Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Coping
Psoriatic arthritis(PsA) is a type ofinflammatory arthritisthat develops in people who have psoriasis. PsA may affect many joints, including the knees.
Psoriasisis a chronic,autoimmune skin disorderthat causes skin cells to build up and form plaques—dry, itchy patches of skin. Both PsA and psoriasis—together calledpsoriatic disease—are chronic, long-term diseases, which means you will have them for the rest of your life.
There are no studies on the frequency of PsA in the knees. Symptoms of both conditions will get progressively worse for people who are not effectively treated. Early diagnosis is vital to minimize joint damage. Fortunately, a variety of treatments can slow down psoriatic disease. Learn more about its symptoms, causes, diagnosis, and treatment.
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PsA does not present the same for everyone. Even its primary symptoms, such as stiffness and swelling, can affect people differently.
For example, some people who have knee PsA might only have mild symptoms in one knee, while other individuals have severe symptoms in both knees. Yet someone else might have severe pain that affects their ability to walk.
Most people with PsA—whether PsA affects their knees or not—will experience pain, skin symptoms, and systemic (whole-body) symptoms.
Pain
It is hard to predict how much pain someone with PsA will experience or how PsA pain will affect a person’s life. For some, the condition progresses quickly and causes more severe symptoms, including pain. For other people, changes may occur at a slower pace, or they may only experience a mild disease course with little pain, swelling, and stiffness.
PsA pain in the knee starts slowly or can appear suddenly. You might notice stiffness and pain upon waking in the morning or after being inactive for a long period.
You might have pain while climbing steps, trying to stand, or kneeling to pick something up. You might hurt from activity or while doing absolutely nothing. In addition to pain, an affected knee might be red and warm to the touch.
Additional symptoms associated with PsA knee pain include the following.
Stiffness and tenderness: PsA will cause stiffness and tenderness in an affected knee. It can also cause swelling as inflammation accumulates around the joint or because ofbone spurs—pieces of bone that develop at the edges of bones where cartilage has depleted.
Decreased range of motion: Damage to bone and cartilage in your knee can make it harder for the knee joints to move smoothly. You may find it painful to bend or flex the knee. You might need a cane or walker to help you keep your balance and move safely.
Cracking and popping of the knee: Much like other types of arthritis, including rheumatoid arthritis (RA) and osteoarthritis (OA), PsA can cause cartilage damage. Cartilage damage makes it harder to bend or straighten your knee. You may also notice a grinding feelingor a cracking or popping sound—a symptom healthcare providers callcrepitus.
Buckling and locking: Knee buckling and locking of the knee are signs of joint instability and damage. Both can increase your risk for a fall. Knee buckling or locking might affect you as you stand up from a sitting position or when you attempt to bend your knees. You might also feel pain at the front of the knee.
Damage associated with buckling and locking is found in both tendon and cartilage. The tendons are the places where muscles join to the bone. Cartilage has many functions, including coverage for joint surfaces so that bones slide smoothly over each other. Tendon damage is calledtendinitis, while damage to the area where tendons or ligaments insert into the bone is calledenthesitis.
Early diagnosis and treatment can ease pain and other PsA symptoms as well as slow down joint damage. It is important to tell your healthcare provider about worsening PsA symptoms, severe knee pain, and if your medications don’t seem to be helping.
Skin Symptoms
Skin symptoms of PsA will appear as red psoriasis skin patches with silver, white, or gray scales. These patches often appear on the scalp, elbows, knees, torso, or buttocks, though they can appear on any part of the skin. Plaques can be painful, and they can itch and burn. Scratching them might put you at risk for a skin infection.
But not everyone with psoriasis will have PsA, and not everyone with PsA will have skin symptoms. In fact, according to the American Academy of Dermatology and the National Psoriasis Foundation, only 30–33% of people with psoriasis also have PsA.
Systemic Symptoms
PsA is asystemic disease, which means it causes inflammation that affects more than just the joints and skin.
Systemic symptoms of PsA include:
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PsA results when the body’s immune system mistakenly attacks healthy cells and tissues. With PsA, the immune system attacks the joints.
In people with psoriasis, a faulty immune system response leads to skin cells growing too quickly and then stacking up on top of each other to form plaques. Both joint and skin symptoms start because of a chronic inflammatory response.
There are no confirmed causes for PsA, but researchers think genetic and environmental triggers might lead to the body’s faulty immune system response. People who have close family members with PsA are also more likely to have the condition.
A 2015 report in the journalCurrent Rheumatology Reportsdiscusses other factors that might contribute to the development of PsA. These include:
Anyone of any age can develop PsA, and, according to the American Academy of Dermatology and the National Psoriasis Foundation, most people with PsA are diagnosed about 10 years after they start having symptoms of psoriasis.
Physical Examination
During a physical exam for PsA, your healthcare provider will closely exam your joints for swelling and tenderness. They will also check your skin for signs of a PsA rash and psoriasis skin plaques. Your healthcare provider may also examine your fingernails to look for pitting, discoloration, and other nail abnormalities.
For knee symptoms, your healthcare provider will examine the knee to look for joint swelling, stiffness, and tenderness. Your range of motion is also checked, and your healthcare provider will want to see how you walk and how you bend your knees.
Lab Tests
Laboratory testing for PsA might include a test for the proteinHLA-B27,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP), andrheumatoid factorblood work as well asjoint fluid testing.
Imaging
Your healthcare provider might use imaging tools to aid in finding the source of knee symptoms or diagnosing PsA. They may use X-rays, magnetic resonance imaging, and ultrasound to check the knees, other joints, bones, ligaments, and tendons for inflammation and damage.
Treatment goals for PsA are to control disease progression and relieve symptoms and pain. Treatment can include medicines to manage pain and reduce the effects of PsA, includingdisease-modifying anti-rheumatic drugs(DMARDs),biologics,immunosuppressants, complementary therapies likephysical therapy, and, as a last resort, surgery.
Pain Management
Arthritis knee pain can be treated with nonsteroidal anti-inflammatory drugs, including ibuprofen and naproxen.Corticosteroid injectionscan be used to treat ongoing inflammation in a single joint, including a chronically inflamed knee.
Topical pain relievers can be helpful for numbing pain in affected joints, including the knees. However, the Arthritis Foundation recommends that people with PsA use these products with caution. The organization suggests that if a product irritates your skin, you stop using it. You should also avoid using these products on inflamed skin or open scales.
Disease-Modifying Anti-Rheumatic Drugs
DMARDs can slow down disease progression in PsA and reduce the potential for joint and tissue damage. The most common DMARDs are methotrexate andsulfasalazine.
While these medications can be effective for treating PsA, long-term use can lead to serious side effects, including increased risk for serious infection, liver damage, and bone marrow problems.
Biologic Drugs
Biologics are a newer type of DMARD. These medications target the parts of your immune system that trigger inflammation. Common biologics include Humira (adalimumab),Orencia (abatacept), and Cosentyx (secukinumab). A major side effect of biologics is that they can significantly increase your risk for infection.
Immunosuppressive Drugs
Immunosuppressive drugs such as cyclosporine can calm down an overactive immune system, which is characteristic of PsA. Because these medications suppress your immune system, however, they can increase your vulnerability to infection.
Physical Therapy
Your healthcare provider might recommend physical therapy to ease knee pain and help you to move and function better. A physical therapist can design a plan for you to improve your range of motion and flexibility and to strengthen leg muscles.
Surgery
Your healthcare provider may recommend ways to help you to cope with PsA and knee symptoms of PsA. Changes to your lifestyle, the use of assistive devices, and other home remedies can help you to better cope and manage pain and inflammation.
Lifestyle Changes
Changes to your lifestyle can protect your knees and reduce the effects of PsA. These might include:
Assistive Devices
A cane, walker, brace or knee sleeve, or more comfortable shoes can reduce pain and make it easier to move around.
Home Remedies
Other home remedies, including heat and cold treatments and meditation, may also be helpful to managing PsA of the knee.
Exercises to Build Strength in Arthritic Knees
A Word From Verywell
Psoriatic arthritis is a chronic condition, and knee symptoms associated with it can adversely affect your quality of life. Work with your healthcare provider to find the best ways to manage PsA and knee pain symptoms that might affect your ability to walk, climb steps, lift, and perform daily tasks.
Even if your knee pain is mild, it can get worse over time, especially if it is not addressed. Talk to your healthcare provider about the best ways to treat knee symptoms so that you can continue to keep moving and enjoying your life.
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Psoriasis Foundation.Psoriatic disease affects more than skin and joints.Krakowski P, Gerkowicz A, Pietrzak A, et al.Psoriatic arthritis—new perspectives.Arch Med Sci. 2019;15(3):580-589. doi:10.5114/aoms.2018.77725American Academy of Orthopaedic Surgeons.Arthritis of the knee.Menter A.Psoriasis and psoriatic arthritis overview.Am J Manag Care. 2016;22(8 Suppl):s216-s224.Elmets CA, Leonardi CL, Davis DMR, et al. JointAAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities.J Am Acad Dermatol. 2019;80(4):1073-1113. doi:10.1016/j.jaad.2018.11.058Takeshita J, Grewal S, Langan SM, et al.Psoriasis and comorbid diseases: epidemiology.J Am Acad Dermatol. 2017;76(3):377-390. doi:10.1016/j.jaad.2016.07.064Singh JA, Guyatt G, Ogdie A, et al.American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis.Arthritis Rheumatol. 2019;71(1):5-32. doi:10.1002/art.40726National Institute of Arthritis & Musculoskeletal & Skin Diseases.Symptoms of psoriatic arthritis.Ogdie A, Gelfand JM.Clinical risk factors for the development of psoriatic arthritis among patients with psoriasis: a review of available evidence.Curr Rheumatol Rep. 2015;17(10):64. doi:10.1007/s11926-015-0540-1Bodis G, Toth V, Schwarting A.Role of human leukocyte antigens (HLA) in autoimmune diseases.Rheumatol Ther. 2018;5(1):5-20. doi:10.1007/s40744-018-0100-zMerola JF, Espinoza LR, Fleischmann R.Distinguishing rheumatoid arthritis from psoriatic arthritis.RMD Open. 2018;4(2):e000656. doi:10.1136/rmdopen-2018-000656Erre GL, Mundula N, Colombo E, et al.Diagnostic accuracy of anticarbamylated protein antibodies in established rheumatoid arthritis: a monocentric cross‐sectional study.ACR Open Rheumatol. 2019;1(7):433-439. doi:10.1002/acr2.11063Mease PJ, Armstrong AW.Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis.Drugs. 2014;74(4):423-441. doi:10.1007/s40265-014-0191-yCoates LC, Helliwell PS.Psoriatic arthritis: state of the art review.Clin Med. 2017;17(1):65-70. doi:10.7861/clinmedicine.17-1-65Arthritis Foundation.Psoriatic arthritis.Menter A.Psoriasis and psoriatic arthritis treatment.Am J Manag Care. 2016;22(8 Suppl):s225-s237.
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Psoriasis Foundation.Psoriatic disease affects more than skin and joints.Krakowski P, Gerkowicz A, Pietrzak A, et al.Psoriatic arthritis—new perspectives.Arch Med Sci. 2019;15(3):580-589. doi:10.5114/aoms.2018.77725American Academy of Orthopaedic Surgeons.Arthritis of the knee.Menter A.Psoriasis and psoriatic arthritis overview.Am J Manag Care. 2016;22(8 Suppl):s216-s224.Elmets CA, Leonardi CL, Davis DMR, et al. JointAAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities.J Am Acad Dermatol. 2019;80(4):1073-1113. doi:10.1016/j.jaad.2018.11.058Takeshita J, Grewal S, Langan SM, et al.Psoriasis and comorbid diseases: epidemiology.J Am Acad Dermatol. 2017;76(3):377-390. doi:10.1016/j.jaad.2016.07.064Singh JA, Guyatt G, Ogdie A, et al.American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis.Arthritis Rheumatol. 2019;71(1):5-32. doi:10.1002/art.40726National Institute of Arthritis & Musculoskeletal & Skin Diseases.Symptoms of psoriatic arthritis.Ogdie A, Gelfand JM.Clinical risk factors for the development of psoriatic arthritis among patients with psoriasis: a review of available evidence.Curr Rheumatol Rep. 2015;17(10):64. doi:10.1007/s11926-015-0540-1Bodis G, Toth V, Schwarting A.Role of human leukocyte antigens (HLA) in autoimmune diseases.Rheumatol Ther. 2018;5(1):5-20. doi:10.1007/s40744-018-0100-zMerola JF, Espinoza LR, Fleischmann R.Distinguishing rheumatoid arthritis from psoriatic arthritis.RMD Open. 2018;4(2):e000656. doi:10.1136/rmdopen-2018-000656Erre GL, Mundula N, Colombo E, et al.Diagnostic accuracy of anticarbamylated protein antibodies in established rheumatoid arthritis: a monocentric cross‐sectional study.ACR Open Rheumatol. 2019;1(7):433-439. doi:10.1002/acr2.11063Mease PJ, Armstrong AW.Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis.Drugs. 2014;74(4):423-441. doi:10.1007/s40265-014-0191-yCoates LC, Helliwell PS.Psoriatic arthritis: state of the art review.Clin Med. 2017;17(1):65-70. doi:10.7861/clinmedicine.17-1-65Arthritis Foundation.Psoriatic arthritis.Menter A.Psoriasis and psoriatic arthritis treatment.Am J Manag Care. 2016;22(8 Suppl):s225-s237.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Psoriasis Foundation.Psoriatic disease affects more than skin and joints.Krakowski P, Gerkowicz A, Pietrzak A, et al.Psoriatic arthritis—new perspectives.Arch Med Sci. 2019;15(3):580-589. doi:10.5114/aoms.2018.77725American Academy of Orthopaedic Surgeons.Arthritis of the knee.Menter A.Psoriasis and psoriatic arthritis overview.Am J Manag Care. 2016;22(8 Suppl):s216-s224.Elmets CA, Leonardi CL, Davis DMR, et al. JointAAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities.J Am Acad Dermatol. 2019;80(4):1073-1113. doi:10.1016/j.jaad.2018.11.058Takeshita J, Grewal S, Langan SM, et al.Psoriasis and comorbid diseases: epidemiology.J Am Acad Dermatol. 2017;76(3):377-390. doi:10.1016/j.jaad.2016.07.064Singh JA, Guyatt G, Ogdie A, et al.American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis.Arthritis Rheumatol. 2019;71(1):5-32. doi:10.1002/art.40726National Institute of Arthritis & Musculoskeletal & Skin Diseases.Symptoms of psoriatic arthritis.Ogdie A, Gelfand JM.Clinical risk factors for the development of psoriatic arthritis among patients with psoriasis: a review of available evidence.Curr Rheumatol Rep. 2015;17(10):64. doi:10.1007/s11926-015-0540-1Bodis G, Toth V, Schwarting A.Role of human leukocyte antigens (HLA) in autoimmune diseases.Rheumatol Ther. 2018;5(1):5-20. doi:10.1007/s40744-018-0100-zMerola JF, Espinoza LR, Fleischmann R.Distinguishing rheumatoid arthritis from psoriatic arthritis.RMD Open. 2018;4(2):e000656. doi:10.1136/rmdopen-2018-000656Erre GL, Mundula N, Colombo E, et al.Diagnostic accuracy of anticarbamylated protein antibodies in established rheumatoid arthritis: a monocentric cross‐sectional study.ACR Open Rheumatol. 2019;1(7):433-439. doi:10.1002/acr2.11063Mease PJ, Armstrong AW.Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis.Drugs. 2014;74(4):423-441. doi:10.1007/s40265-014-0191-yCoates LC, Helliwell PS.Psoriatic arthritis: state of the art review.Clin Med. 2017;17(1):65-70. doi:10.7861/clinmedicine.17-1-65Arthritis Foundation.Psoriatic arthritis.Menter A.Psoriasis and psoriatic arthritis treatment.Am J Manag Care. 2016;22(8 Suppl):s225-s237.
National Psoriasis Foundation.Psoriatic disease affects more than skin and joints.
Krakowski P, Gerkowicz A, Pietrzak A, et al.Psoriatic arthritis—new perspectives.Arch Med Sci. 2019;15(3):580-589. doi:10.5114/aoms.2018.77725
American Academy of Orthopaedic Surgeons.Arthritis of the knee.
Menter A.Psoriasis and psoriatic arthritis overview.Am J Manag Care. 2016;22(8 Suppl):s216-s224.
Elmets CA, Leonardi CL, Davis DMR, et al. JointAAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities.J Am Acad Dermatol. 2019;80(4):1073-1113. doi:10.1016/j.jaad.2018.11.058
Takeshita J, Grewal S, Langan SM, et al.Psoriasis and comorbid diseases: epidemiology.J Am Acad Dermatol. 2017;76(3):377-390. doi:10.1016/j.jaad.2016.07.064
Singh JA, Guyatt G, Ogdie A, et al.American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis.Arthritis Rheumatol. 2019;71(1):5-32. doi:10.1002/art.40726
National Institute of Arthritis & Musculoskeletal & Skin Diseases.Symptoms of psoriatic arthritis.
Ogdie A, Gelfand JM.Clinical risk factors for the development of psoriatic arthritis among patients with psoriasis: a review of available evidence.Curr Rheumatol Rep. 2015;17(10):64. doi:10.1007/s11926-015-0540-1
Bodis G, Toth V, Schwarting A.Role of human leukocyte antigens (HLA) in autoimmune diseases.Rheumatol Ther. 2018;5(1):5-20. doi:10.1007/s40744-018-0100-z
Merola JF, Espinoza LR, Fleischmann R.Distinguishing rheumatoid arthritis from psoriatic arthritis.RMD Open. 2018;4(2):e000656. doi:10.1136/rmdopen-2018-000656
Erre GL, Mundula N, Colombo E, et al.Diagnostic accuracy of anticarbamylated protein antibodies in established rheumatoid arthritis: a monocentric cross‐sectional study.ACR Open Rheumatol. 2019;1(7):433-439. doi:10.1002/acr2.11063
Mease PJ, Armstrong AW.Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis.Drugs. 2014;74(4):423-441. doi:10.1007/s40265-014-0191-y
Coates LC, Helliwell PS.Psoriatic arthritis: state of the art review.Clin Med. 2017;17(1):65-70. doi:10.7861/clinmedicine.17-1-65
Arthritis Foundation.Psoriatic arthritis.
Menter A.Psoriasis and psoriatic arthritis treatment.Am J Manag Care. 2016;22(8 Suppl):s225-s237.
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