
Having psoriasis also puts you at risk for psoriatic arthritis (PsA), an inflammatory disease that affects the joints. About one-third of people with psoriasis will get PsA, but painful, swollen joints sometimes don't appear until many years after psoriasis starts.
Psoriasis affects each person differently. Some have mild symptoms, while others have severe symptoms. Each bout of symptoms is called a flare.
If you do develop PsA, early treatment is important. The sooner you start on medicine, the better your chance of avoiding joint damage and disability. You'll be more likely to get prompt treatment if you know the symptoms of PsA and report them to your doctor right away.
Along with the psoriasis rash, these are some warning signs of PsA you should know about.
Joint Pain and Stiffness
Like other types of arthritis, PsA causes pain, tenderness, swelling, and stiffness in the joints. It can affect any joint, but you'll most likely feel pain in your:
- Fingers
- Toes
- Knees
- Elbows
- Back
The affected joints may be hard to move. They can feel especially stiff in the morning, but should start to loosen up as you move.
PsA comes in different types, each of which affects certain joints:
Asymmetric oligoarthritis. This type is in fewer than five joints. The painful joints usually aren't on the same side of your body. For example, one knee is sore but the other knee feels fine.
Symmetric polyarthritis. This type affects more than five joints. You'll have symptoms in the same joints on both sides of your body, so both knees or elbows will hurt at the same time.
Distal arthritis. This type affects the joint of the fingers and toes that's closest to the nail.
Spondyloarthritis. This form of arthritis affects joints of the spine. Spondyloarthritis causes back pain, stiffness, and trouble moving the back and neck.
Arthritis mutilans. This rare type affects fewer than 5% of people with PsA. It's also the most severe form. Arthritis mutilans causes severe inflammation that damages joints in the hands and feet. In time, the bones of the fingers and toes may get disfigured and shorter.
The severity of psoriasis and PsA aren't related. You can have a lot of psoriasis plaques but very few painful joints. Or you might have very few psoriasis plaques and a lot of painful joints.
Foot Pain
Tendons and ligaments are thick bands of tissue that hold muscles and bones together and keep joints stable. Enthesis is the place where tendons and ligaments attach to bones. You have more than 100 of these spots all over your body. One in three people with PsA have inflammation in the entheses.
Pain, tenderness, and swelling are symptoms of inflamed entheses. Often you'll feel pain in the sole of your foot or the back of your heel (Achilles tendon).
Swollen Fingers and Toes
Inflammation from PsA can swell up the fingers and toes until they look like little sausages. Dactylitis is the medical term for this symptom. The finger and toe joints may also be painful.
Up to half of people with PsA have swollen fingers or toes. Sometimes dactylitis is the first sign of PsA, and other symptoms don't appear until months or years later.
Fatigue
This is a very common symptom of PsA. It's not normal, everyday fatigue. A PsA flare can exhaust you physically and mentally. Almost 1 in 3 people with PsA have fatigue that's severe enough to disrupt their job and other activities.
One reason PsA makes you feel so tired is because your body releases inflammatory chemicals called cytokines. These chemicals inflame your joints and cause fatigue. Another reason is that pain and other PsA symptoms can prevent you from getting a good night's sleep.
Nail Changes
Up to 80% of people with PsA have changes in their nails, which is a sign of inflammation. Nail changes could warn that PsA is in your future. Often they appear one to two years before joint pain and swelling start.
These are some common nail changes in PsA:
- Pitting. Small dents in the nail
- Onycholysis. The nail separates from the bed beneath it.
- Subungual hyperkeratosis. Thickened nails
- Beau's lines. Ridges and grooves in the nail
- Color changes. Yellow, red, or brown color to the nails, sometimes with white spots
- Splinter hemorrhages. Bruises or bleeding under the nail
Eye Pain and Redness
You might not connect vision symptoms with PsA, but this disease can affect your eyes. About 7% of people with PsA develop uveitis and conjunctivitis or inflammation in the eye. By contrast, uveitis affects less than 1% of people who don't have PsA.
Symptoms of uveitis include:
- Pain and redness seen in the whites of one or both eyes
- Blurry vision
- Light sensitivity
Eye changes are sometimes the first symptom of PsA. Because uveitis can cause vision loss if you don't treat it, see an eye doctor if you have symptoms like the ones listed above.
PsA Complications
Anti-inflammatory medicines, biologic drugs, and corticosteroids are some of the treatments for PsA. Getting on the right treatment can reduce symptom flares and prevent complications.
If you don't treat PsA, it could get worse over time and cause complications like these:
Arthritis mutilans. This severe form of PsA damages joints in the hands. Eventually the fingers can become deformed.
Eye damage. Inflammation from uveitis can lead to vision loss.
Related conditions. Having PsA also puts you at increased risk for obesity, type 2 diabetes, high cholesterol, high blood pressure, and heart disease.
What to Do If You Suspect PsA
See a doctor if you have symptoms of PsA. You can start with your primary care doctor. If they suspect PsA, they'll refer you to a rheumatologist – a doctor who specializes in treating joint diseases.
Your doctor will ask about your symptoms and order tests like an X-ray, ultrasound, or MRI to look for joint changes that are typical of PsA. If you do have this condition, starting on a treatment early can help prevent joint damage and other complications.
Show Sources
Photo Credit: Moment/Getty Images
SOURCES:
Arthritis Foundation: "Enthesitis in Psoriatic Arthritis," "Psoriatic Arthritis," "Treatment Options for Psoriatic Arthritis."
Cleveland Clinic: "Dactylitis (Sausage Fingers)," "How Does Psoriatic Arthritis Affect Your Nails?" "How to Manage Psoriatic Arthritis Fatigue."
Johns Hopkins Arthritis Center: "Psoriatic Arthritis Treatment."
Mayo Clinic: "Psoriatic Arthritis."
MedlinePlus: "Psoriatic Arthritis."
National Institute of Arthritis and Musculoskeletal and Skin Diseases: "Psoriatic Arthritis," "Psoriatic Arthritis: Diagnosis, Treatment, and Steps to Take."
National Psoriasis Foundation: "About Psoriatic Arthritis," "Eye Inflammation and Psoriatic Arthritis," "Psoriasis Statistics."
NHS: "Psoriatic Arthritis."
Seminars in Arthritis & Rheumatism: "Dactylitis: A Hallmark of Psoriatic Arthritis."
StatPearls: "Psoriatic Arthritis."
Eurasian Journal of Medicine: "The Frequency of Association of Nail Involvement and Psoriatic Arthritis in Psoriasis Patients."
Journal of Rheumatology: "Effect of Fatigue on Health-Related Quality of Life and Work Productivity in Psoriatic Arthritis: Findings of a Real-World Survey."
UpToDate: "Patient Education: Psoriatic Arthritis (Beyond the Basics)."