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HomeAnswersInternal Medicineknee painWhat causes knee pain and swelling in me?

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

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. K. Shobana

Published At July 23, 2016
Reviewed AtFebruary 15, 2024

Patient's Query

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.

Hello,

Welcome to icliniq.com. I have reviewed all the information you provided. Please provide me with more details about your problem. How long have you been experiencing pain in your left knee? Are there any other joints, such as your wrist or elbow, that are also painful? It is mentioned that your ANA (antinuclear antibody) report is positive. If possible, please upload the report so that I can assess the pattern of immunofluorescence and provide further advice. Additionally, I would like to know how long you have been taking Sazo (Sulfasalazine) and OXCQ (Hydroxychloroquine), and if there has been any improvement since starting these medications. Could you also provide information about your RA factor, anti-CCP (anti-cyclic citrullinated peptide), and ESR (erythrocyte sedimentation rate) report? Lastly, have you recently experienced any sexually transmitted diseases (STDs) or urinary tract infections (UTIs)?

Patient's Query

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.

Hello,

Welcome back to icliniq.com. I have reviewed all the data you provided (attachment removed to protect patient identity). The reports indicate a seropositive monoarticular variant of rheumatoid arthritis with a superimposed traumatic septic or osteoarthritis component.

Both Sazo and OXCQ medications require 4 to 5 months for their full effect, so please continue taking both medications as prescribed.

Based on the images, there appears to be mild swelling in the left knee. However, two possibilities need to be considered: synovial hypertrophy and joint effusion. Clinical examination and ultrasound of the knee can help differentiate between the two. Since you mentioned that fluid was previously removed from the knee joint, please upload the reports of the synovial fluid analysis conducted at that time.

You can apply hot compresses for relief, and I recommend consulting a physiotherapist for treatments like wax bath and infrared therapy (IR) to provide a smoothing effect.

There is no correlation between swelling and the phases of the moon, such as full moon or new moon days.

Lastly, the ANA report is positive, so we need to conduct an ANA profile to determine any underlying associated diseases. If CRP and ESR levels are still elevated, we may need to consider adding a third-generation drug like Methotrexate to control inflammation in the body.

Please update me with further details and continue the same medications while also undergoing daily physiotherapy.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Naresh Kumar M.
Dr. Naresh Kumar M.

Internal Medicine

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