Psoriatic arthritis (PsA) is often misunderstood, and those misconceptions can make it harder for people to recognize symptoms, seek care, or understand what living with the condition is really like. It can also be challenging to explain the effects of the condition to friends, family, and co-workers.
“Psoriatic arthritis can also be difficult to diagnose, which can add to the confusion,” says Christopher Richard Morris, MD, a board-certified rheumatologist in Kingsport, Tennessee.
From its demographics to its progression, misconceptions about this autoimmune disease can be surprisingly persistent. Here are five common myths — and the facts to help set the record straight.
Everyday Health
1. Myth: Everyone With Psoriatic Arthritis Has Psoriasis
Not everyone with one condition will automatically have the other. While there is a strong link between psoriasis and psoriatic arthritis, up to 17 percent of people with a PsA diagnosis don’t have any visible skin symptoms at the time of their joint diagnosis.
“Though most adult patients develop psoriasis concurrently or before the symptoms of arthritis, there is a small subset of patients where arthritis develops before the skin manifestations,” says Nayaab Bakshi, DO, a fellow at Stony Brook Medicine’s division of rheumatology in Stony Brook, New York.
That said, Dr. Morris points out that there are PsA patients who may not be aware they also have psoriasis, which manifests in different ways. There can be patches of thick, scaly skin that can appear on the scalp, elbows, knees, or lower back; yellow-brown spots on the nails; or pustules can develop on the hands or feet.
“Psoriasis is not recognized easily, and you may not know what to be looking for,” Morris says. If you do notice a skin eruption, he adds, make an appointment with a dermatologist for a thorough examination.
2. Myth: PsA Is Caused by ‘Wear and Tear,’ Like Osteoarthritis
While both conditions are defined by joint pain, they are driven by different biological processes. Osteoarthritis is a degenerative disease in which the cartilage in the joints breaks down over time due to age, injury, or repetitive use.
PsA is inflammatory, which means joint damage is caused by an overactive immune response.
“Inflammation in psoriatic arthritis triggers a cascade of immune responses that cause joint pain, swelling, and destruction through multiple mechanisms: synovial tissue invasion, cartilage breakdown, and bone erosion,” says Dr. Bakshi. The synovium is the lining in the joints that can become inflamed, causing pain, swelling, and stiffness.
In psoriatic arthritis, your immune system also mistakenly tells your body to strip away bone in some spots while simultaneously building extra bone in others. This uneven process can reshape the joint, whereas osteoarthritis involves the gradual breakdown of protective cartilage.
3. Myth: If Your Skin Is Clear, Your Joints Are Fine
While there is some correlation between the severity of skin symptoms and the severity of the joint pain, the two don’t always move in tandem. The skin and the joints are independent targets of the same overactive immune system.
“We have an immune system that can be directed in many different ways,” says Aly Cohen, MD, a rheumatologist and an integrative health specialist in Princeton, New Jersey, and the medical director of the online education platform the Smart Human. “Because of that variability, you can’t always predict what’s going to become inflamed.”
One study found that some immune cells can migrate from the skin into the joints, where they may continue to trigger inflammation. This could help explain why your joints are affected while your skin looks perfectly healthy.
But it is true that if your skin isn’t clear, your joints may also be affected. Bakshi says the severity of skin symptoms can mirror the severity of joint pain. On the other hand, patients can also have severe psoriasis with mild joint disease, or minimal skin issues with significant joint pain and damage.
4. Myth: Psoriatic Arthritis Primarily Affects Elderly People
Since PsA isn’t an aging-joint issue like osteoarthritis, it doesn’t take decades of living for it to emerge. PsA is triggered by a malfunctioning immune system, and that can activate at any age, including in childhood. Studies suggest that the disease is most common in people 40 to 59 years old.
“There is no great way to understand the demographics,” says Dr. Cohen. “It used to be considered male dominant, but I’ve seen it equalize over the years.” It was also long considered a Caucasian disease, but research now suggests Hispanic and non-white PsA patients may experience more pain and limitations in their daily activities.
More than 1.5 million people in the United States have PsA, and about one-third of people who have the skin condition will develop it. Most people develop psoriasis about 10 to 20 years before being diagnosed with PsA.
5. Myth: The Symptoms Are Limited to Joint Pain and Skin Rash
PsA is often thought of as a condition that is limited to two specific areas, but that view is incomplete. “Psoriatic arthritis (PsA) is a multisystem inflammatory disease that extends beyond joint and skin involvement,” says Bakshi.
In addition to achy joints and skin rashes, other symptoms of PsA include:
Tenderness in the areas where tendons or ligaments attach to bones, such as the back of the heel or sole of the foot
Painful, sausage-like swelling of a whole finger or toe
Nail changes, such as pitting (tiny dents), crumbling, or separation from the nail bed.
Eye inflammation, especially uveitis, which can cause eye pain, redness, and blurry vision, and must be treated promptly to avoid vision loss.
Inflammatory bowel disease
An increased risk of heart disease
The Takeaway
Misconceptions about psoriatic arthritis (PsA) are common, largely because it can be difficult to recognize and diagnose; it can have both a joint and a skin component, and doesn’t always present in obvious or predictable ways.
PsA is an inflammatory disease, not the result of cartilage deterioration. It’s caused by an overactive immune system that damages joints in complex ways, and skin symptoms don’t always reliably reflect what’s happening in the joints.
PsA can affect the whole body, can develop at almost any age, and can impact more than joints and skin. It can also affect your eye, digestive, and cardiovascular health.
Understanding the condition and the effects it may have can help you manage it better.
Physical activity is a vital component of a healthy lifestyle. While the recommendations for exercise may vary for each individual, general guidelines from public health agencies typically suggest most people should get around 30 minutes of moderate-intensity aerobic exercise per day.
People with arthritis may be hesitant to head to the gym or engage in home workouts because the instinct to rest is strong when joints feel stiff or painful. However, health care advocates note that movement is one of the most effective treatments for arthritis.
Recent data from the Centers for Disease Control and Prevention says arthritis remains a leading cause of disability in 2026. Roughly one in four adults in the United States have been diagnosed with some form of arthritis. The Arthritis Foundation says exercise is not just a lifestyle choice, but an essential component of joint health. People who engage in physical activity report a 40 percent reduction in pain on average. Here is a prescription for safely navigating physical activity while managing arthritis.
Exercise can remain a key component of daily life, even for those with arthritis
Emphasize exercise that improves flexibility. The Better Health Channel says people with arthritis should focus on exercises that reduce stiffness and keep joints moving through their full range-of-motion. Examples include gentle neck rotations, shoulder rolls and finger stretches daily, especially in the morning during flare-ups.
Incorporate low-impact aerobic movements. Cardiovascular exercises improve heart health and help with weight management, which is essential for people with arthritis. The Arthritis Foundation says losing just one pound of body weight can remove four pounds of pressure from the knees. Walking, cycling and water exercises are low-impact ways to get the cardio a body needs, says the Mayo Clinic.
Make resistance training part of your routine. Building strong muscles can help protect the joints by acting as shock absorbers. People can use bodyweight exercises like chair squats, resistance bands or light dumbbells to build muscle. The Arthritis Foundation recommends focusing on the muscles surrounding joints experiencing the most pain, such as quadriceps for knee arthritis or abdominals to protect the hips and spine.
Assess pain. Experts suggest using something called the two-hour rule to determine if exercise added to or diminished arthritis pain. If joint pain is higher two hours after exercising, then it’s important to reduce the duration or intensity of exercise the next time. During a flare-up, do not stop moving entirely, but shift to gentle range-of-motion stretching only, suggests the Mayo Clinic.
Almost one in four adults over 40 has knee osteoarthritis, a common knee issue that occurs when cartilage in joints wears away from use. While you can't fully prevent knee osteoarthritis, we asked Steven Svoboda, MD, a board-certified orthopaedic surgeon at MedStar Washington Hospital Center, how you can keep your knees healthy as you age.
*This interview has been edited and condensed for clarity.
Q: I’ve always been active, but I’ve noticed my knees starting to hurt more as I get older. Why is this happening, and how would I know if this is just normal aging or something more serious?
Svoboda: A lot of things get attributed to aging, but knee pain isn't always part of normal aging. It isn'talways related to a big injury, either. Sometimes it's from the subtle changes that occur when you're expecting more from your body than what it was built for.
Maybe you start to have knee pain after going all in on a new workout regimen. After a few months, you might notice some pain without necessarily having an injury. In those cases, it's likely related to overuse. Your body can adapt to what's expected of it, but you need to follow a plan and navigate this carefully.
Let's say you're inspired to start jogging and you want to run a 10K. It would be a good idea to see a physical therapist and ask them how to avoid getting anterior knee pain during your training. They can teach you exercises and stretches to help keep your knees healthy. You could also go to a strength and conditioning coach or personal trainer who understands how toease you into a new workout routinewithout risking injuries.
Q: What are the best things I can do to protect my knees and keep them healthy as I age?
Svoboda: Don't injure your knees. If you have a significant ligament injury, like an ACL or a meniscus tear, your risk of arthritis goes up seven or eight times, according to some studies. So, it's not an insignificant thing to injure yourself.
It is important to stay active and seek out new things that expand your horizons. But make sure you are smart and thoughtful when starting a new activity, at any age. Don't cash in some of your body's resilience on an overuse injury. If some is good, more isn't always better.
Other factors that influence knee health include obesity and nicotine use. People with obesity and those who smoke are at risk for pain and arthritis in their knees. If you have concerns about weight management or smoking cessation, speak with your healthcare provider.
Q: Is it even important to worry about protecting my knees if they aren’t bothering me yet? Can’t I just get knee replacements as I get older?
Svoboda: At the right time, surgeries can make a bad case a lot better, but there are no quick fixes.
Knee replacements aren't that good, and they don't make your knee normal. Some studies estimate that 10%-20% of people who have knee replacements are dissatisfied. There's nothing worse than operating on someone who wants a quick fix, but ends up disappointed because they didn't have realistic expectations about the long recovery period.
If you can avoid things that are bad for you, that can pay off in the end. I said don't get injured, but I'm not saying don't play contact, collision sports. If you do play those sports, wear your braces, do the proper training, get strong, and learn your techniques really well.
Arthritis affects millions worldwide and is a leading cause of chronic pain and disability. While medications, injections, and surgery can be a part of managing symptoms, sometimes you can avoid all those with a less medical approach. Regular exercise is one of the most effective, low-risk strategies to reduce arthritis pain, improve function, and enhance quality of life.
It is estimated that in the United States alone, 58.5 million people aged 18 years and older have arthritis. It is a leading cause of disability, with 25.7 million adults reporting activity limitations. Projections suggest that by 2040, an estimated 34.6 million adults with arthritis will report arthritis related activity limitations, which is due to the growth of an aging population. Osteoarthritis is the most common form, affecting over 32 million adults. Arthritis is a major driver of medical costs and loss of productivity.
Mark Cutright, MD
“Exercise helps reduce arthritis pain and inflammation in several ways,” said Mark Cutright, MD, an orthopaedist with West Tennessee Medical Group’s Innovative Orthopaedics. “Regular movement stimulates blood flow, which delivers nutrients and removes inflammatory by-products. Exercise also triggers the release of endorphins, which are the body’s natural painkillers and can lower the levels of inflammatory chemicals over time.”
Regular exercise strengthens muscles. Strong muscles act as shock absorbers and stabilize joints, reducing stress on cartilage and connective tissue. This is especially important for weight-bearing joints like knees and hips. Exercise increases joint range of motion and flexibility. Gentle stretching and full-range movements prevent stiffness, maintain mobility, and make daily activities easier. It can also improve balance and coordination, which can reduce the risk of falls. Exercise can help you maintain a healthy weight, which reduces the load on joints, which can directly lower pain and slow the progression of the disease.
Numerous studies and clinical guidelines support exercise for osteoarthritis and rheumatoid arthritis. For knee and hip osteoarthritis, there is evidence that shows exercise reduces pain and improves function.
“A balanced exercise program that can be beneficial for arthritis pain should include aerobic, strength, flexibility, and balance training. As each component contributes differently to pain reduction and joint health,” said Dr. Cutright. “Low-impact exercise is essential for reducing arthritis pain, as it strengthens muscles, improves joint flexibility, and lowers stiffness. Consistent movement reduces stiffness, while strength training protects joints.”
The top exercises for arthritis include walking, water aerobics, swimming, yoga, and tai chi.
Aerobic exercise improves cardiovascular fitness, helps with weight control, and reduces systemic inflammation. Low-impact walking on smooth surfaces, cycling, or using an elliptical reduces pressure on joints. Other options include swimming, water aerobics, and low-impact dance classes.
Strength training builds muscle around affected joints, improves joint stability, and supports daily activities. It has also been shown to decrease pain and increase strength and mobility.
Examples of this type of exercise include resistance bands, bodyweight exercises, free weights, weight machines, and Pilates-style controlled resistance.
Flexibility and range-of-motion exercises maintain or increase joint mobility and reduce stiffness. These include gentle stretching, modified yoga, tai chi, joint-specific range-of-motion activities, and improve range of motion, balance, and reduce stress. Balance exercises such as standing on one leg with support, heel-to-toe walking, tai chi, and stability ball routines decrease fall risk and improve functional stability. Mind–body practices like tai chi and yoga also provide moderate benefits for pain, function, and psychological well-being.
Exercise is a cornerstone of arthritis management. Regular, well-chosen movement reduces pain, strengthens muscles, maintains flexibility, and improves overall function and mood. A successful program combines aerobic activity, strength training, flexibility, and balance work that is tailored to your condition, abilities, and preferences. Start gently, progress gradually, listen to your body, and seek professional guidance when needed. With consistency and the right approach, you can significantly reduce arthritis pain, allowing you to enjoy more comfortable, active days.
DEAR DR. ROACH: I want to know what you think about vagus nerve stimulation (VNS), both the surgically implanted type as well as the external non-invasive device for rheumatoid arthritis (RA) and other indications. What kind of doctor does this? Just reading about it gives me hope that less drugs are being used to treat these conditions. -- L.L.
ANSWER: VNS uses electrical impulses to trigger some of the many actions of the vagus nerve. VNS is approved by the Food and Drug Administration for some types of drug-resistant epilepsy, headache disorders, and drug-resistant depression.
For RA in particular, a recent randomized trial showed effectiveness at improving symptoms of joint pain and swelling through an implantable VNS device, compared to a “sham” device that didn’t use electrical stimulation. VNS works by inhibiting the inflammatory pathway by electrically stimulating specific receptors. The effect size is modest but statistically significant.
Other studies on non-invasive devices, most commonly one that’s used on the ear, didn’t improve the disease activity of RA. RA is a complex, multi-system disease that can cause disfiguring and disabling joint disease, and it can also affect the heart, lungs, and other internal organs. Since a VNS device hasn’t been proven to modify disease activity, it is my opinion that this device should be used in conjunction with appropriate disease-modifying treatments as recommended by an expert.
I have respect for RA as I recall the days before effective treatments, when I saw many patients with severe joint disease who nearly lost the entire use of their fingers and hands. Rheumatologists are the experts in treating RA and would likely be the person to order a VNS device from.
If you’re struggling with knee arthritis, you know how painful it can be. The good news is that pain in your knee joint doesn’t need to slow you down. A new study shows that three nonsurgical treatments—knee bracing, water therapy and exercise—ease the pain and inflammation significantly. Here, a top doctor and physical therapist share simple ways to incorporate these strategies and get the relief you deserve.
What is knee arthritis?
Knee osteoarthritis is the wearing out of cartilage at the ends of the bones that allow them to glide freely, explains McKenna Campbell-Potter, MD, a board-certified sports medicine physician at Hospital for Special Surgery (HSS).
“Multiple factors contribute to developing knee arthritis including mechanical load, biologic susceptibility [genetics] and prior joint injuries” she notes. “I tell my patients it's like developing potholes on a road, and it can lead to pain and stiffness in the joint.”
According to the Cleveland Clinic, common knee arthritis symptoms include:
A clicking or cracking sound in your knee
Trouble walking
Joint pain and swelling
Knee stiffness
So what can you do about knee arthritis? Plenty, it turns out.
Boyloso
3 drug-free remedies for knee arthritis
While there are medical interventions to treat arthritis in the knee, such as NSAIDs to ease discomfort and even surgery, a recent study in PLOS One showed that three non-drug strategies—knee bracing, water therapy and exercise—eased knee osteoarthritis (OA) without the potential side effects of medications.
Real-world experience on the frontlines backs up this research. “Often, medications are like putting a band-aid on something instead of addressing the root cause,” adds physical therapist Jonathan Su, DPT, C-IAYT, CSCS, author of 6-Minute Knee Pain Cure. “Exercise and other non-drug approaches, on the other hand, offer more lasting relief.”
Here, we explore each of these three strategies and how they make it easier to enjoy your favorite daily activities.
Knee braces
Knee braces work because they redistribute the load on your knee. Additionally, Su explains, they "hug" the joint, which helps suppress pain signals.
“Compression knee sleeves are often sufficient for mild to moderate knee arthritis," says Dr. Campbell-Potter. "I typically recommendneoprene sleevesbecause they have a good balance of strength and flexibility.” While she doesn't endorse any specific brands, she says there’s no reason to break the bank on a knee brace. You can find relatively inexpensive options at stores like CVS and Walgreens.
"I generally prefer the pull-on knee sleeve and advise wearing it during activity—if you're going on a longer walk, cooking or cleaning," she adds. "The goal is to support your knee but not leave an indentation when you take it off—that's a sign it's too tight."
Water therapy
Because we're more buoyant in water, it takes the pressure off our knees. And aquatherapy for OA couldn't be easier: Su recommends fast walking, walking sideways, walking backwards or even running in chest-high water to help strengthen your knee. After all, the ultimate goal, Su says, is to strengthen the ”brace” you were born with—the knee muscles that naturally support your joints—so you won't need an external brace at all.
Low-impact exercises for osteoarthritis of the knees
The third key to easing knee arthritis is exercise, specifically those that strengthen the muscles around the knee, creating support and easing arthritis as you enjoy daily life. Here are a few simple moves Su recommends:
Sidelying knee lift: Lying on your side with knees straight, lift your top leg; hold for five seconds, then lower. Repeat 10 to 15 times on each side. (You can use ankle weights to increase the difficulty.)
Supine bridge: Lying on your back with knees bent and feet flat on the floor, lift your hips off the ground, squeezing your glutes and keeping your core engaged; hold for five seconds, then lower. Repeat 10 to 15 times. (You can hold a weight on your pelvis to increase the difficulty.)
Hamstring curls: Standing upright (hold onto a chair or wall for balance, if needed), bend one knee and bring your heel toward your buttocks; hold for three to five seconds, then lower. Repeat 10 to 15 times on each leg. (You can use ankle weights to increase the difficulty.)
The bottom line on easing knee osteoarthritis
While medications and even surgery are important tools in our arsenal, research shows that easing the symptoms of knee osteoarthritis can include: knee braces, water therapy and exercise. These simple strategies can make a real difference in how your knees feel, helping you move more freely and live more fully.
