Q. What is the exact cause for my knee pain and swelling?

Answered by
Dr. Naresh Kumar Monigari
and medically reviewed by iCliniq medical review team.
Published on Jul 22, 2016 and last reviewed on: Oct 09, 2018

Hi doctor,

I am a 40 year old female. My height is 5'4" and my weight is 64 kg. I am suffering from left knee pain with some swelling and stiffness for the past three years. I am taking Sazo 2000 and OXC 200 for two months, but had no relief. I have ANA 48.5 and CRP 7.9. My MRI showed no tears, but some fluid or effusion.

Dr. Naresh Kumar Monigari

General Medicine Internal Medicine
#

Hello,

Welcome to icliniq.com.

I had gone through all the data posted. Kindly tell me more details about your problem.

  • Since when is the pain in the left knee present? Do you have any other joint pain like wrist or elbow?
  • Your ANA (antinuclear antibody) report is positive. Kindly upload the report so that I can check the pattern of immunofluorescence and advice further.
  • How long you have used Sazo (Sulfasalazine) and OXCQ (Hydroxychloroquine)? Is there any improvement after using these drugs?
  • What about RA factor, anti-CCP (anti-cyclic citrullinated peptide) and ESR report?
  • Have you suffered from STD (sexually transmitted disease) or UTI (urinary tract infection) in the recent past?

Revert back with the answers to the above questions to an internal medicine physician online -->https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Thank you doctor,

This problem has persisted for more than three years since January. No other joint has involved. No such immunofluorescence pattern in ANA report and only mentioned as 48.5. As stated, I am using Sazo and OXCQ for two months without any improvement. I feel only a little reduction in swelling, but all other symptoms are the same like pain, stiffness and inability to move without pain. I also used Defza 18 mg for 10 days and 6 mg for 20 days for a total of one month. Before two years, my RA factor was 120 with ESR 65. I was not affected with an STD or UTI in the past.

My past medical history is as follows. I met with a hyperextension injury to the left knee on the wet floor, resulting in immediate pain, but after two to three days it got milder. After 15 days, it developed stiffness, difficulty in bending, sitting or rising from a seated position. The knee got swollen. Then after some days, the doctor made an aspiration of 100 cc of clear fluid from the knee and the culture reported no microorganisms in the joint fluid. But, no improvement in the pain and the swelling also persisted. Medicine prescribed by that doctor were Alanz-D, Pantoprazole and Augmentin 635. After 15 days or so, we went to another specialist due to unavailability of that previous surgeon and he diagnosed it as septic arthritis and treated with following medications. Stafcure CV 500, Enzomac, Hifenac-P, Pantium DSR and I continued it for 15 days. There was mild relief of pain, but swelling and stiffness did not go away at all.After 9 months, the next doctor suspected it as synovitis or septic arthritis and prescribed Katadol 100 mg, Chymoral Forte and Shelcal K2 for seven days. Then, ESR came as 64 with CRP 10.3 and RA factor 120. After seven days with no improvement in symptoms, he changed the regimen to Inmecin 25 mg, Omez 20, Peptica, Ostium K2 and Chymoral Forte DS for 15 days. Again, there was no change in symptoms after 15 days.

Again, we approached another doctor after a year and he ordered an MRI and blood work. The MRI impression shows osteoarthritic changes and mild joint effusion with complex suprapatellar collection. There was no meniscal or cartilage injury seen.

My pain and stiffness are always there. I am getting stitching and shooting type of pain on the lateral aspect of the knee especially. Swelling is present all the time, significantly increased on full moon and new moon times. Swelling will even go down to the leg and foot. Cold gave me more trouble than hot as when we used ice-pack in the past, I felt more immense pain and could not tolerate it more than a minute or so. Winter weather gives me a little more trouble than summer. I feel feverish on and off, especially at night-time, but no real fever on thermometer. My mother has traumatic knee osteoarthritis (end-stage) and paternal grandmother had gout.

Dr. Naresh Kumar Monigari

General Medicine Internal Medicine
#

Hello,

Welcome back to icliniq.com.

I had gone through all the data posted (attachment removed to protect patient identity).

  • The reports are suggestive of seropositive monoarticular variant of rheumatoid arthritis with superimposed traumatic septic or osteoarthritis component.
  • Both the medications Sazo and OXCQ needs 4 to 5 months time for their full effect. So, kindly continue both the medications.
  • From the images, I can see there is mild swelling of the left knee. But, it can be due to two reasons.
  • Synovial hypertrophy versus joint effusion, which can be differentiated by clinical examination and ultrasound examination of the knee.
  • Give only hot compresses and you can consult a physiotherapist for wax bath and IR therapy (infrared), which gives smoothening effect.
  • There is no relation to full moon or new moon day with swelling.
  • Then, lastly ANA report is positive. So, we need to do an ANA profile to determine the underlying associated disease.
  • Kindly do CRP and ESR if they are still elevated and then we may need to add third generation drug like Methotrexate to control inflammation in the body.
  • Kindly update me with further details and continue the same medications for now and daily physiotherapy.

Revert back with the reports to an internal medicine physician online -->https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

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