What Is Psoriatic Arthritis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

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

It affects about 1.5 million people in the United States. The condition usually affects those between ages 30 and 50, but it can start at any age, even in childhood. Men and women are equally at risk for having psoriatic arthritis.

A large proportion of people with psoriatic arthritis also have psoriasis?— a condition that causes the rapid buildup of skin cells.

Usually, the psoriasis develops first, and the painful, swollen joints come later. But in some people, psoriasis and joint pain start at the same time, and in some, the joint problems come first, followed by psoriasis.

There’s no cure for psoriatic arthritis, but there are therapies to control the symptoms and to reduce the inflammation that can lead to joint damage and other serious health consequences.

Signs and Symptoms of Psoriatic Arthritis

Psoriatic arthritis can cause a broad range of symptoms. Not everyone with the disease experiences all of these symptoms, and the severity of symptoms varies from person to person.

Early signs and symptoms of psoriatic arthritis may include:

  • Painful, swollen joints
  • Psoriasis, or itchy, scaly patches of discolored or raised skin
  • Fatigue
  • Enthesitis, or pain and stiffness in the tissues surrounding the joints
  • Dactylitis, or “sausage-like” swelling of the fingers or toes
  • Pain and stiffness in the back or pelvis
  • Joint stiffness and reduced range of motion
  • Inflammation of the eyes, called uveitis
  • Nails that become pitted, crumble, or lift from the nail beds
It’s important to note that while plaque psoriasis (the most common type of psoriasis) in white people generally appears as red or pink patches with silvery-white scales, in people with darker skin, the patches may look gray, purple, or brown.

More advanced symptoms of psoriatic arthritis — particularly disease that goes untreated — can include:

  • Deformities of the fingers or toes
  • Fusion of the bones in the spine
  • Fusion of other joints in the body

Psoriatic arthritis is considered a chronic disease.

Symptoms typically worsen over time, but you might experience periods of improvement or remission, alternating with episodes of intensified symptoms, known as “flares,” which may last for several days.

Identifying what triggers your flares may help you to avoid them. Common triggers include stress, skin injuries, infections such as the flu, skipping prescribed medications, drug interactions, and possibly certain foods.

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

Causes and Risk Factors of Psoriatic Arthritis

Doctors aren’t exactly sure what causes psoriatic arthritis, but they do know it happens when your body’s immune system starts to attack healthy tissue. This faulty process causes inflammation in your joints and an overproduction of skin cells.

Experts believe that both genetic and environmental influences may be to blame for the immune system failure.

Certain factors that may increase your risk include:

  • Having Psoriasis?Being diagnosed with psoriasis is the greatest risk factor for developing psoriatic arthritis.
  • Family History?Many people with psoriatic arthritis have a family member with psoriatic arthritis.
  • Infection?Having a viral or bacterial infection may activate the immune system and trigger psoriatic arthritis in people with a genetic predisposition.
  • Age?Anyone can develop psoriatic arthritis, but it’s more common in those between ages 30 and 50.
  • Obesity Obesity is a risk factor for developing psoriatic arthritis. It’s also associated with more severe disease, and it reduces a person’s response to psoriatic arthritis treatments.

How Is Psoriatic Arthritis Diagnosed?

To diagnose psoriatic arthritis, your doctor will ask you about your symptoms — when they started, whether they come and go or remain consistent, and what, if anything, improves them — as well as any family history of psoriasis, psoriatic arthritis, or other inflammatory or autoimmune diseases.

Your doctor will perform a physical exam to look for:

  • Swollen joints
  • Skin or nail changes
  • Eye problems
  • Joint tenderness

You may be asked to undergo one or more imaging tests so your physician can get a better look at your joints. Imaging options include:

Some of the other tests a doctor may do to confirm a diagnosis of psoriatic arthritis include:

  • One or more blood tests to rule out rheumatoid arthritis
  • Testing of a sample of fluid from your joints to rule out gout and infectious arthritis

  • A skin?biopsy?to confirm a psoriasis diagnosis.

The 5 Different Types of Psoriatic Arthritis

Psoriatic arthritis is not one size fits all. It's important to understand what version you are living with in order to seek proper treatment.
The 5 Different Types of Psoriatic Arthritis

Types of Psoriatic Arthritis

Depending on the pattern of your symptoms, you may be diagnosed with a specific type of psoriatic arthritis:

Symmetric Psoriatic Arthritis

As its name implies, this type affects joints on both sides of your body at the same time. It may not affect the exact same joints on opposite sides of the body, but rather the same general areas. About half of people with psoriatic arthritis have the symmetric kind.

Asymmetric Psoriatic Arthritis

With the asymmetric type, problems don’t develop in the same joints, or even the same areas, on both sides of the body. It occurs in about 35 percent of people with the disease, according to CreakyJoints.

Spondylitis

This form of psoriatic arthritis is characterized by pain and stiffness in the neck, spine, and sacroiliac joints, between your sacrum and your pelvis.

Distal Psoriatic Arthritis

Distal psoriatic arthritis is characterized by inflammation and stiffness near the ends of the fingers and toes and nail changes like pitting of the nail surface and lifting away from the nail bed. Distal psoriatic arthritis often co-occurs with other types of psoriatic arthritis.

Arthritis Mutilans

People with arthritis mutilans experience deformities in the small joints at the ends of the fingers and toes. This type is considered the most severe form of psoriatic arthritis, but it only affects about 5 percent of people with the condition.

Treatment and Medication Options for Psoriatic Arthritis

Medication is the mainstay of treatment for psoriatic arthritis. Your rheumatologist will recommend which medication to try first according to the severity of your symptoms, any drugs you have tried in the past, any other drugs you’re currently taking (for psoriatic arthritis or another condition), your overall health, and your personal preferences. Some of the medications used to treat psoriatic arthritis are taken as pills, some are injections, and some are given as IV infusions.

Ideally, medications will keep psoriatic arthritis under control and surgery won’t be needed, but if it is, a few options are available, including synovectomy, joint replacement, and joint fusion.

Lifestyle measures such as getting regular exercise can also help with symptom management and improving your overall health and mood.

Medicines

Medicines used for treating psoriatic arthritis include the following:

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)?NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve), can help reduce inflammation and pain. While these medicines are available over-the-counter (OTC), your doctor may be able to write you a prescription for a stronger version.
  • Steroids Steroids can help reduce inflammation quickly. They can be given orally or are sometimes injected right into the problematic joint.
  • Disease-Modifying Anti-Rheumatic Drugs (DMARDs) DMARDs are often recommended if your condition doesn’t improve with NSAIDS. They can help slow the progression of the disease and prevent permanent joint damage. The most commonly used DMARD is methotrexate (Trexall).
  • Janus Kinase (JAK) Inhibitors?JAK inhibitors are a new type of DMARD that blocks certain enzymes that can cause inflammation. They are taken as pills. JAK inhibitors approved to treat psoriatic arthritis include tofacitinib (Xeljanz) and upadacitinib (Rinvoq).
  • Phosphodiesterase-4 (PDE4) Inhibitors PDE4 inhibitors are another new DMARD. They work by selectively targeting small molecules inside immune cells to correct the overactive immune response that causes inflammation in psoriatic arthritis. The drug apremilast (Otezla) is the only PDE4 inhibitor approved for psoriatic arthritis.
  • Biologics Biologics target specific cells or proteins in the immune system that play a role in the development of psoriatic arthritis. They can lessen pain and improve swollen joints. Nearly a dozen biologic drugs are approved for the treatment of psoriatic arthritis.

Treatments for Psoriasis

The medications used to treat psoriatic arthritis may also control psoriasis, but if they don’t, other options include:

  • Topical therapies, including creams, lotions, shampoos, gels, sprays, and ointments, are applied directly to the skin.
  • Phototherapy, or light therapy, in which the skin is exposed to ultraviolet light, suppresses immune activity in the skin.
  • Systemic therapies other than those used for psoriatic arthritis may be prescribed for psoriasis.

Surgery

In some cases, surgery may be needed to repair or replace joints that are severely damaged by psoriatic arthritis.

  • Synovectomy is the removal of the synovium, the connective tissue that lines the insides of joints. In psoriatic arthritis, the synovium can become inflamed and overgrown, causing swelling and pain in the joint and contributing to the destruction of the cartilage.
  • Joint replacement surgery involves removing the diseased joint and replacing it with an artificial prosthesis.
  • Joint fusion can relieve pain and discomfort in the joint, but it also eliminates any movement in the joint. It is generally done as a last resort to control pain.

Lifestyle Approaches

Some lifestyle habits that may improve your pain and help you feel better overall include:

  • Exercise. Regular physical activity can make your joints more flexible. Try walking, riding a bike, or swimming.
  • Maintain a healthy weight. Being overweight can put more strain on your joints, which increases pain. Losing a few extra pounds can relieve this stress and give you more energy.
  • Rest when you need to. Psoriatic arthritis, and sometimes the medicines you take to treat it, can cause extreme fatigue. While being active is important, it’s also vital to rest when you’re tired.

Clinical Trials

Researchers are always testing new therapies to help conditions like psoriatic arthritis. If you’re interested in participating in a clinical trial, visit ClinicalTrials.gov to search for studies in your area.

Learn More About Psoriatic Arthritis Treatments

Complications and Comorbidities of Psoriatic Arthritis

When the inflammation that causes psoriatic arthritis is not controlled, complications including the following can occur, according the Arthritis Foundation:

  • Damage to cartilage and bones within the joints
  • Uveitis or conjunctivitis
  • Stomach problems, diarrhea, and bloating
  • Osteoporosis
  • Damage to blood vessels and heart muscle
  • Shortness of breath, coughing, and lung disease

People with psoriatic arthritis are also at higher risk of developing metabolic diseases including:

  • High blood pressure
  • Metabolic syndrome (a combination of high blood pressure, central obesity, high cholesterol, and high blood sugar)
  • Obesity
  • High blood cholesterol
  • Cardiovascular disease
  • Metabolic dysfunction–associated steatotic liver disease (previously known as nonalcoholic fatty liver disease)

The reason for the higher risk of metabolic diseases is unknown, but it may be that psoriatic arthritis and metabolic disease have shared risk factors, or the higher risk could be the consequences of reduced physical function and activity, chronic systemic inflammation and its treatment, or simply chance.

Psoriatic Arthritis Support

Connecting to others who have psoriatic arthritis can help you feel more supported and may also help you find effective ways to manage the disease. One of these organizations may offer the resources you need:

CreakyJoints

Creaky Joints 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, Talk Psoriasis 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!

The 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 the arthritis helpline.

Common Questions & Answers

What are the early warning signs of psoriatic arthritis?
Psoriasis is often the first symptom of psoriatic arthritis, but for some people, it starts with painful, swollen joints.
What is methotrexate?
Methotrexate is a type of medication often referred to as a DMARD, or disease-modifying anti-rheumatic drug, that is sometimes used to slow the progression of psoriatic arthritis and prevent permanent joint damage.
What are biologics?
Biologics are a group of medications that can be prescribed for psoriatic arthritis. They target specific cells or proteins in the immune system that play a role in the development of psoriatic arthritis.
What is a sausage digit?
Fingers or toes affected by dactylitis are sometimes referred to as “sausage digits” because the entire digit swells up like a sausage.
What is enthesitis?
Enthesitis is inflammation of the entheses, the area where ligaments or tendons connect to your bones. Typically, it causes joint pain and stiffness that’s particularly noticeable when you move the joint.

Resources We Trust

  • Mayo Clinic:?Coping With the Emotional Ups and Downs of Psoriatic Arthritis
  • Cleveland Clinic: Psoriatic Arthritis
  • Arthritis Foundation: Psoriatic Arthritis Guidelines for Managing Comorbidities
  • National Psoriasis Foundation: Understanding Inflammation
  • Spondylitis Association of America: Distinguishing Clinical Features in Psoriatic Arthritis

Additional reporting by Ingrid Strauch.

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

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  2. Tiwari V et al. Psoriatic Arthritis. StatPearls. January 7, 2024.
  3. How Psoriasis Affects Black People and People of Color. Cleveland Clinic. May 1, 2023.
  4. Psoriatic Arthritis. Mayo Clinic. October 2, 2021.
  5. Kumthekar A et al. Obesity and Psoriatic Arthritis: A Narrative Review. Rheumatology and Therapy. September 2020.
  6. Psoriatic Arthritis. Arthritis Foundation.
  7. Jara S. The Different ‘Types’ of Psoriatic Arthritis — and Why Knowing Your Type Matters. CreakyJoints. November 20, 2019.
  8. Dejcman D et al. Pulmonary Manifestations of Rheumatoid Arthritis, Psoriatic Arthritis and Peripheral Spondyloarthritis: Prevalence, Diagnostic Approach and Treatment Options. Current Rheumatology Reviews. 2021.
  9. Barbarroja N. Nonalcoholic Fatty Liver Disease in Inflammatory Arthritis: Relationship With Cardiovascular Risk. Frontiers in Immunology. September 23, 2022.
  10. Gupta S et al. Comorbidities in Psoriatic Arthritis: A Systematic Review and Meta-Analysis. Rheumatology International. January 9, 2021.
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