Hello Drs.,
My 56-years old Dad, who is a physically pretty active man for his age, is dealing with a recurring swelling of his knee (type 4, i.e. “bone on bone”, osteoarthritis). This started to occure after he presumably overexerted his knee during a three day act of renovating a room in his house in March this year. About one month prior to that, he started taking 1,25mg Bisoprolol and 2,5 mg Rivaroxaban daily due to an incident of atrial fibrillation.
Could there be a connection between taking this medication an a susceptibility to (knee) swelling?
I am of the opinion that the re-swelling is more likely due to the fact that he always starts to reload the knee too quickly whenever the swelling goes away by cycle too far (40+ km) or hiking too much or a combination of both.
Thanks in advance
Theoretically there is a risk of bleeding into joints (known as a “hemarthrosis”), however this would be extremely uncommon on such a low dose of rivaroxaban.
Transient joint swelling is quite common in osteoarthritis alone, and I think you are right that this is more likely to be related to the rate of loading compared to his level of adaptation. When discussing this with him I would NOT frame it as a “wear and tear” issue (since this leads many patients to avoid activity/loading), but rather that the dose of activity needs to be increased more gradually based on his tolerance over time.
Thanks Austin for your response. Unfortunately I had two typos, first the daily dose of rivaroxaban is 20mg (not 2,5mg) and the age of my father is 66 not 56.
Being a long time follower of your material I was aware of not framing it as a “wear and tear” issue but the picture has already been firmly painted by each and every medical practitioner he has ever seen. Avoiding activity is not the problem, the problem is rather that the “mechanical picture” of the joints leads to thinking that the knee simply needs to be replaced like a spare part in a car. I don’t think that replacing the knee is the solution, necessarily, as he could tolerate a lot of activity (like regularly cycling 100km in a day) before the incident of overtaxing his knee in March. And even since then he had days where he cycled 50-60km a day because he felt well but the knee just has swollen afterwards. He does not get the idea of gradually increasing the load. For example he says that the cycled 20km several times without problems then he “slightly” increased to 40km and the knee has been swollen the following day.
Unfortunately, I’m afraid his mind is made up and the knee replacement is about to come.