Knee joints, which bear the brunt of almost all our actions, or inaction for that matter, are prone to aches and pains. Often, the aches are managed with the topical application of anti-inflammatory gels or sprays, and at times, with over-the-counter painkillers. However, if the pain persists, and consistently worsens, leading to swelling and difficulty in performing regular activities, it could be a sign of something more serious – knee synovitis or angry knee.
Angry knee or synovitis, considered a precursor to rheumatoid arthritis, affects people of all ages, says Bishwaranjan Das, consultant extended scope physiotherapist (hip, knee and sports injury), Kasturba Medical College Hospital, Mangaluru, India.
The condition is alarmingly common. “Nearly 30 to 40 per cent of individuals visiting me every day have an angry knee,” says Das. “Nearly 70 per cent of this number are youngsters.”
What is knee synovitis?
Synovium is a soft-tissue membrane that envelopes the joints in the knees, elbows, shoulders, feet, ankles and wrists. This membrane contains the synovial fluid, a lubricant for the joints. An infected, inflamed or degenerated synovium causes synovitis (angry knee).
Though synovium is present in all the major joints in the human body, synovial disorders are mostly seen in the knee joints, avers a 2020 study by Dr Tarun Goyal and team of the All India Institute of Medical Sciences.
Same symptoms, two causes: case studies
The symptoms of an angry knee include drastic swelling and pain in the knee; difficulty in moving the knee for everyday activities (such as getting in and out of the car and negotiating stairs) and redness and warmth around the knee.
“This condition [synovitis] is common in two types of individuals — those with inflammatory arthritis (rheumatoid arthritis), and those with degenerative arthritis (osteoarthritis). While the former is prevalent in young and middle-aged individuals; the latter is a degenerative condition that occurs due to age-related wear and tear among the elderly,” says Dr Sagar Umerjikar, an orthopaedic surgeon from Kalaburagi, Karnataka, India.
Preetika Naik and Kalavathi Pradeep, who consulted Dr Umerijikar, represent the two distinct groups.
Naik, a homemaker from Kalaburagi, was diagnosed with synovitis caused by rheumatoid arthritis when she turned 40.
“I had a stressful week with the children’s exams and household chores, I experienced a sudden and acute swelling in my left knee one evening,” recalls Naik. “I thought one day’s rest would heal the pain. But the pain persisted for five days, and I also experienced sharp stiffness in my knee joints early morning. I visited my orthopaedic doctor, and the doctor examined my knee for any history of trauma. Clinical diagnosis indicated a warmth around the knee, swelling in the kneecap, limited range of movement of the kneecap, increased fluid in the knee cap.”
Pradeep, a receptionist at a grocery store in Kalaburgi, was 60 when she experienced increasing pain in both knee joints. “I had this pain for two years, but the pain increased after my retirement,” she says. “I had no history of injury. Hence I never visited the doctor assuming the pain would fade.”
Pradeep’s deformity was progressing drastically at that point. Gait was affected and the movement range of the knee joints was restricted due to pain and deformity.
“Ms Pradeep came in with drastic knee swelling, joint line tenderness due to degeneration and consistent pain. Ms Naik came in with drastic knee swelling, knee-joint malalignment, gait issues, deformity and limited range of knee movement,” says Dr Umerjikar. “Ms Naik was diagnosed with synovitis with rheumatoid arthritis. Ms Pradeep may have developed degenerative arthritis (osteoarthritis) in the last few years and because it was not treated, it has led to synovitis.”
Are women more prone?
A sedentary lifestyle and obesity are the primary causes of the angry knee. A bad or neglected knee injury, bad posture, and subtle bone malalignment, mostly seen in women, are the other main reasons.
“Sitting idle or sedentary for long hours with a bent knee (more than 90 degrees) can increase pressure on the kneecap and induce knee-joint inflammation or proliferation,” says Das. “Those who have developed arthritis can develop synovitis if the condition is left untreated.”
Dr Umerjikar adds, “Women are more prone to inflammatory arthritis than men.”
Das gives a rationale for this observation. “Most women have subtle bone malalignment that can give rise to these issues as they age,” he explains. “Secondly, metabolic changes that arise due to menopause induce numerous bodily changes that could lead to early arthritis and in turn lead to synovial inflammation as well.”
Treating the angry knee
The conventional treatment involves medication and rehab.
“Treatment should be a combination of rehabilitation (physiotherapy), medications and injection therapy,” says Dr Das. “Chondroprotective (tablets that protect the cartilage), collagen supplements are administered to reduce knee joint inflammation. Additionally, injection therapy (including steroid injection, stem cell therapy or platelet-rich plasma or PRP therapy) is also recommended.”
Dr Umerjikar elaborates on another approach— DMARDs (disease-modifying antirheumatic drugs) in the case of rheumatoid arthritis. “It can also include compression bandages for the knee. In chronic cases, inflamed synovium is treated arthroscopically (keyhole surgery for checking or repairing the joints) or as part of total knee replacement.”
Surgical intervention could be employed if rehabilitation does not help. The most common surgical procedure to remove the synovial fluid is arthroscopic synovectomy, which is preferred over open synovectomy since it allows for ‘fast recovery, less postoperative pain, and excellent cosmetic effect’.
Preventing the angry knee
It is important not to neglect knee pain or injury. An angry knee caused by bad posture can be easily prevented through:
- Regular physical exercise along with gait training: Subtle bone abnormalities force people to walk in a manner wherein the angle at the hip level is slightly more than normal (for instance, walking pigeon-toed, also known as in-toeing, or catwalk) can lead to bone abnormalities. This can be corrected through gait training
- Taking care of posture
- Regular exercise and leading an active lifestyle
Takeaways
- Angry knee or synovitis is a precursor to rheumatoid arthritis and affects people of all ages.
- The symptoms include swelling and pain in the knee, difficulty in moving the knee for everyday activities and redness and warmth around the knee.
- Sedentary lifestyle and obesity are the primary causes of the angry knee. Subtle bone malalignment, mostly seen in women, is another reason.
- The treatment involves medication and rehabilitation with surgical intervention in extreme cases.
