Arthritis knee pain is likely if you found very tender spots on your knee's joint lines, more than on the bone just above and below them.

If one of your knees feels very knobbly here, it is even more likely.

Finding tenderness on the back of your patella as well, would also be consistent with this.

A plain x-ray of your knee¹ is the clincher.

In osteoarthritis, as in the X-ray on the left, the knee cartilage has become thinner. It can wear away, even exposing the underlying bone. You may be well aware of this because you feel arthritis knee pain and can hear crackly or grating noise when your joints move.

The ligaments holding the bones of the joint together, become shortened.

The bone under the gristle, becomes more dense. At the edges of the gristle, the bone develops protruding lumps. These are often easy to feel on fingers and the knee.

bone appearance in knee osteoarthritis

Magnetic resonance imaging (MRI) is more sensitive, showing cartilage changes much earlier than X-ray.

Fat-suppressed MRI sequences which are more fluid-sensitive than conventional MRI can show subchondral bone marrow oedema-like lesions3 (BMLs.)
"These BMLs appear to be sclerotic compared with unaffected regions from the same individual based on the increased bone volume fraction and increased trabecular thickness. The mineral density in these lesions, however, is reduced and may render this area to be mechanically compromised,
The body has thickened up the bone here, but it isn't well mineralized bone. This probably explains why calcium injections can help.

Osteoarthritis explained

Joints between bones normally allow free movement, within limits which depend on the shapes of the bones and the length of the ligaments joining them.

This freedom of movement depends on cartilage (gristle,) which covers the bone ends. This is very smooth and is well lubricated.

In this common form of arthritis, initially the articular cartilage is unable to maintain itself and breaks down, becoming rough and stringy.

Rheumatoid arthritis is primarily due to inflammation, with mechanical damage a secondary result. Osteoarthritis is primarily a mechanical breakdown, with (mild) inflammation as a secondary result.

It happens especially in the joints of the spine,the hip, knees and hands.In the inherited “primary generalized osteoarthritis” knobs form on the fingers, on each side just before the start of the fingernail.

It often develops as a late result of injury to joints.

In the knee and ankle particularly, it is a complication of being overweight.

Hereditary hemochromatosisˢᵉᵉ ᵇᵉˡᵒʷ causes osteoarthritis. The hands are usually affected first, followed by the large joints of the lower extremities and spine. Even without a family history, ensure that your iron levels are checked.

DESPITE ALL THIS, OSTEOARTHRITIS IS NOT USUALLY A PAINFUL CONDITION! People can be walking around unaware of it, with joints which have definite disease on X-ray and no arthritis knee pain.

When an osteoarthritic knee itself is painful, the pain cannnot come from damaged gristle, as this has no nerves. The pain probably mostly comes from the bone immediately under the gristle.

Episodes of pain and swelling - inflammatory osteoarthritis

Painful episodes (even with swelling and heat) can result from internal derangements in an arthritic knee. Semilunar Cartilages can tear and pieces of articular cartilage can break off the bone ends into the joint cavity.

Inflammatory osteoarthritis can have food intolerance reactions maintaining it. The nightshade family get a lot of publicity in this regard, but good old cows milk is the commonest culprit.

It is well worth going on an allergy elimination diet to check this out. One form of such a diet is to include only foods you eat once a week or less often. The reasoning behind this is that if they were a problem, you would have become aware of it long ago.

So diet for osteoarthritis patients needs to be individualized, with the possibility of food intolerance in mind.

The role of your muscles in osteoarthritis

Continual pain when present, often comes from the muscles rather than the joint.

As well as the bony changes described above, the muscles which control the movement of the joint, can become weaker and/or tighter. They may then be tender so it hurts to press on or stretch them.

Joint movement is then further restricted, and abnormal movements may become possible, causing further damage.

The muscles need to be regularly exercised and stretched to prevent this.

Specifically in the knee, the first movement to become restricted is fully straightening your knee, due to hamstring shortening.

Hereditary haemochromatosis

This condition is excessive iron accumulation in the body, due to mutation in the HFE gene increasing iron uptake in the gut.

Common symptoms include weakness, fatigue, arthralgia (joint pain) and arthritis, intermittent abdominal pain, loss of libido, and impotence.

Symptoms appear 10 or so years earlier in middle aged men, because women lose iron during menstruation and pregnancy in their reproductive years.

Too much iron is always a potential hazard², even without this genetic background. Sam Queen of the Institute of Health Realities uses the the proportion of the blood iron carrier protein which is occupied by iron (transferrin saturation) as one of his danger markers in body chemistry.

More on arthritis knee pain medications and treatments.

Cramping, tight pain in your calf when walking?

Notes and references for arthritis knee pain page

1. A standing, weight bearing X-ray gives a more accurate idea of the loss of gristle. This is shown by the "joint space narrowing" - the reduced distance between the bones.

It also gives the "static alignment" of the bones - whether there is knock knee or bandy knee deformity.

2. Mursu J et al Dietary supplements and mortality rate in older women: The Iowa Women's Health Study. Arch Intern Med. 2011;171:1625-1633.
This is an observational study, the sort which can show an association but not prove cause and effect. It is like the Nurses Health Study which incorrectly attributed health benefits to oestrogen and progestin HRT.
See the study at...

3. See under "imaging" on Osteoarthritis of the spine: the facet joints

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