Psoriatic arthritis is a type of inflammatory arthritis in which the immune system mistakenly attacks the joints. The condition affects people differently, so it doesn’t have clearly defined stages like rheumatoid arthritis. However, PsA can progressively worsen over time — especially if it’s not properly treated.

The sooner PsA is diagnosed, the sooner treatment can begin to control inflammation and prevent or slow disease progression, including joint damage. Even a six-month delay in diagnosis can lead to worse outcomes, so knowing what to look for and when to seek medical advice is crucial.

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If you already have skin psoriasis, it’s important to watch out for symptoms of PsA, as your risk is higher. Up to 30 percent of people with psoriasis develop PsA, according to Cleveland Clinic. Also, many people who develop PsA have a family history of PsA or psoriasis.

Up to 30 percent of people with psoriasis develop PsA, according to Cleveland Clinic.

Although PsA doesn’t have specified stages, there are levels of severity that may be helpful in understanding or describing your joint pain.

Subclinical Psoriatic Arthritis

In research studies, imaging tests can sometimes show early signs of inflammation before symptoms of PsA appear. Certain biomarkers (markers found in your blood) are used to help detect early PsA in people with psoriasis. Subclinical PsA isn’t an official diagnosis, and estimates of how common it is vary widely depending on the definitions and tests used. Many people with subclinical findings of PsA never develop symptoms of psoriatic arthritis.

Scientists are working on finding specific lesions (abnormalities on imaging tests) in people with subclinical PsA that could help predict who will develop symptomatic PsA.

Early Psoriatic Arthritis

When PsA begins, you’ll usually experience joint symptoms, such as pain and swelling in the fingers and toes (dactylitis or “sausage digits”), as well as symptoms of psoriasis like skin rashes.​

You might also notice fatigue and stiffness as symptoms of early PsA. A study of people living with PsA found that 36 percent of participants had seen their primary doctor for musculoskeletal issues, such as joint pain or stiffness, in the five years leading up to their PsA diagnosis.

Symptoms of PsA can also include enthesitis, which is pain and swelling in the tendons and ligaments where they connect to your bones. Enthesitis is common on the bottom of the feet (plantar fasciitis) and in the heels (Achilles tendinitis).

Moderate to Severe Psoriatic Arthritis

Moderate to severe PsA can seriously affect your quality of life. Flare-ups can make daily physical activities difficult, and they might affect your emotional and physical health. Common painkillers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may treat the symptoms of the disease. However, stronger medications, such as disease-modifying antirheumatic drugs (DMARDs), are usually necessary to prevent further damage to the joints and other parts of the body.​

Joint Deformities

PsA that has progressed may cause irreversible joint damage and deformity. Some people with PsA develop spondylitis (inflammation of the spine). Spondylitis can cause neck and lower back pain, or it can lead to complete fusion of bones in the spine.

Chronic inflammation of the finger and toe joints can cause the fingers and toes to shorten and collapse, a rare condition called arthritis mutilans. Less than 5 percent of people with PsA have arthritis mutilans. Although the exact causes of arthritis mutilans are unknown, PsA treatments can reduce your risk of developing the condition.

Damage to Other Parts of the Body

If left untreated, PsA and its inflammation can have effects beyond the joints and tendons. Later — or sometimes even early in the course of PsA — some people experience uveitis (inflammation in the eye). Without treatment, uveitis in PsA can cause permanent damage to the eyes.

If left untreated, PsA inflammation can have effects beyond the joints and tendons.

PsA is also linked to a higher risk of heart damage, liver damage, and inflammatory bowel disease, including Crohn’s disease.

Measuring Psoriatic Arthritis Progression

A dermatologist (skin specialist) or rheumatologist (a specialist in diseases that affect the joints, muscles, bones, and immune system) can help determine whether you have PsA and how far it has progressed. They will examine your affected joints for swelling and tenderness and press on the soles of your feet near the heels to check for pain.

In addition, they may test your range of motion and examine your fingernails and nail beds. Pitting, crumbling, and ridged nails are early symptoms of PsA. Your healthcare provider will also ask you about pain, fatigue, and other physical symptoms and how they affect your quality of life.

Imaging Tests

Imaging tests such as X-rays, ultrasounds, MRI scans, and CT scans help healthcare providers measure the progression of PsA. Tracking joint damage over time on X-rays is called measuring radiographic progression.

Certain tests are better at detecting PsA damage to the soft tissues. For example, ultrasound can detect enthesitis even before it causes you pain. MRI scans can also detect damage caused by PsA.

X-rays help diagnose PsA as the condition advances. In more advanced cases, X-rays can show a characteristic finding called the “pencil-in-cup” appearance, where bone and joint damage changes the shape of the joint.

Slowing the Progression of Psoriatic Arthritis

Many medications, such as over-the-counter painkillers (e.g., naproxen and ibuprofen) and corticosteroid injections, can ease the pain and inflammation of PsA. DMARDs and biologic DMARDs can also limit disease activity and keep PsA from getting worse.

Disease-Modifying Antirheumatic Drugs

DMARDs work to reduce joint and tissue damage and slow PsA disease progression. Without DMARDs, the joint tissues of people with PsA would likely be destroyed over time by inflammation. Some DMARDs used to treat psoriatic arthritis are approved by the U.S. Food and Drug Administration (FDA) for other health conditions, but not specifically for PsA. This is called “off-label” use and is a normal practice.

DMARDs increase the risk of infections. This is because they affect the immune system. While DMARDs are effective at controlling joint inflammation and other PsA symptoms, it’s important to discuss the risks and benefits with your healthcare provider and let them know if you experience any side effects.

Biologic DMARDs

Biologic DMARDs work against specific proteins that cause inflammation. Tumor necrosis factor (TNF) inhibitors are biologic DMARDs that block certain proteins that maintain inflammation. They have been shown to help control symptoms and slow joint damage in many people with PsA. Other biologic options are interleukin-12/23 inhibitors or interleukin-17 inhibitors, which target immune proteins that play an important role in maintaining inflammation in PsA.

Not everyone with PsA will need biologic DMARDs as part of their treatment plan. The symptoms of psoriatic arthritis can often be managed with conventional DMARDs.

Janus Kinase Inhibitors

Newer medications called targeted synthetic DMARDs are also available. These drugs are Janus kinase (JAK) inhibitors — they block JAK enzymes that are often activated in autoimmune disorders. These drugs can also block PsA disease progression.

For more information about PsA progression and treatment, talk to your healthcare team.

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