From the Guidelines
Knee effusion should be treated with a combination of rest, ice, compression, and elevation (RICE) for 2-3 days, along with over-the-counter anti-inflammatory medications like ibuprofen (400-800 mg every 6-8 hours) or naproxen (220-440 mg every 12 hours), and if symptoms persist, aspiration or corticosteroid injection may be recommended. For immediate relief:
- Rest the affected knee and avoid weight-bearing activities.
- Apply ice for 15-20 minutes every 2-3 hours.
- Use a compression bandage to reduce swelling.
- Elevate the leg above heart level when resting. If symptoms persist beyond a week or are severe, consult a doctor. They may recommend:
- Aspiration (draining fluid from the knee) as indicated by 1, which can provide immediate relief by removing excess fluid.
- Corticosteroid injection (e.g., methylprednisolone 40-80 mg) as indicated by 1, which can offer powerful anti-inflammatory effects directly in the joint.
- Physical therapy exercises to strengthen surrounding muscles. The RICE method helps reduce inflammation and pain by limiting blood flow to the area and reducing tissue swelling. Anti-inflammatory medications work by inhibiting prostaglandin production, which contributes to inflammation and pain. In more severe cases, aspiration can provide immediate relief by removing excess fluid, while corticosteroids offer powerful anti-inflammatory effects directly in the joint. According to 1, ultrasound-guided aspirations of soft tissue fluid collections and joint effusions is becoming increasingly common and can be useful for detecting fluid, including joint effusions. It is essential to note that the treatment should be tailored to the individual patient, taking into account factors such as age, comorbidity, and the presence of inflammation, as recommended by 1 and 1. In addition, paracetamol is the oral analgesic to try first and, if successful, the preferred long-term oral analgesic, as indicated by 1 and 1. NSAIDs should be considered in patients unresponsive to paracetamol, especially in the presence of clinically overt synovitis, as indicated by 1. Intra-articular injection of long-acting corticosteroid is indicated for flare of knee pain, especially if accompanied by effusion, as recommended by 1. SYSADOA (glucosamine sulphate, chondroitin sulphate, diacerein, and hyaluronic acid) may possess structure modification properties, but more studies are required to confirm their efficacy, as indicated by 1 and 1.
From the Research
Diagnosis of Knee Effusion
- Knee effusion, also known as fluid accumulation in the knee joint, can be diagnosed through various methods, including physical examination, musculoskeletal ultrasonography (US), and synovial fluid analysis 2.
- The diagnosis of knee effusion is often based on the presence of fluid in the knee joint, which can be measured using ultrasonography, with fluid > 4 mm considered as effusion 2.
Treatment of Knee Effusion
- Conservative treatment options for knee effusion include non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, hyaluronic acid, and chondroprotectors 3, 4.
- Intra-articular injections, such as anakinra, an IL-1 receptor antagonist, have shown promising results in reducing knee effusion and improving symptoms 5.
- Low-dose spironolactone has also been found to be a safe and effective medical treatment for osteoarthritis-related knee effusion 2.
- A cell-free formulation for articular cartilage regeneration (BIOF2) has been shown to be a safe and effective therapeutic alternative when combined with usual medical care for knee osteoarthritis 6.
- Treatment outcomes may vary depending on the presence of comorbidities, such as obesity or malalignment conditions, which can affect the efficacy of treatment 6.