Psoriatic arthritis (PsA), a form of chronic inflammatory arthritis, is characterized by symptoms of joint pain, swelling, and stiffness. These symptoms occur when the body’s immune system mistakenly attacks healthy tissue, causing inflammation and damage that limits range of motion and mobility. About 30 percent of people who have psoriasis, or a family history of the skin condition, eventually develop PsA, according to the National Psoriasis Foundation.

Psoriatic arthritis affects everyone differently. Some people have only one joint involved; others may have three or more impacted joints. Symptoms can be mild and develop slowly or arise suddenly and severely. They can include swelling in fingers and toes, heel pain, an achy lower back, or pitted nails.

Because psoriatic arthritis shares many symptoms with rheumatoid arthritis (RA), it’s often misdiagnosed, particularly in the absence of psoriatic skin lesions. In a 2018 study, 96 percent of people with psoriatic arthritis received at least one previous misdiagnosis, and 30 percent were only diagnosed after five years or more.

Recognizing the signs and symptoms of psoriatic arthritis is critical for early diagnosis. Studies have shown that even a six-month delay in getting a diagnosis, or starting medication after first noticing psoriatic arthritis symptoms, can impact treatment effectiveness and lead to a worse outcome.

A rheumatologist can identify PsA symptoms and evaluate treatment options to manage them. The National Psoriasis Foundation also offers a five-question quiz to assess if you have the symptoms of psoriatic arthritis.

Symptoms by Type of Psoriatic Arthritis

There are five types of psoriatic arthritis, each defined by the impacted joints. Large and small joints can be involved. It’s also possible to have more than one PsA type.

Asymmetric Oligoarthritis

One of the most common types of psoriatic arthritis, asymmetric oligoarthritis occurs in 70 percent to 80 percent of people with PsA. The mildest form of PsA, it typically involves one to four joints on just one side of the body.

Symmetric Polyarthritis

Symmetric polyarthritis affects 5 percent to 20 percent of people with psoriatic arthritis. It generally progresses from minimal joint involvement on one side of the body to five or more joints on both sides of the body. Polyarthritis is a hallmark symptom of rheumatoid arthritis, and PsA symptoms can be confused with that disorder.

Spondylitis

Spondylitis, or psoriatic arthritis of the lower back and spine, affects 5 percent to 20 percent of people with PsA. Inflammation between vertebrae causes pain, swelling, morning stiffness, and limited mobility in joints of the neck, lower back, and sacroiliac region near the pelvis. In some people, spondylitis also affects the skin, intestines, and eyes, according to the American College of Rheumatology. Unchecked, it can lead to bone damage, deformities, and fusion in the spine. You can learn more about spondylitis at MySpondylitisTeam.

Distal Arthritis

Distal arthritis refers to inflammation and stiffness in the distal interphalangeal joints, those closest to the tips of fingers and toes. Nail changes — another psoriatic arthritis differentiator — are common with distal arthritis, which is experienced by 10 percent of people with PsA.

Arthritis Mutilans

The rarest and most severe type of psoriatic arthritis, arthritis mutilans attacks joints in the hands and feet, causing deformation and impaired movement. Bone loss in the joints can cause shortening of fingers and toes. Neck and back pain may also occur.

Common Symptoms of Psoriatic Arthritis

Psoriatic arthritis not only affects the body’s joints. It can also create symptoms in the skin, eyes, and other organs, as well as affect quality of life. The following symptoms include early warning signs, as well as common indicators of advanced disease.

Dactylitis

A painful, sausage-like swelling of an entire finger or toe, dactylitis is the first symptom someone with psoriatic arthritis might experience, and a hallmark of the disease. It can affect multiple digits on either side of the body and lead to permanent joint damage if untreated. Sausage digits may also be a sign of disease progression.

Nail Changes

Pitting, ridging, and flaking under the nail, or separation from the nail bed (known as onycholysis) are early PsA symptoms. They are unique to this arthritic disease. Up to 90 percent of people with PsA experience nail changes. Nail changes may appear on one finger or toenail or on all 20 nails.

Enthesitis

Swollen, tender joints — a common psoriatic arthritis symptom — are caused by inflammation of the entheses, the place where ligaments attach to the bone. Nearly 50 percent of people with PsA experience this symptom, most frequently in the plantar fascia (bottom of the feet) and Achilles tendon (heel), making it painful to walk. Enthesitis can also affect the spine, elbows, ribs, and neck, making tissues in these areas tight and ropey.

Peripheral Arthritis

Psoriatic arthritis also attacks the large joints of the arms and legs, causing swelling and pain. Fingers and toes, as well as elbows, wrists, knees, and ankles may also be affected.

Skin Psoriasis

Itchy, red, purple, or silvery lesions appear prior to the onset of psoriatic arthritis in approximately 75 percent of people with PsA. Skin disease can appear an average of 10 to 20 years before developing PsA. Some studies found that psoriasis can be more severe in people with PsA.

Uveitis

Uveitis, an inflammatory eye condition, is common in people with PsA (as well as for people with rheumatoid arthritis). Swelling of the uvea, the middle layer of the eye, causes pain, redness, sensitivity to light, and decreased or blurry vision. Left untreated, uveitis can damage eye tissue and lead to vision loss.

Fatigue

High levels of inflammation have been linked to fatigue in PsA. The physical and emotional challenges of living with a debilitating chronic illness are also contributors. A Danish survey of 1,062 people with PsA found that 50 percent had moderate-to-severe fatigue. An earlier study observed that 1 in 5 people with PsA also have fibromyalgia, which causes fatigue.

Depression and Anxiety

People with PsA often experience mood disorders. A 2014 study found that more than 36 percent of individuals with the disease reported some degree of depression or anxiety. Those studied also had high levels of joint disease, disability, and fatigue.

Related Psoriatic Arthritis Conditions

Psoriatic arthritis also increases the risk of other health conditions, or comorbidities, including:

• Inflammatory bowel disease
• Diabetes
• Cardiovascular disease
• Obesity
• Osteoporosis
• Shortness of breath and coughing

When Do Psoriatic Arthritis Symptoms Appear?

Symptoms of psoriatic arthritis typically appear between the ages of 30 and 50. They may arise gradually or suddenly, or flare up periodically. PsA may also affect one or more joints — most commonly in the hand, foot, or knee — and worsen over time, according to the American Academy of Dermatology.

PsA typically develops about 10 to 20 years after the onset of psoriasis, but PsA can present even before skin symptoms appear. Most people are first examined by a dermatologist or internist to identify PsA symptoms, before being referred to a rheumatologist, who specializes in arthritis.

Is It Psoriatic or Rheumatoid Arthritis?

Psoriatic arthritis and rheumatoid arthritis are both autoimmune diseases involving inflammation that causes pain, swelling, and stiffness in joints. The disease can flare up or go into remission. A PsA diagnosis, however, requires an individual to have at least three of the following:

• Skin psoriasis
• Nail changes
• Dactylitis
• Negative blood test for rheumatoid factor
• Joint inflammation and damage shown on X-rays or MRI

Early diagnosis is important. Left unchecked, inflammatory symptoms can worsen and cause permanent damage that leads to disability.

Do Psoriatic Arthritis Symptoms Go Away?

There’s no cure for PsA, and symptoms may increase during disease flares. With some types of PsA, joint symptoms are progressive and can lead to disability. Remission occurs in less than 20 percent of people with psoriatic arthritis.

Fortunately, there are treatments that can help manage symptoms of PsA and slow disease progression. Treatments for managing symptoms include corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDS) like Advil or Motrin (Ibuprofen). Treatments for controlling disease progression include disease-modifying antirheumatic drugs (DMARDs) and biologic DMARDs. Physical therapy and lifestyle changes can also be an important part of a psoriatic arthritis treatment plan. Talk to your doctor about ways to manage your PsA.

Learn more about treatments for psoriatic arthritis.

References

1. About Psoriatic Arthritis — National Psoriasis Foundation
2. Diagnostic experiences of patients with psoriatic arthritis: misdiagnosis common — Annals of the Rheumatic Diseases
3. Psoriatic Arthritis Screening Test — National Psoriasis Foundation
4. Are You at Risk for Psoriatic Arthritis? — National Psoriasis Foundation
5. Psoriatic Arthritis — Genetics Home Reference
6. Psoriatic Arthritis — Cleveland Clinic Disease Management
7. Psoriatic Arthritis and Back Pain — Arthritis Foundation
8. Spondyloarthritis — American College of Rheumatology
9. The Different Types of Psoriatic Arthritis — and Why Knowing Your Type Matters — Creaky Joints
10. Nail Involvement in Psoriatic Arthritis — Reumatologia
11. Psoriatic Arthritis — DermNet NZ
12. Psoriatic Arthritis Symptoms You Can’t Afford to Ignore — Creaky Joints
13. What Is Uveitis? What to Know About How Arthritis Affects Your Eyes — Creaky Joints
14. Fatigue and Psoriatic Arthritis — National Psoriasis Foundation
15. Depression and Anxiety in Psoriatic Disease — The Journal of Rheumatology
16. Psoriatic Arthritis: Symptoms — American Academy of Dermatology
17. Psoriatic Arthritis Signs & Symptoms — Johns Hopkins Arthritis Center
18. Rheumatoid Factor — Mayo Clinic

Laurie has been a health care writer, reporter, and editor for the past 14 years. Learn more about her here.

Ariel Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Learn more about him here. Review provided by VeriMed Healthcare Network.