Psoriatic Bakers cyst

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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A Baker's cyst is a condition where synovial fluid (fluid manufactured by the lining cells of the joint capsule) accumulates in the back part of the knee joint.

Continued accumulation leads to swelling in the back of the knee and sometimes pain as well. Patients complain of a tight feeling behind the knee when they bend their knee.

The fluid may also dissect downward between the muscles of the calf. The appearance may mimic that of deep vein thrombosis (blood clot in the calf). Ultrasound with Doppler imaging may be needed to differentiate the two.

Various conditions including rheumatoid arthritis, psoriatic arthritis, Reiters disease, osteoarthritis, gout, pseudogout, and mechanical derangement of the knee may be associated with this problem. Accumulation of synovial fluid occurs by a one-way valve mechanism. Synovial fluid is forced from the front to the back of the knee and cannot flow back.

Treatment is directed at the underlying condition. If this is due to an inflammatory condition such as rheumatoid arthritis or psoriatic arthritis, then better control of the disease with medication is needed.

Also, withdrawal of fluid from the knee and simulataneous injection of steroid into the knee joint accompanied by rest, elevation of the leg, and ice will help.

Aspiration of the fluid with injection of glucocorticoid using ultrasound guidance is often very successful in eliminating the problem.

In rare cases, surgery is required.

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