Psoriatic arthritis is an autoimmune disease that causes inflammation of the skin, joints, tendons, and nails.
Most people with psoriatic arthritis experience skin problems first and then, years later, joint pain, swelling, or stiffness. But not everyone follows that pattern.
The severity of psoriatic arthritis symptoms varies a lot. Some people have mild symptoms, while others experience debilitating pain that affects their daily lives. For some people, symptoms are constant, while for others, they come and go. A sudden worsening of symptoms is referred to as a flare.
Because starting on treatment earlier may lessen the risk of joint damage later on, it’s important to recognize the early signs and symptoms of psoriatic arthritis.
These are some of the common early signs and symptoms of psoriatic arthritis.
Skin Rash (Psoriasis)
For most people, psoriatic arthritis is preceded by psoriasis, a type of skin rash that usually appears as red patches with silvery scales, which are called plaques. Psoriasis plaques can show up anywhere on the body, but are common on the scalp, elbows, knees, or around the ears. The rash may itch and burn.
In some cases, arthritis symptoms such as stiff or painful joints come first, before psoriasis. And for some people, joint and skin symptoms start at the same time.
Fatigue
Generalized fatigue is a common symptom of psoriatic arthritis. While effective treatment can reduce fatigue in psoriatic arthritis, some medications used to treat the disease can also contribute to it.
Painful, Swollen Joints
Any joint can be affected by psoriatic arthritis, but it commonly impacts the fingers and toes, as well as the wrists, knees, and ankles. Joint pain and swelling may occur on one or both sides of the body, and the pain may be worse in the morning or after you’ve rested.
Joint Stiffness
Stiff joints may make moving or bending difficult. Along with pain in the joints, joint stiffness is usually worse in the morning or after you’ve been still for a while.
Reduced Range of Motion
The pain and stiffness associated with psoriatic arthritis can affect your range of motion. You may not be able to move your joints and limbs easily.
Swollen Fingers or Toes
Many people with psoriatic arthritis experience a symptom known as dactylitis, or “sausage digit” — the dramatic swelling of a finger or toe. Since other forms of arthritis don’t generally cause this type of swelling, the symptom can help doctors home in on a diagnosis of psoriatic arthritis.
Nail Problems
With psoriatic arthritis, fingernails and toenails may become pitted, flaky, or look infected. Sometimes they can even lift from the nail bed. Such nail changes can also occur in people who have psoriasis but not psoriatic arthritis.
Enthesitis: Heel or Foot Pain
Enthesitis, which is characterized by pain and swelling where tendons or ligaments attach to bones, is common in people with psoriatic arthritis. This symptom usually occurs at the back of the heel or on the bottom of the foot.
Eye Inflammation
Psoriatic arthritis can sometimes cause inflammation of the eyes called uveitis, which is characterized by irritation, redness, and vision problems.
Back Pain
Some people with psoriatic arthritis develop spondylitis — a condition that causes inflammation in your spine or pelvis. (Inflammation of the pelvis is called sacroiliitis.) This can lead to back pain and stiffness, most commonly in the lower back, neck, and upper back.
Psoriatic arthritis that goes untreated or inadequately treated can destroy the joints and cause permanent disfigurement, including shortening of the fingers and toes due to erosion of the bones or joints, and bony fusion of the joints, meaning they can no longer bend. People who have psoriatic spondylitis can develop fusion of the bones in the spine.
Arthritis mutilans is a severe form of bone and joint destruction in the fingers and toes in which the digits are shortened or telescoped — effectively sliding into themselves — and the joints may be excessively mobile and nonfunctional.
Pencil-in-cup deformity is a form of arthritis mutilans in which one end of the bone is worn down into the shape of a pencil tip, and the facing bone is worn into the shape of a cup. These bone changes can be seen only on an X-ray.
Early, effective treatment for psoriatic arthritis can help prevent this type of severe damage and may also lower the risk of heart disease, a condition for which people with psoriatic arthritis are at higher risk.
An estimated 30 percent of people with psoriasis develop psoriatic arthritis. Both are autoimmune, inflammatory conditions, and both are more likely to occur if a family member has the disease. But environmental factors also play a role in who develops psoriasis or psoriatic arthritis.
While there’s no sure-fire way to identify which individuals with psoriasis will develop psoriatic arthritis, a literature review found that people with psoriasis who had any of the following were at higher risk:
Increased psoriasis severity
Positive family history for psoriasis or psoriatic arthritis
History of musculoskeletal pain, morning stiffness, fatigue, and difficulty with activities of daily living
Scalp, intergluteal (between the buttocks), or perianal (around the anus) psoriasis
Nail deformities or thickening
Dactylitis (sausage digits)
If you’ve already been diagnosed with psoriasis and you’re experiencing possible symptoms of psoriatic arthritis, you should bring it to the attention of your dermatologist or primary care doctor right away. If you’re not sure whether your symptoms merit a doctor visit, consider taking the National Psoriasis Foundation’s online psoriatic arthritis screening test for people with psoriasis.
If you don’t have psoriasis but have possible symptoms of psoriatic arthritis, you should similarly bring them to the attention of your primary care doctor right away. The sooner psoriatic arthritis is treated, the less likely it is to become disabling, and the sooner you can regain your quality of life.
And if you’ve been diagnosed with psoriatic arthritis and are experiencing bothersome symptoms, speak to your rheumatologist. You may need a change in your treatment regimen.
Are you looking to connect to others who have psoriatic arthritis? One of these organizations may offer the resources you need:
CreakyJoints is a digital community for arthritis patients and their caregivers. It offers education, support, advocacy, and patient-centered research resources for people with all types of arthritis.
Talk Psoriasis, sponsored by the National Psoriasis Foundation, offers a free helpline, patient navigators, and the Psoriasis One to One program, which connects individuals with someone else who has psoriatic disease.
Live Yes! Arthritis Network, sponsored by the Arthritis Foundation, connects you with local, peer-led support groups. You can also attend webinars, hear podcasts, watch exercise videos, and contact with the arthritis helpline.
