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.
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
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