Can Psoriatic Arthritis Cause Knee Pain?

From healthcentral.com

Knee pain is a common complain when you have PsA, but the right treatment plan can help keep symptoms to a minimum 

Living with the autoimmune condition psoriatic arthritis (PsA) means you’ve likely felt pain in your joints—and the knees are one of the most affected areas, according to the Arthritis Foundation. These joints are a main target of a malfunctioning immune system, which causes pain, swelling, and stiffness. “PsA loves the large joints like the knees and hips,” says Stella Bard, M.D., a board-certified rheumatologist who practices in both New York City and McKinney, TX. “But in most people, it affects multiple joints.”

Understanding the symptoms, causes, and common treatments for PsA of the knee can help you get the care you need to start to feel better.

Symptoms of Psoriatic Arthritis in the Knee                                                  

Everyone with PsA has their own unique set and pattern of symptoms. “Some people who have knee PsA might only have mild symptoms in one knee, while others may have severe symptoms in both knees, or intense pain that makes it difficult to walk,” says Dr. Bard. Because PsA is a chronic (lifelong) disease, it tends to get worse over time. But you may have periods where your PsA symptoms improve, or even go away altogether (known as remission), adds Dr. Bard.

Some of the more common symptoms you may experience if PsA is affecting your knees include:

• Pain in and around the knee joint, which can vary in severity. It may occur in certain positions, such as standing up from being seated. “This is known as gelling,” Dr. Bard explains. “It happens when the fluid leaks from blood vessels around an inactive joint and blocks the joint’s cartilage.”

• Reduced range of motion in the knee, which is caused by inflammation

• Stiffness in the knee joint, especially when you wake up in the morning or during the night. This can occur because swelling of the joint increases when you haven’t been active for a while, says Dr. Bard.

• Swelling in and around the knee joint

• Tendinitis (inflammation around the area where the tendon attaches to the bone) and enthesitis (inflammation at the precise attachment point of the tendon)

Symptoms Not Related to the Knee

There are a few other ways that PsA can show up besides joint pain, according to the National Psoriasis Foundation (NPF), including:

• Anaemia

• Fatigue

• Nail psoriasis (pitting, crumbling, and lifting of the fingernails and/or toenails)

• Pain where tendons and ligaments attach to the bones, caused by inflammation (for instance at the back of the heel or the sole of the foot)

• Small raised areas of skin known as papules

• Spondylitis (lower back pain caused by inflammation of the joints between the vertebrae of your spine and in the joints between your spine and pelvis)

• Swollen, sausage-like fingers and toes (also called dactylitis)

• Uveitis (redness and pain in the eye)

In addition, keep in mind that if you have PsA, you may also have psoriasis, another chronic autoimmune condition that occurs when skin cells build up faster than normal, resulting in discoloured, scaly, sometimes itchy patches on the skin. According to the NPF, PsA affects up to 33% of people with psoriasis. Most people with PsA first experience psoriasis, and the two conditions can occur together.

Causes of Psoriatic Arthritis Knee Pain

There’s not one specific cause of PsA. However, there’s a strong genetic component, with research suggesting that around 33% to 50% of people with PsA have at least one immediate family member with the condition. Several genes have been identified that people with PsA have in common, but the exact role they play remains unclear.

Additionally, experts believe that a combination of the following risk factors may make you more likely to develop PsA:

• Being overweight or obese: While the link is unclear, some evidence suggests that obesity may increase the level of cytokines—proteins that produce inflammation in the joints—in the body. Additionally, a study published in the Annals of the Rheumatic Diseases found that people with PsA who were overweight or obese were more likely to have more psoriasis, joint pain, and inflammation than those who were at a healthy weight.

• Previous injury to a particular joint (such as a knee injury) means you could be more likely to feel PsA in that part of your body.

• Smoking and heavily drinking alcohol may worsen inflammation and increase your risk of PsA, especially if you have pre-existing psoriasis, although research to date is inconclusive.

• Stress kickstarts the immune system’s inflammatory response, which can activate joint damage in people with PsA and other types of arthritis, according to the Arthritis Foundation.

Diagnosing Psoriatic Arthritis in the Knee

There are no specific tests to diagnose psoriatic arthritis in the knee, says Diana Girnita, M.D., Ph.D., who is board-certified in rheumatology and internal medicine based in Irvine, CA, and the founder of Rheumatologist OnCall. “The key steps are a good history and a thorough physical exam, along with lab tests and imaging,” Dr. Girnita explains.

There are some common blood tests done for inflammatory arthritis that can help to differentiate PsA from rheumatoid arthritis, says Dr. Girnita. These include:

• Cyclic citrullinated peptide (CCP) antibody test

• HLA B27 antigen, a test that looks for a protein found on the surface of white blood cells

• Rheumatoid factor (RF) test

If the outcome is still unclear, you may also get an MRI with and without contrast. “This highlights signs of inflammation in the knee,” says Dr. Girnita. “Together with the patient’s history, physical exam, and test results, this will allow me to make an accurate diagnosis.”

Treating Psoriatic Arthritis Knee Pain

Knee pain for this condition will be managed by treating the disease as a whole. While there’s no single cure for PsA, the good news is that there are several treatments that can control the systemic inflammation caused by psoriatic arthritis, including in the affected joints, which can help relieve the pain. These are some options your doctor may recommend:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are available without a prescription and may be enough to control some symptoms in mild PsA. These include ibuprofen (Advil, Motrin) and naproxen sodium (Aleve), to relieve pain and reduce inflammation, with stronger NSAIDs available on prescription.

• Conventional disease-modifying antirheumatic drugs (DMARDs) like Trexall or Otrexup (methotrexate), Arava (leflunomide), and Azulfidine (sulfasalazine) are designed to slow disease progression and prevent permanent damage to joints and surrounding tissues.

• Biologic agents such as Humira (adalimumab), Cimzia (certolizumab), Enbrel (etanercept), and Remicade (infliximab) target different parts of the immune system.

• Small molecule drugs. These targeted synthetic DMARDs like Xeljanz (tofacitinib) may be prescribed if conventional DMARDs and biologic agents haven't worked.

Treatment for knee PsA will depend on how severe your symptoms are, and you might have to try different treatments before you find one that brings you relief.

During a flare of PsA symptoms affecting your knee, steroid injections into the joint can also help to reduce inflammation. “This is a great option when only one joint is involved, as it is a targeted therapy,” says Dr. Girnita. “Instead of taking oral steroids for several days or even weeks, a single injection can calm down the inflamed joint.”

If your knee joint becomes severely damaged due to PsA to the point where you lose function and the pain can’t be managed, knee replacement is an option, adds Dr. Girnita. There are different types of joint replacement surgery which your health care team will discuss with you at length, alongside the risks and benefits of each option.

Managing PsA Knee Pain

In addition to keeping up with the best medication options for your knee, there are a few other changes you can make to help manage the pain and make your day-to-day life a little easier.

Assistive Devices

To take the pressure off your knee, consider using a cane for stability when you’re standing and walking, says Dr. Girnita. Other devices, like a shower seat or bench in the tub, can make it easier to avoid slipping in the bath.

Exercise

Rest is important, of course, but research has found that people with PsA who exercise regularly report less pain and fatigue and a better quality of life. Dr. Girnita agrees that people with PsA feel significantly better when they’re active. “Joint stiffness usually eases within an hour of moving around,” she says.

The most important thing to do is follow an exercise regimen that’s right for you, she adds—it doesn’t matter what anyone else does. The NPF recommends sticking to the activity level your body was used to before you had PsA. If you’ve never exercised regularly, it’s absolutely fine to start with gentle activities like walking, swimming, and yoga. If you don’t know where to start, ask a physical therapist to help you create an exercise plan.

Talk With Your Doctor

Your knees are important load-bearing joints, and when they’re affected by PsA the impact on your daily life can be significant. Stay in touch with your doctors and on top of your appointments, and be sure to discuss any changes in your symptoms or how your disease is responding to your treatment plan. With the right approach, you can help keep knee pain and mobility issues to a minimum.

https://www.healthcentral.com/condition/psoriatic-arthritis/psoriatic-arthritis-prognosis

Why Does Psoriasis Show Up on Knees?

From verywellhealth.com

Knees and elbows, known as extensor surfaces, are common spots for psoriasis 

Psoriasis on knees and elbows is very common. That leads to inflamed, itchy skin covered in plaques or scales. Healthcare providers aren’t sure why it appears more often on extensor surfaces, the skin outside a joint. However, they do know that these areas, including the knees and elbows, are more likely to have psoriasis than other areas of skin. 

This article will give information about psoriasis on the knees and psoriasis on the elbows. It will cover how to treat dry elbows and knees and how to cope with psoriasis. 

tumeyes / Getty Images

Psoriasis on Knees: What It Looks Like

The most common symptoms of psoriasis are having inflamed and red areas of skin. Plaque psoriasis is the most common type, making up about 90% of psoriasis cases. Most cases of psoriasis on the knees are plaque psoriasis. In addition to the red flakes, you may notice a white or silver coating around the plaques on your kneecaps.

People with darker skin are less likely to notice red patches from psoriasis. If you have darker skin, you might notice areas that are hyper-pigmented (darker) or purple-tinged rather than red.

Are Dry Elbows a Sign of Psoriasis?

The elbows are another common site of psoriasis. However, if you have dry elbows, psoriasis isn’t necessarily the cause. Elbows, like knees, are extensor surfaces that are often exposed and prone to bumps or scrapes. Overtime, that can lead to skin thickening or dry skin. Still, if you’re worried about your elbows or think you may have psoriasis, it’s best to speak with a dermatologist.  

Other Places Psoriasis Could Be 

Psoriasis can appear on any part of the body. However, it’s more common in certain places. In addition to the knees and elbows, plaque psoriasis is common on the scalp and lower back.

Plaque psoriasis and other types of psoriasis can also appear on the:

• Face
• Palms
• Soles of the feet
• Fingernails and toenails
• Mouth

Causes of Psoriasis Flares on Knee Caps

Like other autoimmune conditions, psoriasis is characterised by flares, which are periods of more intense symptoms. When a flare calms down, you may experience a time of remission or very few symptoms. 

The causes of psoriasis flares can include everything from stress to weather changes to the clothing or soap that comes into contact with your skin. Doctors aren’t sure why, exactly, the kneecaps are more prone to psoriasis, but it could be because the skin here is under a lot of strain. Whether from bending and moving, rubbing pants, scraped knees, or other causes, the skin on your kneecaps takes a beating. That may leave it prone to psoriasis symptoms. 

The best way to identify the cause of psoriasis flares on your kneecaps is by keeping a symptoms journal. That way, you can learn what contributes to your symptoms and limit your exposure to your triggers in the future. 

Associated Knee Complications

In addition to symptoms on the knee caps, psoriasis can lead to pain, swelling and stiffness in the knees. These are symptoms of a condition known as psoriatic arthritis, where arthritis symptoms are associated with psoriasis. Up to 40% of people with psoriasis will develop psoriatic arthritis. This condition can make daily movements like walking or climbing stairs painful. Symptoms, especially stiffness, are often worse in the morning. 

If you have symptoms of psoriatic arthritis in your knees, see a rheumatologist. These doctors specialize in treating inflammatory and autoimmune diseases and will be able to provide the care you need. 

How Psoriasis on Knees Is Diagnosed 

A dermatologist is the best doctor to diagnose psoriasis. Before giving you a diagnosis, they’ll examine you and discuss your symptoms. They’ll also take steps to rule out other skin conditions like eczema, which can be confused for psoriasis. 

Treatment for Psoriasis on Knees 

Although there’s no cure for psoriasis, there are many different treatment options. A dermatologist can help you develop a treatment plan for psoriasis on your knees. This might include topical creams, oral medications, light therapy, and more.

In addition, there are home remedies and lifestyle changes that can help keep psoriasis symptoms at bay. Avoiding triggers, moisturising regularly, and avoiding clothes that worsen your symptoms can be helpful. 

Psoriasis on the knees can be very visible. Or, it can impact the types of clothing you can (or can’t) wear. That can compound the emotional and mental toll of psoriasis. Therapy can be a powerful tool for people living with a psoriasis diagnosis. 

Summary

It’s common to have psoriasis on the knees. Knees and elbows, known as extensor surfaces, are frequent locations for psoriasis flares, although the condition can appear anywhere. In addition to skin symptoms like itchiness and redness, people with psoriasis can develop psoriatic arthritis, which leads to stiffness, pain, and inflammation in joints, including the knee. A dermatologist and rheumatologist can help you develop a multi-faceted treatment plan to address psoriasis on the knees.

https://www.verywellhealth.com/psoriasis-on-knees-7098190

Psoriasis on the Knees and Elbows: What It Looks Like, How to Treat It

From everydayhealth.com

The knees and elbows are among the most common spots for psoriasis. Here, special concerns and treatments to try 

Ellen Pace’s journey with psoriasis has been a long one. “I’m 67, I’ve had psoriasis since I was 11 years old, and it’s been a challenge throughout,” says Pace, a psychotherapist who lives in Brooklyn, New York. “I’ve always gotten flares on my knees and elbows, and it’s really unsightly.”

She’s been mortified by these flares since childhood. “As a kid, I’d go to day camp wearing jeans and long-sleeved shirts — and I never, ever wore a bathing suit,” she recalls.

What Knee and Elbow Psoriasis Looks Like

The knees and elbows are the most common location for psoriasis flare-ups. “Those are the textbook cases,” says Elisabeth Richard, MD, an assistant professor of dermatology at the Johns Hopkins University School of Medicine in Baltimore.

Psoriasis on these body parts tends to have a distinctive appearance: “You’ll usually see a well-circumscribed plaque, bigger than a centimetre, with thickened skin and overlying white scales,” Dr. Richard explains. Plaques may appear red or salmon pink on white skin and purple or brown on Black or brown skin.

Psoriasis most often appears on the front of the knees and the elbows, known as extensor surfaces, says Jeffrey Cohen, MD, an assistant professor of dermatology and director of the psoriasis treatment program at Yale Medical School in New Haven, Connecticut.

The prevalence of psoriasis in these areas is likely no accident. “We lean on our knees and elbows frequently, or they are apt to rub against clothing. That can result in a process called Koebnerization, in which micro-traumas like rubbing or banging skin potentially lead to flare-ups,” Dr. Cohen explains.

What Knee and Elbow Psoriasis Feels Like

Typically, psoriasis on the knees and elbows isn’t itchy or painful, according to Richard, “unless the skin becomes very thick. Then small cuts, known as fissures, can develop.”

With knee psoriasis, there is some evidence that the condition can harm not just the skin but also the joint. In a 2021 study published in the journal Frontiers in Medicine of more than 10,000 people with psoriasis, women with psoriasis, in particular, were significantly more likely to end up having total knee replacement surgery than people of the same age without psoriasis.

Flare-ups on the knees and elbows can also cause emotional pain. “I see a lot of patients who don’t feel comfortable wearing shorts or short sleeves, even in summer, because they’re embarrassed,” Cohen says.

Pace says that even as a successful psychotherapist, she feels the same self-consciousness about her skin that she did as an insecure 11-year-old. “I still won’t wear a bathing suit — and even though I had a pool built, I won’t go in, because I don’t want anyone to see my flares,” she says.

Knowing that other people in her family have also dealt with psoriasis — the condition has a strong genetic link — hasn’t eased her distress. “I have it worse than my other relatives, and at times, I’ve thought, ‘Why me?’ It has definitely played a psychological game with me.”

Psoriasis flares might appear on the knees and elbows because of small traumas to those areas from leaning or rubbing against clothes.Natalia Serdyuk/iStock; Getty Images; Canva

Psoriasis Treatments Can Help the Knees and Elbows

The good news is that people with psoriasis on the knees and elbows have numerous treatment options that can make a significant difference.

Most dermatologists will typically start out by prescribing topical steroids. Non-steroidal topical treatments are another, relatively new alternative since the U.S. Food and Drug Administration (FDA) approved tapinarof (Vtama) and roflumilast (Zoryve) creams.

There is also a new non-steroidal oral treatment (in pill form) called deucravacitinib (Sotyktu), for people with moderate to severe psoriasis. Cohen explains that it helps minimize inflammation by blocking certain molecules that affect immune system signaling.

Other treatments include light therapy (also called phototherapy), which can be a good option when psoriasis is localized as opposed to all over the body. Pace purchased her own light box and used it for 10 years. “It helped,” she says, “but I eventually stopped because I was worried about developing skin cancer.” (Light therapy utilizes ultraviolet B — UVB — rays rather than the UVA kind to minimize skin cancer risk.)

Richard says that one alternative method for delivering phototherapy is the excimer laser. “You can use a handpiece to deliver the treatment in a very focused way,” she says.

Two more options for people with moderate to severe psoriasis are methotrexate, a chemotherapy drug also used to treat psoriasis and psoriatic arthritis, as well as a class of drugs known as biologics, which are administered via IV or injection. These medications target underlying inflammation by suppressing the body’s immune response but can cause side effects.

Pace has tried a number of biologics. “They worked wonderfully,” she says. Yet eventually, side effects got in her way. “It happened like clockwork — after taking them for three months, I’d start to experience joint pain and nausea,” she says.

Cohen and Richard emphasize that physicians and patients often need to explore a number of therapies before finding the one that works best at a given point in time.

Sunlight and Moisturizers Can Also Help With Psoriasis

For now, Pace is not using medication for her psoriasis, but she is spending more time at her home in Florida. “The one thing that really helps me is the sun,” she says. Keeping her knees, elbows, and other affected areas well moisturized helps, too. “Aquaphor is my friend,” she quips.

Richard agrees: “It’s really important to stay ahead of the dryness with moisturization, and hypoallergenic ointments are best.”

The most important thing to do, says Cohen, is to keep working with your dermatologist. “The main thing I want to impress on people who feel disheartened is that we have a lot of good treatments out there, and the options are expanding all the time.”

https://www.everydayhealth.com/psoriasis/psoriasis-on-the-knees-and-elbows-what-it-looks-like-how-to-treat-it/