How Psoriatic Arthritis Affects the Knees | MyPsoriasisTeam

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How Psoriatic Arthritis Affects the Knees

Medically reviewed by Kevin Berman, M.D., Ph.D.
Written by Victoria Menard
Posted on February 10, 2021

About 30 percent of people with psoriasis develop psoriatic arthritis (PsA). Like rheumatoid arthritis, this form of chronic inflammatory arthritis occurs when the body’s immune system mistakenly attacks its own healthy tissues.

Although some people have only one joint affected by PsA, it can affect any joint in the body. For many individuals, the symptoms of psoriatic arthritis develop in the knees, causing joint pain, swelling, and stiffness.

A rheumatologist can help identify PsA symptoms in your knee joints and prescribe or recommend treatments to alleviate pain and prevent the condition from progressing.

Impacts of Psoriatic Arthritis in the Knees

PsA tends to be asymmetric, meaning different joints on either side of the body are affected (rather than both knees or both elbows, for example). Symptoms in the knees can be mild and develop slowly or arise suddenly and severely. Arthritis usually follows the appearance of psoriasis on the skin. In addition to pain, swelling, and stiffness in the knee joints, PsA can lead to enthesitis and peripheral arthritis.

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Enthesitis

Enthesitis refers to inflammation in the enthesis — one of the more than 100 sites in the body where ligaments or tendons insert into the bones. Inflammation in one of the entheses 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 use the presence of enthesitis to confirm a diagnosis of psoriatic arthritis.

Enthesitis often occurs early on in people with PsA, but it may develop at any stage of the disease. The condition most commonly affects the knees, as well as the shoulders, elbows, hips, and heels.

Peripheral Arthritis

Peripheral arthritis is a form of arthritis that tends to affect larger joints, including the knees, elbows, wrists, and ankles. According to the Arthritis Foundation, peripheral arthritis is common in people with PsA.

Peripheral arthritis may cause discomfort that migrates from one joint to another, and, if left untreated, can cause pain lasting 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 alleviate 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 health care provider know if you experience signs and symptoms of psoriatic arthritis in one or both knees. Studies have shown that even a six-month delay in diagnosis or starting medication after first noticing psoriatic arthritis symptoms can have an impact on the effectiveness of treatment.

Being diagnosed with PsA may involve X-rays or blood tests along with a thorough exam of your joints. After your doctor has determined that psoriatic arthritis is the cause of your knee pain, they will work with you to find the right treatment or combination of treatments for your condition.

Treatment of psoriatic arthritis usually aims to reduce inflammation and provide relief for painful joints. Your health care team may prescribe or recommend the following treatments for your PsA-related knee symptoms.

Medications

One of the main goals of treating PsA with medication is to control inflammation. This step, in turn, helps reduce joint pain and prevent joint damage. Certain over-the-counter medicines may help reduce your condition’s symptoms. If those drugs don’t help your joint pain and swelling, then your doctor may need to prescribe stronger medications.

There are several types of medications that may be used to manage PsA in the knees.

Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs, or NSAIDs, can help relieve pain and reduce inflammation caused by PsA. These drugs include over-the-counter medications, like Advil (Ibuprofen) and Aleve (Naproxen), as well as stronger prescription options.

Disease-Modifying Antirheumatic Drugs

Disease-modifying antirheumatic drugs (DMARDs), which include Otrexup (Methotrexate) and Arava (Leflunomide), reduce inflammation and help slow the progression of PsA.

Biologic DMARDs may be prescribed if conventional DMARDs aren’t successful at treating PsA. Biologic therapies don’t take effect immediately and may take up to three months to start having a noticeable effect on the symptoms of psoriatic arthritis. Biologics are the newest class of medication used to treat PsA. They specifically target overactive inflammatory pathways to stop the pain and halt the progression of joint disease, and they may even repair previous joint damage.

Steroid Injections

Steroid injections, which are administered directly into the knee joints, can quickly reduce inflammation and help ease knee discomfort caused by PsA. Talk to your doctor about the benefits and potential side effects associated with steroid injections.

Physical and Occupational Therapy

Physical therapy can help you remain active while managing PsA-related knee pain. A physical therapist will work with you to assess your mobility and movements and address your unique needs. The goal of physical therapy is to reduce pain, make it easier to perform everyday tasks, and prevent disability.

Occupational therapy provides alternative ways of performing various daily activities to help reduce joint strain and pain.

Knee Braces

A knee brace can help reduce pain and stress on your joints, as well as improve or protect your mobility. Knee braces provide a wide range of benefits, including keeping your knee aligned properly, supporting the joint to ease pain, preventing injury, and allowing 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 they won’t cure arthritis, knee braces can help relieve pain and support movement.

Join a Community That Understands

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis. On MyPsoriasisTeam, members of a community of more than 87,000 strong provide each other with support, share their stories, and discuss life with psoriasis and PsA.

Do you experience PsA symptoms in your knees? How do you manage your pain? Join MyPsoriasisTeam today and share your story in the comments below, or start a conversation by posting on your Activities page.

Posted on February 10, 2021
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Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Victoria Menard is a writer at MyHealthTeam. Learn more about her here.

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