How Does Psoriatic Arthritis Affect the Knees?

Reviewed by: HU Medical Review Board | Last reviewed: July 2022

Psoriatic arthritis (PsA) is a chronic disease that causes pain and inflammation in the joints. PsA can affect the hands, feet, eyes, and nails, as well as the hips, back, and spine. It also commonly affects the knees.1,2

What are the symptoms?

PsA is a disease that can come and go. It affects each person a bit differently. When it occurs in the knees, symptoms can include:1-3

  • Stiffness, especially first thing in the morning or after resting for a long time
  • Reduced range of motion
  • Decreased flexibility
  • Pain when you move the knee
  • Pain when you put weight on the knee
  • Swelling in the knee
  • Appearing red and feeling warm to the touch

In some people, PsA is asymmetrical. This means it affects only one side of the body. For example, PsA may involve the right knee while the left knee feels fine. PsA can also be symmetrical, meaning it affects both sides of the body. In this case, a person may have pain in both knees.2

PsA affects not only joints. It also can inflame the attachment points of tendons and ligaments to bones (entheses), and the fluid-filled tissue found between the bones (synovial bursa).2

When one or both knees are affected by PsA, joint stability is at risk. If left untreated, the condition can become severe and may even lead to damage around the cartilage of the knee and joint erosion.2

How is it diagnosed?

A PsA diagnosis starts with a visit to your doctor or rheumatologist. They will do a physical exam and assessment to learn about your medical history and when your symptoms started.1

Advanced imaging tools can help them complete the overall picture. X-rays, MRI, and ultrasound may be used to find changes to the bones and joints. These tools also can help your doctor create the most appropriate treatment plan.1,2

How is PsA in the knees treated?

The main goal of PsA treatment is to reduce inflammation, wherever it may occur in the body. Over time, PsA can get worse. It can cause debilitating damage to the joints if left untreated.1-3

If the pain is mild enough, non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and swelling. Injections of steroids also may reduce inflammation.1-3

If the pain is more severe, your doctor will likely recommend systemic treatments that target joint disease. These treatment options include:1-3

  • Disease-modifying anti-rheumatic drugs (DMARDs) – DMARDs help calm your symptoms and help slow the progression of the disease.
  • Biologics – These drugs are often prescribed for people with PsA to reduce inflammation.
  • Anti-tumor necrosis factor (TNF) agents – TNFs create inflammation in the body. Anti-TNF agents fight that inflammation. They may be considered as a treatment method if DMARDs or biologics are not working.

When the above treatment options are not enough, your doctor may recommend joint replacement surgery. This will depend on your situation and the extent of the damage to your knee.1,2

Other treatment options

Physical and occupational therapy can help strengthen your knees and maintain their function. A physical therapy program generally includes:2,3

  • Performing exercises and stretches
  • Applying heat and cold to the knees
  • Using orthotics and assistive devices to help you walk and move

Some other complementary and alternative therapies you can try are:2,3

  • Exercise – Regular, gentle exercise can help with stiffness and maintaining range of motion. Low-impact activities such as swimming and walking are advised for knee pain.
  • Heat/cold therapy – Try taking a hot bath, or place heat packs over your knees. Heat helps soothe sore joints. Alternatively, a cold compress, ice pack, or cold bath can reduce swelling.
  • Knee splint – This can help stabilize your knee when moving around. Just be sure to remove the splint often to allow for gentle movement and stretching.
  • Weight loss – Losing weight will decrease pressure on your knees, which usually decreases knee pain. A dietitian can help you adopt a weight-loss plan.

Early diagnosis is critical to get the best treatment outcomes. If you have PsA and knee pain, make an appointment with your doctor to talk about your treatment options. A common approach is combining drug treatment and non-drug therapies like regular exercise and physical therapy.1,2

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