If you’re living with psoriasis, you may already be familiar with skin symptoms like plaques, itching, and irritation. But if you wake up with stiff, swollen joints or fatigue that just won’t go away, these could be early warning signs that your skin condition is affecting more than just your skin — it may be progressing into your joints.

About 30 percent of people with psoriasis develop psoriatic arthritis (PsA). PsA happens when the immune system attacks the joints, causing painful flare-ups and joint damage over time. Most people who have PsA experience skin symptoms first, but in some cases, joints are the only areas affected.

One MyPsoriasisTeam member who developed PsA after psoriasis explained, “I have nearly unnoticeable psoriasis in my hair … I developed PsA after having three major surgeries in 18 months.”

Learning to recognize the signs and symptoms of PsA can help you get treatment before too much damage occurs. When left untreated, over time, joint damage from PsA can lead to reduced range of motion and joint deformation. By keeping PsA under control in the early stages, you can protect your joints and feel your best.

Here are some early warning signs of psoriatic arthritis to watch for. Knowing them can help you and your rheumatologist catch PsA early and start treatment before lasting joint damage occurs.

1. Joint Changes

One of the first signs of psoriatic arthritis can be changes to your joints. They may feel stiff, painful, swollen, and warmer than the rest of your body. This can be mild or severe. PsA often starts in small joints, like those in your fingers and toes. But you might also notice it first in larger joints, such as your knees or your shoulders.

A member of MyPsoriasisTeam shared, “My knee is swollen, and bending it is difficult. I struggle to walk up and down the stairs as well.”

2. Swollen Fingers or Toes (Dactylitis)

Sometimes, swelling in your fingers or toes can become severe. This is called dactylitis. The swelling can make your fingers and toes look like small sausages. Fingers may be especially hard to move or bend.

This can interfere with daily life and tasks like typing or picking up objects. Dactylitis usually affects the entire finger or toe, not just one joint. Close to 40 percent of people with PsA will have dactylitis at some point.

3. Joint Stiffness

PsA may make your joints feel stiff. This can be caused by dactylitis, but sometimes your joints may feel stiff without any obvious swelling.

Many people notice it first thing in the morning, called morning stiffness. Others notice it after using a particular joint a lot. Stiffness can happen in any joint in your body.

4. Foot Pain

Psoriatic arthritis can also cause foot and heel pain. This usually comes from inflammation in your ligaments and tendons, specifically where they attach to bones.

When this happens in places like your plantar fascia (on the bottom of your foot) or your Achilles tendon (on the back of your heel), it causes significant pain in your feet or heels. This inflammation is called enthesitis. Enthesitis can range from mild to severe pain. Sometimes the foot pain comes with swelling, but not always.

5. Back Pain

PsA may begin in your back, often in your lower back. The pain can spread to your hips or your buttocks, which can make it hard to tell where it started. The pain may make it hard to sleep at night. It may also cause morning stiffness that may last longer than 30 minutes.

This pain comes from inflammation in the lower part of your spine, called spondylitis. It often affects the sacroiliac joint — where the spine meets the pelvis. Without treatment, this can reduce your mobility and make daily activities harder.

6. Nail Changes

Even though PsA usually affects the joints, one of the early symptoms of psoriatic arthritis is changes in your fingernails and toenails. They may look cracked, or you may see pits on the surface of your nails. Some nails may develop white spots, lift from the nail bed, or become thick or discolored.

These changes may look like a nail infection, but sometimes they’re actually a sign of PsA.

One member of MyPsoriasisTeam who experienced nail changes shared, “I’m newly diagnosed with PsA. All 10 of my nails were affected.”

7. Eye Inflammation

PsA can also affect your eyes. Inflammation can make your eyes red or extremely sensitive to light. You may also notice blurred vision. Eye inflammation, also called uveitis, can also cause your eyes to hurt.

It’s very important to get medical care right away if you notice eye symptoms. Without treatment, inflammation can cause permanent changes to your vision, including losing all or part of your vision.

8. Fatigue

Fatigue is another early symptom of PsA. Fatigue is more than just being tired, and getting more sleep doesn’t make it go away. It can make daily activities harder and leave you feeling frustrated and overwhelmed. This fatigue is likely caused by inflammation in your body, which can drain your energy. You may feel fatigued until your PsA and the inflammation are under control.

A member of MyPsoriasisTeam who experienced fatigue explained, “The fatigue is insidious and, I think, an underappreciated component of PsA.”

If fatigue is strong, you may feel very unwell. When you add sore joints and other PsA symptoms, it’s easy to see why living with psoriatic arthritis might make you feel ill, especially during a flare.

If you notice any of these symptoms, talk to your healthcare provider. They may refer you to a rheumatologist, a doctor who specializes in bones, joints, and muscles. With the right diagnosis and treatment plan, you can begin managing your symptoms and feel better.

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On MyPsoriasisTeam, people share their experiences with psoriasis and psoriatic arthritis, get advice, and find support from others who understand.

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