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Sudden and severe knee swelling


I was diagnosed with RA about a year ago (well, first rheumatologist thought maybe sjogrens, then diagnosed undifferentiated connective tissue disease, but second rheumatologist said no it's definitely RA so here I am.) My bloodwork has been pretty good on plaquenil and sulfasalazine, even though those are quite mild dmards. About a week ago, I woke with knee effusion-- massive swelling and pain, I couldn't bend or straighten the leg and couldn't put any weight on it. Luckily, I was visiting my parents over the holidays so I had someone around to help me down stairs. I saw a rheumatologist here, who drained the excess fluid and injected cortisone. I'm doing a lot better now, I'm walking with a cane instead of barely being able to hobble across a room with a walker like a week ago, but I'm absolutely terrified about this happening again. As it is I've missed three days of work (at the end of a winter break, no less!) and I'm the only person who teaches what I teach, so time off is a big problem.
Im seeing my normal Doctor early next week when I'm back home, but I just wanted to know if anyone else has similar experiences to share? I know water on the knee is common enough in an RA flare, but most of what I can find online is geared towards knee effusion after trauma, rather than inflammatory arthritis.

I walk to work, my job is fairly active with lots of up and down stairs... So I'm pretty thoroughly freaked out by the thought of not being able to use my leg!

  1. HI lilyanne! I am so sorry you experienced this issue! I will say that, as you stated, it is not an uncommon problem to have when you have RA. I cannot say whether it will happen again or not. One of our contributors, Kelly Mack, has extensive experience with knee issues (swelling, pain, infection, knee replacement). You might find her articles helpful. If you type "knee" into the blue search box on the right hand side of the page (near the top), you will find many of her articles. Since you are pretty active it work, it might make sense for you to discuss this with your rheumatologist. He/she may have some recommendations for you or may even refer you to a physical therapist. A PT can help you exercise and hopefully, strengthen, the joint without causing further damage. You might check out this information on knee issues associated with RA -- I know many of our members have to find the balance between exercising the joint without causing damage and it's a different balance for each individual. Not using it enough can cause more stiffness, while using it too much can seem to speed damage to the joint. Hopefully, your rheumatologist can work with you to find that balance. But, I do hope you can avoid experiencing this particular issue altogether! Thank you for reaching out and I hope you are back to teaching very soon. Best, Erin, Team Member.

    1. Thank you so much for your reply! I saw a new rheumatologist yesterday (my third at this practice, since the second is off on maternity leave!) and he stopped Sulfasalazine and started me on Methotrexate. Hopefully that kicks in soon, since I've been very fatigued and have had more wrist, hand, and foot pain lately than I have for a while.

      I'm really glad I found this website, so many articles! So much good information!

  2. Hi Lilyanne~

    I'm glad you are working with your rheumatologist to find the right treatment - teamwork with your doctor is really key to getting RA under control! I truly hope that the methotrexate ends up helping you! Did your doctor mention taking a folic acid supplement? I find that really helps me manage methotrexate side effects, so if you end up experiencing any side effects that may be something to ask your doctor about.

    Hang in there and remember we are here to support you!

    ~Mariah~ (Site Moderator)

    1. Hi Mariah,

      Yes, my doctor prescribed 1mg of folic acid daily. I took my first dose of Methotrexate last night, and did not take my evening sulfasalazine as directed, and I actually feel pretty good today! A couple minor waves of nausea but nothing compared to the migraines I get sometimes.

      I still feel like taking a week's worth of medication in one go can't possibly work, though obviously it does!

      I'm so grateful for the quick responses moderators have given to my questions. This is such a wonderful resource!

  3. Hi my name is Sally,
    I am 60 and live on the Sunshine Coast in Australia. I woke up one day in October with burning, aching and swollen ball of my right foot. It was so painful I had to take painkillers and bath my feet in cold water. I put it down to working all day in my garage lifting heavy stuff and hard leather shoes with no support. The inflammation persisted and moved to a painful swelling in my knee. It was red hot and felt like a bruise where I had walked into something. The severe pain had left my foot though it still felt inflamed. My right hip which had been an ongoing problem from sitting studying gave way on me where I could not stand or put weight on my leg. I went to the osteopath who manipulated my lower back and the next morning my knees were so swollen I could not bend either of them or walk down the stairs. I went to the Dr and had a blood test. My rheumatoid factors were up. I told the Dr I had a similar condition 15 years ago which statred with a unrinary tract infection where the inflammation moved from one joint to the other. I saw a rheumaologist who was not sympathetic but put me on Salazopryine. I think 3 years later it settled down. Now I have it back! I do not think it ever really went away as I often woke up with aching joints especially between my shoulder blades and right hip. I do not feel as though I have ever had a proper diagnosis. I am seeing the same old rheumatologist EVENTUALLY it is a 4 month wait. In the meantime the GP has increased my Salazopyrent to 6 tablets a day (500mg). On Monday the pain moved to my left shoulder where it was so painful it was frozen I could not sleep or move it. I felt the inflammation leave my shoulder after 48 hours where i have no pain in my shoulder anymore but I knew it was moving to my neck where I have had a stiff neck for 3 days. I felt as though my head was a bowling bowl and I had no mucles or inflammed connective tissue that could not support my head. The stiffness is still in my neck but the pain in my foot is back. It is so frustrating I am usually such an active person. I wish I could find some answers. I wonder if it is like a chronic virus that is dormant in my body and flares up like the flu. Perhaps Epstein Barr or PID. Hope someone can help me make sence of this debilitating illness and pain. I just want to get better and have the energy and motivation I used to have. Many Thanks for any help Sally

    1. Hi SallyCristina! I am sorry you are experience such high levels of pain. I know that some of our members and at least one of our contributors have dealt with Epstein Barr. You may discuss this further with your physician and see if he/she will refer you to e specialist or test for these conditions. I think at this stage, you may only be able to get definitive answers with some more testing. Do you feel like this is different from a 'typical' flare? I do hope you get some relief from the pain very soon. Thank you for reaching out to the community. Best, Erin, Team Member.

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