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Dr Basu
Dr Basu, Experienced Specialist
Category: Medical
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Experience:  MD
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Im a 71 year old male. Have stiff joints for many years, but

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I'm a 71 year old male. Have stiff joints for many years, but no pain. My RA doctor precribes Flurbiprofen, 200 mg daily. Works great. 2 months ago while walking my knee just starts to hurt. After a few days I go to Urgent Care. Dr takes x-ray but doesn't see anything wrong and refers me to an Orth Surgeon. Surgeon takes MRI and says I have a torn meniscus that needs to be scoped. But he also says I'll need total knee replacement in 3 months. Sounds aggressive to me. He gives me a corisone shot in knee and 3 gel shots a week apart. During this time I'm also going for PT 3 times a week. But I'm getting worse every day, especially days of therapy. Severe pain, not just discomfort. I go see my RA doctor and another ortho surgeon. Neither mentions knee replacement. First they said inflammed bursa and I get a bursa shot from RA. No help. Now RA says it's a soft tissue problem, and another shot yesterday. Per his advice I rode the staionary bike, no resistance , 10 minutes yesterday. I've been in agony ever since. I'll await further questions.
The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.

Hi there,
This is Dr. D.J., experienced Internal Medicine Specialist.
I am here to address your concerns and provide great service.

Did you see any improvement with the gel shots and cortisone shots in the knee joint?
Also, do you hear clicking noise with knee movement?
Customer: replied 2 years ago.

No improvement from gel shots or shot in knee. Shot in bursa left of center helped that spot. Pain is below knee where RA gave bursa and soft tissue shots. No clicking noise.

Then you may still have chronic bursitis and soft tissue related problem.
RA can affect the surrounding tissues of the joint.
Knee osteoarthritis may be present as well but may not be that advanced requiring knee replacement.
Probably repeated cortisone shot may be helpful.
Also physical therapy should be moderated to avoid worsening of the symptoms.
The therapy should focus on strengthening the knee muscles and avoid too much weight bearing and high impact activities like running or jogging.
Now do you notice any swelling around the knee joint?
Customer: replied 2 years ago.

No swelling. Running, jogging!! I can barely walk with a walker. The pain is that bad.

In this case, I will suggest a second review of the MRI to see if there is significant arthritis in the joint.
If there is no tear, then meniscal tear repair arthroscopically may be a solution.
Of course RA can get worse over time.
If surgery is not an option, then I will suggest other RA medications like methotrexate to help with your symptoms.

Best wishes
Customer: replied 2 years ago.

I have Ostheoarthritis. Your meniscus comment is confusing. I've already had torn meniscus surgery.

Thanks for the clarification.
In that case, you will likely need total knee replacement surgery.
The conservative options have been exhausted --injections, physical therapy.
Given your situation, your healthy knee will be affected from overuse if you do not address the 'bad knee' soon.
RA medications are your only other option before considering surgery if the recent cortisone shot does not provide adequate relief.

Best wishes
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