Why puffy knees can be a sign of “silent” arthritis

The pain was innocuous enough at first, says Melanie Hutt.

‘It started with slight swellings in my ankles and knees, and a little pain occasionally,’ recalls the 31-year-old charity fundraiser from London.

‘I mentioned it to my GP, and was told that people have all sorts of aches and pains, and it was probably nothing to worry about.’

“I was getting a lot of stiffness, especially in the morning, and it had spread to my toes, fingers and elbows,” said Melanie Hutt

But as time went on, Melanie’s symptoms worsened.

‘I was getting a lot of stiffness, especially in the morning, and it had spread to my toes, fingers and elbows.’

Melanie had to live with this crippling pain for two years before a GP spotted it might be rheumatoid arthritis.

‘She referred me to a rheumatologist, and it was finally diagnosed,’ says Melanie.

‘I was put on to an anti-inflammatory drug and had a general steroid injection for the pain. There were improvements straight away.’

Rheumatoid arthritis, in which the body’s immune system over-reacts, causing inflammation, heat, pain and swelling in the joints, affects more than half a million people in Britain, with women and the over-40s most at risk.

Yet according to leading arthritis charities, thousands of people may be living with the condition without knowing it, because both patients and GPs are ignorant of the symptoms.

Worryingly, they warn that if the condition is not treated within three months of the symptoms starting, patients are at risk of joint damage and long-term disability and pain.

Without prompt action, the chronic inflammation also increases the risk of other health problems, including heart disease.

As a result, patients with rheumatoid arthritis are at risk of dying five to ten years earlier than average.

A new survey by Arthritis Research UK and the National Rheumatoid Arthritis Society found that nearly six out of ten people had experienced some of the symptoms associated with rheumatoid arthritis.

However, many ignored them, with almost half assuming pain, stiffness and swelling in the joints was a normal part of ageing, and a third putting it down to overdoing it in the gym or garden.


It”s not known what causes rheumatoid arthritis, although genetic susceptibility and environmental factors, such as a viral or bacterial infection may trigger it

‘There are too many people in the UK with the symptoms of inflammatory and rheumatoid arthritis who are not seeking treatment,’ says Professor Alan Silman, medical director at Arthritis Research UK.

‘The first 12 weeks of symptoms developing are critical — if arthritis is caught in this time and treated aggressively, there is less joint damage and reduced chance of long-term disability.’

It’s not known what causes rheumatoid arthritis, although genetic susceptibility and environmental factors, such as a viral or bacterial infection may trigger it.

Symptoms include stiffness first thing in the morning that lasts for at least an hour and swelling and pain in the affected joints which are usually warm and swollen.

Although it mostly develops in the wrists and knuckles, the knees and joints of the ball of the foot, shoulders and elbows are often affected as well. The condition is usually diagnosed with a blood test.

There is no cure, but there are a number of treatments, including painkillers and anti-rheumatic drugs, which slow down the progression of the disease and ease symptoms.

In some cases surgery, including joint replacements or synovectomy — removal of the lining of an inflamed joint — may be necessary.

However, drugs work properly only in 50 to 70 per cent of patients.

In an effort to overcome this problem, scientists have recently announced that they are developing a new treatment for the condition — a type of vaccine that ‘re-sets’ the immune system in rheumatoid arthritis sufferers so it doesn’t overreact.

This injectable treatment requires doctors to first take a blood sample from the patient. They then extract a type of white blood cell called dendritic cells — these form part of the immune system and their job is to switch other immune cells into ‘fight’ mode when the body is under attack.

For some reason, in rheumatoid arthritis these cells fire-up the immune system and it begins to mistakenly attack healthy tissue.

Scientists at the University of Queensland have found if they add an existing anti-inflammatory drug called Bay11-7082 to the dendritic cells before injecting them back into the body, it seems to stop the immune system from overreacting.

The results of a trial on 29 patients showed those with the worst symptoms had the greatest benefit.

Six months after receiving a jab, patients reported reduced pain and better mobility. Blood tests also revealed a significant drop in levels of inflammatory chemicals circulating in the body.

British experts believe this kind of therapy could be the key to controlling the disease in the future.

Arthritis Research UK spokesman Professor John Isaacs, who is carrying out similar research into rheumatoid arthritis vaccines at Newcastle University, said: ‘This area of research is all about trying to switch off the disease. If we can do that, it would be hugely significant. The research is in its early stages, but it looks very encouraging.’

But until these treatments become widely available, early diagnosis and treatment is vital, says consultant rheumatologist Dr Karim Raza, of Birmingham University.

‘Drugs like methotrexate, which control rheumatoid arthritis by suppressing the immune system response, work best if used early and can, in many patients, lead to ‘remission’ — a state where there is virtually no evidence of ongoing joint inflammation.’

He adds, ‘It takes, on average, six months from the onset of symptoms before a patient sees a rheumatologist.

‘Much of this is because patients delay seeing their GP. There are, of course, also cases where the delay is on the part of the healthcare system — for example, delays by GPs in referring patients to specialists.’

The charities behind the new survey have now launched a campaign to highlight the three key symptoms to look out for: early morning joint stiffness lasting more than 30 minutes; persistent swelling of one joint or more, especially hand joints; and pain when joints are squeezed.

For more information, visit arthritisresearchuk.org.

Additional reporting: PAT HAGAN.