About 30 percent of people with psoriasis develop psoriatic arthritis (PsA). Like rheumatoid arthritis, PsA is an inflammatory arthritis that happens when the body’s immune system mistakenly attacks its own healthy tissues.

PsA has five different types and can affect one joint or many. It often shows up in the leg joints, like the knees, causing pain, swelling, and stiffness. One type, called the polyarticular symmetric subtype, affects the same joints on both sides of the body — usually the small joints in the hands.

A rheumatologist can help identify PsA signs and symptoms. They can recommend the right treatments to ease pain and protect your joints from damage.

Impacts of Psoriatic Arthritis in the Knees

PsA tends to be asymmetric. That means it affects different joints on either side of the body. For example, your right knee and left elbow may be affected. Symptoms in the knees can be mild and develop slowly. They may also arise suddenly and severely. Arthritis usually starts after the skin symptoms of psoriasis, but not always. In addition to pain, swelling, and stiffness in the knee joints, PsA can lead to other inflammatory problems, known as enthesitis and peripheral arthritis.

Enthesitis

Enthesitis refers to inflammation in the entheses, which is where ligaments or tendons insert into the bones. There are more than 100 enthesis points in the body, and inflammation in one can lead to pain and stiffness in the area, especially when you move. It can also result in bone spurs (abnormal growths that develop on the edge of a bone), as well as pitting and separation of the fingernails and toenails from the nail bed.

Although anyone can develop enthesitis, the condition is far more prevalent among people with PsA. In fact, because it affects an estimated 1 in 3 people with PsA, enthesitis has been referred to as a hallmark of psoriatic arthritis. Because it is so common in PsA, rheumatologists often consider enthesitis to be a clue that the person has PsA versus another type of arthritis.

Enthesitis usually starts early on in people with PsA, affecting areas like the shoulders, elbows, hips, and heels.

Peripheral Arthritis

Peripheral arthritis is a type of arthritis that affects joints in your arms and legs. In PsA, it usually shows up in the knees, elbows, wrists, or ankles. According to the Arthritis Foundation, it’s common for people with PsA to have this kind of arthritis.

The pain may move from one joint to another. If it’s not treated, the pain can last anywhere from a few days to several weeks.

What Does PsA in the Knees Feel Like?

Many MyPsoriasisTeam members have shared how it feels to have PsA affect their knees. One MyPsoriasisTeam member wrote that their left knee was “hot to the touch” and that pain had spread to the area behind their knees. Another member with psoriasis and PsA commented, “I don’t know which is worse — the knee pain or the psoriasis.”

Some members have shared what it’s like to deal with a limited range of motion as a result of their PsA. One member, describing the stiffness they felt while walking, wrote: “I felt like I was walking like a robot because my knees were so stiff and wouldn’t bend right.” This member added that although they “made it through,” they still experienced stiffness and some back-of-knee pain on one side the next day. Another member reported experiencing similar symptoms, writing: “There are days my knees and legs lock up.”

Many MyPsoriasisTeam members have expressed frustration while waiting to have surgery to help ease their symptoms. As one member wrote, “The pain in my knees is getting worse every day. I’m not sure how much longer I can keep putting off knee replacement surgery. I was told a year ago that was pretty much my last option.”

Treating and Managing PsA in the Knees

It’s important to let your healthcare provider know if you experience signs and symptoms of psoriatic arthritis in one or both knees. Even a six-month delay in diagnosis or treatment can affect how well you can manage the disease.

Being diagnosed with PsA may involve X-rays, ultrasounds, and blood tests, along with a thorough exam of your joints. If your doctor decides that PsA is responsible for your knee symptoms, they’ll work with you on a treatment plan.

Medications

PsA medications control inflammation to help reduce joint pain and prevent joint damage. In addition to prescription treatment, certain over-the-counter medicines can also improve your symptoms.

Here are some medications that may help manage PsA in the knees:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are available over the counter and by prescription to reduce joint pain and inflammation.
• Disease-modifying antirheumatic drugs (DMARDs) are prescription treatments to slow PsA disease progression.
• Biologics are a group of drugs that target specific cells or proteins in the immune system for PsA treatment.
• Janus-kinase inhibitors (JAK inhibitors) target one specific pathway in the immune system that’s overactive with PsA (different from biologics).
• Phosphodiesterase 4 inhibitors (PDE4 inhibitors) target another overactive immune system pathway associated with PsA.
• Steroid injections quickly reduce inflammation and help ease knee discomfort with injections directly into the joint. This is a common option when only one joint is affected.

Physical and Occupational Therapy

Physical therapy can help you stay active while avoiding knee pain. Your physical therapist will observe how you move and teach you therapeutic exercises you can do at home.

Occupational therapy offers alternative ways to do your daily activities. By teaching you to modify your usual movements, an occupational therapist can show you how to avoid straining your joints at work and home.

Knee Braces

A knee brace offers support and lowers stress on your joints. It also helps protect your mobility. Knee braces provide a wide range of benefits. They keep your knee aligned properly, support the joint to ease pain, prevent injury, and allow damaged ligaments to heal.

You can find knee braces at pharmacies and sporting goods stores. A physical therapist can help ensure you are using a brace properly. Although knee braces won’t cure arthritis, they can make daily life a little easier.

Knee Replacement Surgery

In more severe cases, a partial or total knee replacement surgery is recommended for joint pain and stiffness. Knee surgery is a common and effective procedure that can improve your mobility and quality of life. It takes about one to two hours in the operating room. You may be cleared to go home the same day or after one night in the hospital.

It’s normal to experience some pain during the first few weeks of recovery. If over-the-counter pain treatments aren’t enough to keep you comfortable after joint replacement surgery, let your healthcare provider know. They can prescribe medication to help you feel better as you heal.

Join a Community That Understands

On MyPsoriasisTeam, the social network for people with psoriasis and psoriatic arthritis, members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Do you have psoriatic arthritis symptoms in your knees? What treatments help you manage and prevent flare-ups? Share your experience in the comments below, or start a conversation by posting on your Activities page.