

• A deep, dull ache inside the knee, rather than on the skin
• Worse after a day of walking, standing or stairs
• Stiffness on first getting up in the morning or after sitting, easing within half an hour or so
• Difficulty finding a comfortable position for the knee
• Sometimes mild swelling, a feeling of warmth, or grinding when you move

In early arthritis, pain is mainly with activity. As it progresses, many people notice pain at rest and at night too.

What night pain tells your surgeon

Night pain is one of the questions a knee surgeon asks when judging how much arthritis is affecting your life. It is considered together with how far you can walk, how stairs and prayer positions feel, your X-rays, and how well other treatments have worked. Night pain alone does not decide whether surgery is needed, but regular night pain despite good non-surgical treatment is one reason patients consider knee replacement.

Other causes to rule out

• A degenerative meniscus tear, often alongside arthritis
• Pes anserine bursitis on the inner side below the joint
• Gout or pseudogout flares, which often start at night
• A Baker's cyst behind the knee
• Hip arthritis felt in the knee
• Rarely, a bone problem such as a stress fracture or an area of bone damage called osteonecrosis, which can cause sudden severe night pain in older adults

Treatment that can help you sleep

Daily strengthening and walking, weight control, suitable pain relief and anti-inflammatory gels, and a pillow between the knees often reduce arthritis night pain. A steroid injection can settle a flare. When pain stays severe, partial or total knee replacement may be discussed.

At Aman Hospital in Doha, Dr. Gelber reviews standing X-rays and examines the knee and hip to confirm whether arthritis is the cause, then goes through options in order, from simplest to most involved.