Dr. Raghu Hiremogalur

Rheumatoid arthritis is an auto-immune chronic disorder that might cause abnormal swelling in the joints when the joint tissues are attacked by the human immune system. The more frequently used body joints, such as the knees, fingers, shoulders, wrists, elbows and hips commonly get affected by the disease. Rheumatoid arthritis can also occur in the ligaments or tendons and might affect areas such as the kidney, bone marrow, eyes, lungs, and heart.

If rheumatoid arthritis is not diagnosed on time, it might lead to future complications, such as blood cancer in the lymph regions, osteoporosis (a medical condition resulting in the weakness of the bones), infections, stiffening of the arteries and dry mouth.

What exactly causes the disease is not known, but a significant damage to the immune system might cause the inflammation of the joints, resulting in this condition. Obesity, a family history of this condition and other lifestyle habits such as smoking tobacco put one at higher risks of this disorder.

The symptoms of rheumatoid arthritis might vary among people. The most common symptoms of rheumatoid arthritis are;

Treatments
The treatment of rheumatoid arthritis includes a prescribed dosage (depending on the intensity of the condition) of non-steroidal anti-inflammatory drugs such as ibuprofen, anti-rheumatoid drugs such as methotrexate and steroid drugs such as prednisone to reduce the swelling and the subsequent pain. Performing regular exercises in order to retain the flexibility of the joints with appropriate consultation from the physiotherapist might cure rheumatoid arthritis.

The knee joint is made up of several elements including the knee cap, meniscus, connective tissue, tendons, ligaments, cartilage, and muscles. Damage to any part of the knee can cause chronic pain.

What can cause knee pain:

Fractures: These are caused by the breaking up of the kneecap due to falls or collisions.ACL Injuries: Caused due to the tearing of the anterior cruciate ligament (that connects the femur and the shinbone). Especially common in sportspersons such as footballers or basketball players.Meniscus tears: The meniscus or the rubber-like cartilage (that acts as a shock absorber) can be torn by sudden jerks or excess pressure.

Arthritis: The chief cause of lingering knee pain, arthritis itself can be of a number of types.

• Osteoarthritis, which is a result of deterioration of cartilages due to wear and tear
• Rheumatoid Arthritis, an inflammatory chronic disorder
• Septic Arthritis, causing pain, swelling and redness.
• Gout caused due to the development of uric acid crystals in the joints

How to deal with it:

• Exercise: Moderate to intense exercise is prescribed for one and all. This, of course, depends on one's overall health and age. If you are already suffering from joint pain, then you may want to go easy on the exercise with a focus on building muscle strength and foundation. If you are healthy, then some amount of daily exercise as a routine will keep those knees in prime working condition and well lubricated as well. Inactivity and a sedentary lifestyle can affect the knees very badly.
• Dealing with Load: Weight is a big one. Carrying around extra pounds and kilograms can be detrimental for your knees in the long run. Your knee is not equipped to handle the excessive weight. It already supports three to five times your weight when you get up and walk around or indulge in some mild jogging. One must be careful of those extra pounds to take the load off the knee and keep it from falling prey to damage.
• Do not Ignore: Warning signals such as chronic or acute knee pain should not be ignored. Remember to see a doctor or an orthopaedic specialist to find out if you have contracted an infection or if you may have suffered a fracture due to an injury.

Ligament Injuries-

The ligaments around the knee are strong. However, sometimes they can become injured. They may be stretched (sprained), or sometimes torn (ruptured). A ligament rupture can be partial (just some of the fibres that make up the ligament are torn) or complete (the ligament is torn through completely). The majority of knee ligament injuries are sprains and not tears and they tend to settle down quickly.

ACL injury and other ligament injuries can be caused by:

• Twisting your knee with the foot planted
• Getting hit on the knee
• Extending the knee too far
• Jumping and landing on a flexed knee
• Stopping suddenly when running
• Suddenly shifting weight from one leg to the other

These injuries are common in soccer players, football players, basketball players, skiers, gymnasts, and other athletes.

Treatment-

1. Rest the knee. 
2. Ice your knee to reduce pain and swelling.
3. Compress your knee. 
4. Elevate your knee on a pillow when you're sitting or lying down.
5. Wear a knee brace to stabilise the knee
6. Practise stretching and strengthening exercises if they are recommended.https://docs.google.com/spreadsheets/d/16Y_GBnYm2-tnHKOSVjyKU9CJ0FLTkPu8q8i5tul8nLs/edit?ts=5ae18dcc#gid=0

For severe collateral ligament tears, you may need surgery to attach the ligament back to the bone if it was pulled away, or to the other part of the ligament if it was torn in the middle.

Meniscus Tear-
A meniscus tear is a common knee injury. The meniscus is a rubbery, C-shaped disc that cushions your knee. Each knee has two menisci (plural of meniscus)-one at the outer edge of the knee and one at the inner edge. The menisci keep your knee steady by balancing your weight across the knee. A torn meniscus can prevent your knee from working right.

A meniscus tear is usually caused by twisting or turning quickly, often with the foot planted while the knee is bent. Meniscus tears can occur when you lift something heavy or play sports. As you get older, your meniscus gets worn. This can make it tear more easily.

Treatment may include:

1. Rest, ice, wrapping the knee with an elastic bandage, and propping up the leg on pillows.
2. Physical therapy.
3. Surgery to repair the meniscus.
4. Surgery to remove part of the meniscus.

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