Joint pain, swelling, and stiffness are the best-known psoriatic arthritis (PsA) symptoms, but they’re not the only symptoms. You may have a range of others that aren’t well-known.

Psoriatic arthritis affects everyone differently. Some people have only one joint involved, while others may have five or more impacted joints. Symptoms can be mild and develop slowly or arise suddenly and severely. They can include:

• Swelling in fingers and toes
• Foot pain
• An achy lower back
• Pitted nails

PsA may occur along with psoriasis skin lesions. Less frequently, PsA can appear without psoriasis symptoms.

Recognizing the signs and symptoms of psoriatic arthritis is critical for early diagnosis and treatment. Read on to discover several symptoms that people with PsA may experience.

Symptoms by Type of Psoriatic Arthritis

Psoriatic arthritis can be grouped into five types. Each is defined by the impacted joints. Large and small joints can be involved. It’s also possible to have more than one PsA type. Keep in mind that not all healthcare providers classify PsA this way.

Asymmetric Oligoarthritis

One of the most common types of psoriatic arthritis is asymmetric oligoarthritis. It’s believed to affect between 35 percent to 60 percent of people with PsA, but prevalence numbers differ between studies. It typically involves one to four joints and rarely affects the same joint on both sides of the body.

Symmetric Polyarthritis

Symmetric polyarthritis is another common form of PsA, affecting about 50 percent of people with the condition. It usually affects five or more joints on both sides of the body. Polyarthritis is also a hallmark symptom of rheumatoid arthritis, and PsA can be confused with that disorder.

Spondylitis

Spondylitis, also called spondyloarthritis, affects up to 32 percent of people with PsA. In this condition, inflammation between vertebrae causes pain, swelling, morning stiffness, and limited mobility in joints of the neck and back. Unchecked, it can lead to issues in other bones (such as the hands and feet), and fusion in the spine.

Distal Arthritis

Distal arthritis refers to inflammation and stiffness in the distal interphalangeal joints, the joints closest to the tips of fingers and toes. Nail changes — another psoriatic arthritis symptom — are common with distal arthritis. Fewer than 1 in 5 people with PsA have distal arthritis on its own. Most people with this condition also have another type of PsA as well.

Arthritis Mutilans

Arthritis mutilans is a severe form of PsA that affects less than 5 percent of people with psoriatic arthritis. This condition damages joints in the hands and feet, causing deformation and impaired movement. Bone loss in the joints can cause shortening of fingers and toes.

Common Symptoms of Psoriatic Arthritis

Psoriatic arthritis affects more than the body’s joints. It can also cause symptoms in the skin, eyes, and other organs. The following symptoms include early warning signs, as well as possible indicators of advanced disease.​

Dactylitis

A painful, sausage-like swelling of an entire finger or toe, dactylitis is often the first symptom of PsA. It can affect multiple digits on either side of the body and affects about 40 percent of people with psoriatic arthritis. Swollen fingers or toes 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 and these nail changes can also occur in psoriasis without PsA. Nail changes may appear on one finger or toenail or on all 20 nails.

Up to 90 percent of people with PsA experience nail changes.

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. It usually affects the plantar fascia (bottom of the feet) and Achilles tendon (heel), making it painful to walk. Enthesitis can also affect other joints, including the elbows.

Peripheral Arthritis

Psoriatic arthritis can attack the large joints of the arms and legs, causing swelling and pain. The symptoms of peripheral arthritis move from one joint to the next rather than affecting one or two locations. It can also impact fingers and toes, as well as other joints.

Skin Psoriasis

Itchy red, purple, or silvery skin lesions appear prior to the onset of psoriatic arthritis in approximately 85 percent of people with PsA. Skin disease can appear an average of seven to 12 years before developing PsA.

Uveitis

Uveitis, an inflammatory eye condition, may affect people with PsA. Swelling of the uvea, the middle layer of the eye, causes pain, redness, sensitivity to light, and decreased or blurry vision. Left untreated, uveitis with PsA can damage eye tissue and lead to vision loss.

Fatigue

Psoriatic arthritis can cause high levels of inflammation, which are linked to fatigue — a deep, persistent tiredness that doesn’t improve with rest. 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.

Depression and Anxiety

People with PsA often experience mood disorders, such as anxiety and depression. Different researchers have shared different findings about how common these conditions are with PsA.

For instance, one study found that about 20 percent of PsA had depression. But other researchers said 69 percent of people with PsA had mild depressive symptoms.

People with PsA often experience mood disorders, such as anxiety and depression.

Related Psoriatic Arthritis Conditions

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

• Inflammatory bowel disease — A group of conditions, like Crohn’s disease or ulcerative colitis, that cause inflammation in the digestive tract
• Cardiovascular (heart) disease — A range of heart and blood vessel problems, including heart attacks and strokes
• Hypertension (high blood pressure) — Increased pressure in the arteries, which raises the risk of heart problems and stroke
• Obesity — Higher body weight may increase the risk of joint pain and other conditions like diabetes
• Diabetes — A condition where blood sugar levels are too high due to problems with insulin
• Nonalcoholic fatty liver disease — Buildup of fat in the liver that isn’t caused by alcohol and can lead to liver damage
• Metabolic syndrome — A cluster of conditions, including high blood pressure and blood sugar, that together raise the risk of heart disease and type 2 diabetes

When Do Psoriatic Arthritis Symptoms Appear?

Symptoms of psoriatic arthritis typically appear in people between the ages of 30 and 50. But keep in mind that anyone of any age can develop PsA. These symptoms may arise gradually or suddenly, or flare up periodically.

PsA typically develops about seven to 12 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.

Because PsA shares many symptoms with rheumatoid arthritis, PsA is often misdiagnosed. This is particularly true in people who don’t have psoriatic skin lesions. In one study, only 4 percent of the participant with PsA had never received a misdiagnosis.

“The doctor I initially went to couldn’t diagnose me properly for about eight months,” one MyPsoriasisTeam member said. “I wasted so much energy, time, and money. The pain in my knee was quite severe for a long time … after finding the right doctor, my right knee is perfectly all right now.”

Your doctor will evaluate your symptoms, perform a physical exam, conduct imaging tests, and order blood tests to help diagnose your condition.

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

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 yet for PsA, and symptoms may increase during disease flares. With certain types of PsA, joint symptoms are progressive and can lead to disability.

Fortunately, there are treatments that can help manage symptoms of PsA and slow disease progression. Treatment options for managing symptoms include corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil or Motrin).

PsA treatments for controlling disease progression include disease-modifying antirheumatic drugs (DMARDs), biologics, and Janus kinase (JAK) inhibitors. 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.

Find Your Team

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

Are you living with psoriatic arthritis? What symptoms led you to seek a diagnosis? Share your experience in the comments below, or start a conversation by posting on MyPsoriasisTeam.