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Does Psoriatic Arthritis Itch?

Medically reviewed by Florentina Negoi, M.D.
Written by Emily Brown
Posted on January 26, 2024

Got a really itchy spot — or spots — on your skin and wondering if psoriatic arthritis (PsA) is to blame? Psoriatic arthritis usually involves psoriasis skin symptoms. Approximately 1 in 3 people with psoriasis develop PsA, and of those who do, many show skin symptoms first, before joint symptoms appear. “I had skin issues long before I had pain in my joints,” one MyPsoriasisTeam member shared.

“Fingers started to peel really bad, and then I would have blisters that would bleed. Didn’t get the arthritis pain right away, but when I did, I got it bad,” wrote another.

Many people with PsA experience both itchy rashes and joint pain at the same time, a difficult combination to live with. Learn more about skin itchiness with PsA, including what PsA rashes look like, what causes them, and what can be done to treat or potentially prevent them.

Symptoms of Psoriasis and Psoriatic Arthritis

Some symptoms of PsA are hidden underneath the surface, such as stiff, tender, and painful joints. However, PsA can also show up as a psoriasis rash. It’s important to note that the severity of one’s psoriasis is not an accurate indicator of the severity of their PsA — someone with PsA may have a lot of stiff, painful joints from PsA but few skin lesions.

Symptoms of psoriasis vary greatly from person to person but generally include:

  • Skin that is dry and cracked and may itch or bleed
  • Patches of thick, discolored skin that looks scaly and itches or burns, usually on the scalp, trunk, elbows, knees, bottoms of the feet, or palms of the hands
  • Thick nails that appear ridged and pitted
  • Issues getting quality sleep

Common symptoms of PsA include:

  • Dactylitis — Swelling in the fingers and toes, making them look like little sausages
  • Stiffness, tenderness, pain, or swelling in the joints, over tendons and entheses (the tissue that connects muscles to bones)
  • Tiredness
  • Less range of motion
  • Nails that are pitting or separated from the nail bed
  • Stiffness and tiredness in the morning
  • Uveitis — Pain and redness in the eye

In addition to swollen joints, fingers, and toes and morning stiffness, foot pain and back pain are some of the early symptoms of PsA. PsA may also show up as neck or back pain or sharp pain in certain areas, such as the level of some tendons or entheses, most frequently the Achilles tendon (also known as Achilles heel).

Psoriatic Arthritis and Rashes

PsA skin rashes often show up as plaque psoriasis, which is the most common form of psoriasis. More than 900 MyPsoriasisTeam members living with PsA report discolored or red patches of scaly skin.

Plaque psoriasis skin lesions usually appear in a symmetrical pattern and can occur anywhere on the body, but specific areas of the body are especially prone:

  • Scalp
  • Knees
  • Elbows
  • Trunk, including the stomach and lower back

In addition to plaque psoriasis, itchy psoriasis rashes might also be a result of other types of psoriasis, including:

  • Pustular psoriasis — Small, pus-filled blisters that usually occur on the palms of the hands and soles of the feet
  • Guttate psoriasis — Small, discolored patches (depending on your skin tone) that usually appear on the trunk, arms, and legs
  • Inverse psoriasis — Moist, discolored patches of skin on areas of the body where your skin folds, such as under breasts, armpits, elbow creases, groin, and in between the buttocks
  • Erythrodermic psoriasis — Extreme discoloration and shedding on large areas of the skin (rare but can signify an emergency)

What Does a Psoriatic Arthritis Rash Look and Feel Like?

A PsA rash commonly shows up as plaque psoriasis, which appears as patches of skin that are raised. Depending on your skin tone, they may be red, pink, or violet in color. These patches may be covered in white-silvery scales from dead skin cell buildup. These rashes may be itchy and painful but are not contagious.

PsA often involves joint pain and skin issues, which can significantly affect quality of life. Some MyPsoriasisTeam members note the itchiness follows where their joints are painful or swollen. “I have major swelling in my hands and feet. I get itching wherever the swelling is :(,” one member shared. Another wrote, “Knuckles constantly itch! My hands are a mess, and my thumb joints are gone.”

Others note skin issues in different parts of the body unrelated to their joint pain. “I had patches of psoriasis on my elbow and scalp with joint pain in hands, feet, and knees,” one member wrote.

PsA skin rashes can be mistaken for other skin conditions, such as eczema, acne, an allergic reaction, or simply dry skin. If you notice a new or worsening rash, be sure to make an appointment with your health care provider for diagnosis and subsequent treatment.

What Causes Itchiness With Psoriatic Arthritis?

Inflammation caused by an overactive immune system is the underlying connecting factor that leads to both PsA skin issues and joint pain.

The exact cause of psoriatic itch is unknown but involves a complex set of interactions between different systems of the body, including the immune, endocrine, nervous, and vascular systems.

Though there may not be any one cause of itchiness associated with PsA, you may find that certain situations trigger an itchy rash. For example, research has shown that certain physical, environmental, and mental factors may make psoriasis itchiness worse, including:

  • Dry skin
  • Winter weather
  • Sweating, such as after exercise
  • High temperatures
  • Hot water
  • Stress

“I have psoriatic arthritis in my hands and feet. With winter here, the affected joints are itching,” one MyPsoriasisTeam member noted. Try to keep tabs on possible triggers for itchiness and rashes as part of your treatment plan for managing and preventing future itchy rashes.

Treatment for Itchiness With Psoriatic Arthritis

Treatment for PsA skin and joint symptoms may be treated separately or in combination. Managing itchy rashes can be frustrating, but you’ll need to resist the temptation to scratch, as it can cause the plaques to thicken.

Treatment options for rashes with PsA depend on the severity of the rash and disease progression. For example, over-the-counter or medicated topical creams may be used to treat mild rashes, while disease-modifying antirheumatic drugs (DMARDs), or biologics, may be needed to reduce the underlying inflammation and subsequently reduce itchy rashes in more severe cases of PsA.

Talk to your health care provider or rheumatologist about treatments for any rashes that show up and how to identify triggers to try to prevent future rashes and flare-ups.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 124,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Do you experience itchiness with PsA? What helps you manage or prevent PsA rashes? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on January 26, 2024
    All updates must be accompanied by text or a picture.

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    Florentina Negoi, M.D. attended the Carol Davila University of Medicine and Pharmacy in Bucharest, Romania, and is currently enrolled in a rheumatology training program at St. Mary Clinical Hospital. Learn more about her here
    Emily Brown is a freelance writer and editor, specializing in health communication and public health. Learn more about her here

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