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Old 06-06-2010, 05:01 PM   #1
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Unhappy One Swollen Knee

I had my knees replaced several years ago and they have been fine. I am told now that I have RA with possible Lupus. For 9 months my right knee has been swollen and very painful. I have had it drained 3 times with cortisone injections. ( The osteo surgeon says my replacements are fine)

The fluid in knee says 2000 white blood count and RA factor. I have been on prednisone and medrol pack- nothing helps . I now take 400mg plaquinel ( for several yrs), and 2000 mg sulfasalazine daily. The nsaids make me really sick and I can't take them.

Has anyone had this problem? I can't seem to get rid of this fluid and I have to walk with a cane. I was walking a mile everyday and also riding my recumbant bike but now can do neither. I am quite frustrated. Any ideas? I see my rheumy again this week. Thanks!

 
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Old 06-06-2010, 07:14 PM   #2
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Re: One Swollen Knee

Hi Pinetree....I also have replaced knees and this past March, both knees blew up and got extremely painful(couldn't walk) and I had a fever of 101. Ended up in the hospital and was scheduled for bilateral revisions with full treatment for infections when my ortho called it off. The did 6 sterile taps(that means no numbing of any kind)in 4 days and it grew nothing. My white count was 20,000 from the joint fluid and even though I have RA, no RA factor was found. So for the past 2 1/2 months I have been tested for everything from TB to rabbit fever(I picked up a dead squirrel) to gout. Negative. So I've done a lot of reading all over the net trying to learn what might be wrong.

If you have positive rheumatoid factor in the joint fluid, the chances are you are developing RA in that knee and will probably get it in the other knee as well since it is a "symetrical" disorder....if it happens on the right, it will happen on the left too. If the cortisone didn't settle down the inflammation, then you might need to increase the drugs you are taking. The combination of Plaquenil and sulfasalzine is considered a "low/medium potency" drug combination. Mind you any steroid is the top of the line and if that doesn't work, who knows what will. And as you know, you can't stay on steroids. So most docs start you very low combo and hope you'll hold with that but there are lots more to try to get it under control. Methotrexate, the biologics(Enbrel etc) and other disease modifiers like Arava. Seems like you need your meds boosted.

You knee seems to have RA. It's rare to get RA in a replaced joint but it does happen and that's why I'm being checked out so thoroughly. They don't remove the synovium when they replace the joints. But when you finally need a revision, they can do a synovectomy and that should shut it down.

But I will mention 1 thing I found. It's called "polyethylene synovitis". The lining of the knee joint can become inflammed like RA due to deterioration of the plastic in the prosthesis. It is also rare and most people don't react to the plastic but it seems to be what I have had for the past year and a half. I think now I've developed low grade infections......perhaps from the synovitis. Nothing is stopping my swelling or fever or pain.

I'd try more and different RA drugs before pursuing anything else like more surgery. If you can shut it down...hallelujah!. If not, like me, go out and investigate everything you can before opting for surgery.

good luck and let me know what your doc thinks....................Jenny

 
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Old 06-07-2010, 05:53 AM   #3
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Re: One Swollen Knee

Thanks so much Jenny for your reply! I have a wonderful ortho surgeon who has xrayed the knee to make sure everything was ok. He also drew the fluid twice and checked for infection before the cortisone injection. I might add that the fluid was all back before I even got home from dr.

The fluid was RA positive with 1:20 titer
2525 WBC
585 RBC
no crystals

I have used Arava for quite some time and rheumy said it was doing no good and switched me to sulfasalazine.

I haven't been able to find anything online about this because it is a replaced knee. I was so happy to have them replaced because now I could go for walks and stuff and now this.

My original problem started in 1999 with Lyme disease. ( definate Lyme, verified by dept of health) but by the time treatment was started it was too late (long story). The lyme is neg. now, but has caused an immune reaction and gone into these problems. The joint fluid is neg lyme too.

Thanks for ideas. I am sorry you are having problems too, but I was thinking I was the only one with this!

 
Old 06-07-2010, 02:06 PM   #4
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Re: One Swollen Knee

I should add that infection is positive in joint fluid only 60.8% of the time and when the infection comes years after the replacement, the only way to really know it isn't an infection is to biopsy the tissue inside the knee joint as most "late infections"(those that didn't occur within 1 year of replacement) are of a type that have a "slime coating" and don't appear in the joint fluid.

But the presence of RA factor says it is probably RA but you can't rule out infection. I'll send you more info if you'd like.

Jenny

 
Old 06-07-2010, 03:30 PM   #5
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Re: One Swollen Knee

Thanks Jenny, I'll keep that in mind. I forgot to say that my ortho surgeon also had me do a nuclear scan to rule out infection . I'm looking forward to what the rheumy says on Thurs.

 
Old 07-29-2010, 03:34 PM   #6
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Re: One Swollen Knee

Hi knee replacement sufferers! I've had both knees replaced and the right one revised. I was about 2 months ago in severe pain in my l knee and had a bone scan done. Now he wants an "indium label wbc" done, but having read about synovitis and its symptoms, i am almost positive that is what this is! I dont think i should have to go thru the blood work to see if its infection. Plus, its starting to not hurt hardly at all anymore. Can infection work itself out?

Last edited by ellen122; 07-29-2010 at 03:36 PM. Reason: DID I SAY I WAS EXTREMELY NEEDLE PHOEBIC!!!

 
Old 07-29-2010, 07:43 PM   #7
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Re: One Swollen Knee

You can get many different types of infections in your knees including viral, fungal and bacterial...and let's not forget about things like Lyme disease in a joint too. I was in the hospital in March for 5 days when my doc thought I might have infections in both knees.

What he needs to do is a sterile knee tap and have the fluid checked for infection and other problems. That's what I had done...several of them until the fluid returned to normal. Sounds more like he's checking to see if the implant has loosened or bone is eroding if he's doing a labeled scan. Infection is checked by direct testing of the joint fluid itself, unless he's looking for an infection in the bone, instead. That is different.

What has he told you so far?

Jenny

 
Old 07-29-2010, 09:48 PM   #8
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Re: One Swollen Knee

Hi and thanks so much for replying. I had the bone scan, then the radiologist sent him a note saying he found "possible infection" and advised an "indium label wbc(white blood count) so, that is supposed to be done next week, but, a copy of the report i received from the bone scan rveals "there is no evidence of loosening and these findings are consistant w/the presence of inflammation. Synovitis would be a common explanation of this although if an infectious process is a concern, correlation w/white cells and/or gallium imaging may be helpful. A letter from dr. Christianson indicated that the bone scan came out positive however, "they were not sure if it was an infection or just a synovitis".
So this is where i stand right now. I am scared to death of needles and this whole picture is painted w/them!! What do you think jenny?

 
Old 07-30-2010, 09:43 AM   #9
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Re: One Swollen Knee

As I mentioned, infections in the joint itself can be of many kinds but only the bacterial kind require they do anything about it surgically. If they suspect the infection is not in the joint but in the bone, they need to do more to figure out if it is and the treat that. I'm not sure what they are after as my treatment was very different. All they did was tap the knees over and over and over again to test for different kinds of infection and inflammation. I only has x-rays done and no bone scans or anything else. So I'm still not sure which they are looking for.

Bone scans are usually done for infections in the bone itself and that can happen and cause loosening eventually also explaining your pain(but it sounds like that been ruled out) your pain. It might have to surgically cleaned out and then you put on antibiotics or just a long course of antibiotics.

If the infection is in the replaced joint and it's bacterial, it's a whole other thing. They have to remove the implant and treat the knee with antibiotics and then put a new implant back in when the infection is clear. It's a tough situation but it rarely occurs years after the surgery. If it's a virus or other type of infection, they may leave it alone for the body to work through.

To this day no one knows what happened to my 2 knees. One theory is that I developed secondary gout to my RA but they never got any crystals out of the knee. On the other hand, I had been sick with a stomach virus earlier in the same week....got really sick really fast, vomiting all over the place. Then 4 days later, the knees blew up and they stuff they took out looked just like pus. My WBC count was 20,000....high enough to be either gout or an infection. But after those initial knee joint taps, everything time they tapped them they got nothing but blood. My doc's PA said that with some kinds of infections, the body starts to clean itself out by bleeding into the joint and then heal itself. And I think that is what happened. Took about 3 months until I felt better but at least I didn't have major surgery on both knees.

I know it's scary and the thought of having your doc put a needle in your knee is scary but it's not that painful and my knees always felt better after wards because they got the junk out of my knee. It's the swelling that makes the joint hurt so taking that away was relief...the hard way.

If tapping your knee is what he has to do, just lay very still, ask to hold the assistant's hand for assurance and don't watch....you'd be laying down anyhow. It's over in a couple of seconds.

If it's a bone infection, then they have to figure out a way to attack it and that usually means antibiotics and "possibly" surgery to clean out the dead bone.

Just take it one day at a time and don't panic. Don't stress over the needles. You won't see it and it's not that bad. Because I have allergies to certain meds, I have them done with no local anesthetic of any kind, spray on skin stuff or the injected stuff. If I can go through having them done on both knees every day for 4 straight days, then you can get through one. I'm not brave but when I know it has to be done, I know that stressing myself out will only make it hurt more. So I try to stay very calm and trust my doc.

Trust that he is going to try to treat you as best he can and be as gentle as he can.

And if you get stressed out, come here and vent. I'm helping my son and his family move into a new house this weekend(closing as I type this)so I will try to get on as frequently as I can but please excuse me if I'm not immediately available. I know how scared you are. I was there, 2 times over, in March.

gentle hugs...............Jenny

 
Old 07-31-2010, 08:58 AM   #10
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Re: One Swollen Knee

Quote:
Originally Posted by jennybyc View Post
As I mentioned, infections in the joint itself can be of many kinds but only the bacterial kind require they do anything about it surgically. If they suspect the infection is not in the joint but in the bone, they need to do more to figure out if it is and the treat that. I'm not sure what they are after as my treatment was very different. All they did was tap the knees over and over and over again to test for different kinds of infection and inflammation. I only has x-rays done and no bone scans or anything else. So I'm still not sure which they are looking for.

Bone scans are usually done for infections in the bone itself and that can happen and cause loosening eventually also explaining your pain(but it sounds like that been ruled out) your pain. It might have to surgically cleaned out and then you put on antibiotics or just a long course of antibiotics.

If the infection is in the replaced joint and it's bacterial, it's a whole other thing. They have to remove the implant and treat the knee with antibiotics and then put a new implant back in when the infection is clear. It's a tough situation but it rarely occurs years after the surgery. If it's a virus or other type of infection, they may leave it alone for the body to work through.

To this day no one knows what happened to my 2 knees. One theory is that I developed secondary gout to my RA but they never got any crystals out of the knee. On the other hand, I had been sick with a stomach virus earlier in the same week....got really sick really fast, vomiting all over the place. Then 4 days later, the knees blew up and they stuff they took out looked just like pus. My WBC count was 20,000....high enough to be either gout or an infection. But after those initial knee joint taps, everything time they tapped them they got nothing but blood. My doc's PA said that with some kinds of infections, the body starts to clean itself out by bleeding into the joint and then heal itself. And I think that is what happened. Took about 3 months until I felt better but at least I didn't have major surgery on both knees.

I know it's scary and the thought of having your doc put a needle in your knee is scary but it's not that painful and my knees always felt better after wards because they got the junk out of my knee. It's the swelling that makes the joint hurt so taking that away was relief...the hard way.

If tapping your knee is what he has to do, just lay very still, ask to hold the assistant's hand for assurance and don't watch....you'd be laying down anyhow. It's over in a couple of seconds.

If it's a bone infection, then they have to figure out a way to attack it and that usually means antibiotics and "possibly" surgery to clean out the dead bone.

Just take it one day at a time and don't panic. Don't stress over the needles. You won't see it and it's not that bad. Because I have allergies to certain meds, I have them done with no local anesthetic of any kind, spray on skin stuff or the injected stuff. If I can go through having them done on both knees every day for 4 straight days, then you can get through one. I'm not brave but when I know it has to be done, I know that stressing myself out will only make it hurt more. So I try to stay very calm and trust my doc.

Trust that he is going to try to treat you as best he can and be as gentle as he can.

And if you get stressed out, come here and vent. I'm helping my son and his family move into a new house this weekend(closing as I type this)so I will try to get on as frequently as I can but please excuse me if I'm not immediately available. I know how scared you are. I was there, 2 times over, in March.

gentle hugs...............Jenny

 
Old 07-31-2010, 09:03 AM   #11
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Re: One Swollen Knee

Thanks jenny!! I identify with the part about the infection working itself out. I really think that's what's happening right now. I went w/a friend to a flea market and was able to walk for 1 hr. I timed it. I keep taking ibprophen each a.m./p.m. And i think its working. The test isnt scheduled until aug.12th so i won't cancel it until the last part of that week, but maybe i'm getting better?

Congrats to your son and family on a new home! Email when your relaxed and have some time.

And thank you for making me feel so much more comfortable w/this procedure. I have a friend going w/me.
Your new on-line friend, ellen

 
Old 08-31-2010, 04:26 AM   #12
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Re: One Swollen Knee

Just an update on knee that maybe might help someone else. I went to see my ortho who said maybe it's time to look in the knee. Yesterday I had arthroscopy done and he found a piece of bone and extremely inflamed synovial lining and removed both. Post op I have not had too much pain , just uncomfortable. I haven't talked to him yet, this is what he told my husband.

So I'm really glad I had the surgery and am hoping it does the trick so I can go for walks again!

 
Old 08-31-2010, 04:32 PM   #13
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Re: One Swollen Knee

Glad to know how it came out! Thank you, Pinetree!

I wonder where that piece of bone came from? That is strange. Ask him for me and let me know. And the synovectomy will help with the RA. Wish I'd had it done too.

My knees are still giving me some trouble but are much better. They blew up again in late June and I figured out what might be behind it. My primary had me taking niacin for high triglycerides. High doses of niacin can trigger gout. and every time I got back on it, I felt worse even though I was doses lower than those that usually trigger it. but I finally did get my dose up there and "BAM" my knees, toes and left ankle blew up in great pain. So they stopped the niacin and I've been better but the left knee is still continuing to swell up. My rheumy says the gout may be here to stay and can be secondary to RA.

I'm glad you got some answers even though it took surgery to find them. I hope this stops the pain for you.

Let me know what the ortho says.

gentle hugs.............Jenny

 
Old 08-31-2010, 07:21 PM   #14
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Re: One Swollen Knee

[
hi jenny, just a line to let you know the outcome of my knee injury. It was a bone infection called "synvititus" or something like that. Very painful but by the time the insurance authorized treatment after the diagnosis, it had almost gone away! Anyway, feeling better and able to go on walks with the girls(dogs) again. Hope all gets better for you. Your knee bud ellen

 
Old 09-01-2010, 07:19 PM   #15
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Re: One Swollen Knee

You probably had synovitis...it's the lining of the knee joint and when it gets infected or inflamed, it really hurts.

I'm glad it has settled down and I wish I could say the same for my knees but the left one just last week got really painful.

Oh well, what next...right? As long as it just keeps getting better.

hugs to you and your knee..................Jenny

 
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