Signs and Symptoms of Psoriatic Arthritis

woman sitting on bed with soe, swollen toes
Pain and swelling at the back of the heel or the bottom of the foot are possible symptoms of psoriatic arthritis.Anupong Thongchan/Getty Images

Psoriatic arthritis?is an autoimmune disease that causes inflammation of the skin, joints, tendons, and nails.

Most people with psoriatic arthritis experience skin problems first and then, years later, joint pain, swelling, or stiffness. But not everyone follows that pattern.

The severity of psoriatic arthritis symptoms varies a lot. Some people have mild symptoms, while others experience debilitating pain that affects their daily lives. For some people, symptoms are constant, while for others, they come and go. A sudden worsening of symptoms is referred to as a flare.

Because starting on treatment earlier may lessen the risk of joint damage later on, it’s important to recognize the early signs and symptoms of psoriatic arthritis.

How Psoriatic Arthritis Affects the Body: Fatigue, psoriasis (rash), back pain, swollen fingers or toes, swollen painful tendons, joint stiffness, pitted flaky nails, painful swollen joints, eye inflammation

Psoriatic arthritis can cause any or all of these symptoms in a person with the condition.

Everyday Health

What Are the Early Warning Signs of Psoriatic Arthritis?

These are some of the common early signs and symptoms of psoriatic arthritis.

Skin Rash (Psoriasis)

For most people, psoriatic arthritis is preceded by psoriasis, a type of skin rash that?usually appears as red patches with silvery scales, which are called plaques. Psoriasis plaques can show up anywhere on the body, but are common on the scalp, elbows, knees, or around the ears. The rash may itch and burn.

In some cases, arthritis symptoms such as stiff or painful joints come first, before psoriasis. And for some people, joint and skin symptoms start at the same time.

Fatigue

Generalized fatigue is a common symptom of psoriatic arthritis. While effective treatment can reduce fatigue in psoriatic arthritis, some medications used to treat the disease can also contribute to it.

Painful, Swollen Joints

Any joint can be affected by psoriatic arthritis, but it commonly impacts the fingers and toes, as well as the wrists, knees, and ankles. Joint pain and swelling may occur on one or both sides of the body, and the pain may be worse in the morning or after you’ve rested.

Joint Stiffness

Stiff joints may make moving or bending difficult. Along with pain in the joints, joint stiffness is usually worse in the morning or after you’ve been still for a while.

Reduced Range of Motion

The pain and stiffness associated with psoriatic arthritis can affect your range of motion. You may not be able to move your joints and limbs easily.

Swollen Fingers or Toes

Many people with psoriatic arthritis experience a symptom known as dactylitis, or “sausage digit” — the dramatic swelling of a finger or toe.

Since other forms of arthritis don’t generally cause this type of swelling, the symptom can help doctors home in on a diagnosis of psoriatic arthritis.

Nail Problems

With psoriatic arthritis, fingernails and toenails may become pitted, flaky, or look infected. Sometimes they can even lift from the nail bed. Such nail changes can also occur in people who have psoriasis but not psoriatic arthritis.

Enthesitis: Heel or Foot Pain

Enthesitis, which is characterized by pain and swelling where tendons or ligaments attach to bones, is common in people with psoriatic arthritis. This symptom usually occurs at the back of the heel or on the bottom of the foot.

Eye Inflammation

Psoriatic arthritis can sometimes cause inflammation of the eyes called uveitis, which is characterized by irritation, redness, and vision problems.

Back Pain

Some people with psoriatic arthritis develop spondylitis?— a condition that causes inflammation in your spine or pelvis. (Inflammation of the pelvis is called sacroiliitis.) This can lead to?back pain?and stiffness, most commonly in the lower back, neck, and upper back.

Advanced Symptoms of Psoriatic Arthritis

Psoriatic arthritis that goes untreated or inadequately treated can destroy the joints and cause permanent disfigurement, including shortening of the fingers and toes due to erosion of the bones or joints, and bony fusion of the joints, meaning they can no longer bend. People who have psoriatic spondylitis?can develop fusion of the bones in the spine.

Arthritis mutilans is a severe form of bone and joint destruction in the fingers and toes in which the digits are shortened or telescoped — effectively sliding into themselves — and the joints may be excessively mobile and nonfunctional.

Pencil-in-cup deformity is a form of arthritis mutilans in which one end of the bone is worn down into the shape of a pencil tip, and the facing bone is worn into the shape of a cup. These bone changes can be seen only on an X-ray.

Early, effective treatment for psoriatic arthritis can help prevent this type of severe damage and may also lower the risk of heart disease, a condition for which people with psoriatic arthritis are at higher risk.

I Have Psoriasis. Am I at Higher Risk for Psoriatic Arthritis?

An estimated 30 percent of people with psoriasis develop psoriatic arthritis.

Both are autoimmune, inflammatory conditions, and both are more likely to occur if a family member has the disease. But environmental factors also play a role in who develops psoriasis or psoriatic arthritis.
While there’s no sure-fire way to identify which individuals with psoriasis will develop psoriatic arthritis, a literature review found that people with psoriasis who had any of the following were at higher risk:

  • Increased psoriasis severity
  • Positive family history for psoriasis or psoriatic arthritis
  • History of musculoskeletal pain, morning stiffness, fatigue, and difficulty with activities of daily living
  • Scalp, intergluteal (between the buttocks), or perianal (around the anus) psoriasis
  • Nail deformities or thickening
  • Dactylitis (sausage digits)

When Should I See My Doctor for Psoriatic Arthritis Symptoms?

If you’ve already been diagnosed with psoriasis and you’re experiencing possible symptoms of psoriatic arthritis, you should bring it to the attention of your dermatologist or primary care doctor right away. If you’re not sure whether your symptoms merit a doctor visit, consider taking the National Psoriasis Foundation’s online psoriatic arthritis screening test for people with psoriasis.

If you don’t have psoriasis but have possible symptoms of psoriatic arthritis, you should similarly bring them to the attention of your primary care doctor right away. The sooner psoriatic arthritis is treated, the less likely it is to become disabling, and the sooner you can regain your quality of life.

And if you’ve been diagnosed with psoriatic arthritis and are experiencing bothersome symptoms, speak to your rheumatologist. You may need a change in your treatment regimen.

Psoriatic Arthritis Support

Are you looking to connect to others who have psoriatic arthritis? One of these organizations may offer the resources you need:

  • CreakyJoints is a digital community for arthritis patients and their caregivers. It offers education, support, advocacy, and patient-centered research resources for people with all types of arthritis.
  • Talk Psoriasis, sponsored by the National Psoriasis Foundation, offers a free helpline, patient navigators, and the Psoriasis One to One program, which connects individuals with someone else who has psoriatic disease.
  • Live Yes! Arthritis Network, sponsored by the Arthritis Foundation, connects you with local, peer-led support groups. You can also attend webinars, hear podcasts, watch exercise videos, and contact with the arthritis helpline.

Common Questions & Answers

What is the first warning sign of psoriatic arthritis?

Psoriasis is often the first warning sign of psoriatic arthritis, although it can take years before other symptoms show up. Sometimes painful or swollen joints are the first sign.

Where does psoriatic arthritis hurt the most?
Psoriatic arthritis affects different people differently. For some people, symptoms in the fingers or wrists may be the worst, while for others, pain in the knees, ankles, or back may hurt the most. It depends on the person.
What time of day is psoriatic arthritis worse?
Joint pain and stiffness are often worse in the morning for people with psoriatic arthritis. Stretching, taking a warm shower or bath, and giving yourself time to move slowly in the morning can help.
What does a psoriatic arthritis flare feel like?
A flare is a sudden worsening of symptoms, whether they be joint pain, pain and swelling in the tendons (called enthesitis), psoriasis, or fatigue. A psoriatic arthritis flare can be physically and mentally exhausting.
What can be mistaken for psoriatic arthritis?

Other forms of arthritis, such as rheumatoid arthritis, can be mistaken for psoriatic arthritis. The disease also shares some symptoms with fibromyalgia, gout, and ankylosing spondylitis.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

  1. Psoriatic Arthritis. Arthritis Foundation.
  2. Sturt K. Ankylosing Spondylitis vs. Psoriatic Arthritis: What’s the Difference? CreakyJoints. March 2, 2020.
  3. Brown J. Psoriatic Arthritis Symptoms You Can’t Afford to Ignore. CreakyJoints. August 1, 2022.
  4. Psoriatic Arthritis: Symptoms. American Academy of Dermatology Association.
  5. Gladman D et al. Psoriatic Arthritis: Epidemiology, Clinical Features, Course, and Outcome. Annals of the Rheumatic Diseases. March 2005.
  6. Symptoms of Psoriatic Arthritis. Spondylitis Association of America.
  7. Overview of Psoriatic Arthritis. Spondylitis Association of America.
  8. Haddad A et al. Psoriatic Arthritis Mutilans: Clinical and Radiographic Criteria. A Systematic Review. Journal of Rheumatology. August 2015.
  9. Chang-Miller A. How Can I Manage Health Risks Related to Psoriatic Arthritis? Mayo Clinic. March 21, 2023.
  10. Zachariae H. Prevalence of Joint Disease in Patients With Psoriasis: Implications for Therapy. American Journal of Clinical Dermatology. 2003.
  11. Busse K. Which Psoriasis Patients Develop Psoriatic Arthritis? Psoriasis Forum. Winter 2010.
  12. Screen for PsA. National Psoriasis Foundation.
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