Psoriatic Arthritis Symptoms

Psoriatic arthritis (PsA) is an autoimmune condition that occurs when a dysfunction in your immune system begins to attack healthy cells and tissue in your body. Symptoms of PsA vary from person to person, but most people with the condition experience pain in their joints and develop inflamed patches on their skin.

PsA is a type of inflammatory arthritis that affects more than 30% of people with psoriasis. Generally, people receive a psoriasis diagnosis before experiencing PsA symptoms. In some cases, some people may have joint pain first and skin-related symptoms later.

Most people with PsA develop symptoms between the ages of 30 and 50, but the condition can affect anyone, including children. No two cases of PsA are the same—sometimes people can have mild symptoms that develop slowly, while others experience severe symptoms quickly. The research on why the onset of symptoms can be so different is still being studied.

Understanding the symptoms of PsA can help you receive an early diagnosis, start treatment sooner, and prevent serious complications like permanent joint damage and life-threatening infections.

Joint Symptoms 

Most people with PsA experience discomfort with their joints. You may have symptoms such as:

• Joint pain: You might feel soreness or stiffness in one or more joints. PsA usually affects the fingers, toes, knees, lower back, neck, and hips. In some cases, pain can be worse in the morning because your body isn’t moving during sleep. 
• Swelling: Inflammation is common with PsA and can cause swelling in your synovium, or the layer of tissue that lines the inside of your joint. When joint tissue becomes swollen, it produces heat which can make your joints feel warm to the touch.
• Limited range of motion: Pain and swelling can change how your joints, ligaments, and nearby muscles move around. You might have difficulty extending your arms, bending your knees, reaching down to the ground, or picking up items. 

PsA can fluctuate between flare-ups (periods where symptoms appear) and remission (periods where symptoms temporarily go away). During a flare-up, joints can feel more tender and symptoms may worsen. These symptoms may subside when you are in remission. 

Skin Symptoms

Nearly 85% of people with PsA have psoriasis. People with PsA may develop psoriatic patches or scales on their skin—sometimes known as “plaques.” Underlying psoriasis causes your immune system to speed up the growth of skin cells. The pile of skin cells can result in thick, scaly, and discolored patches. 

The appearance of psoriasis can look different based on your skin tone. People with darker skin may have patches that are purple or brown, while those with lighter skin may notice patches that are red or pink. 

Plaques can appear anywhere on the body, but often affect the hands, feet, elbows, knees, and scalp. Where your patches develop and how they look largely depends on the type of psoriasis you have:

• Plaque psoriasis
• Guttate psoriasis
• Inverse psoriasis
• Pustular psoriasis
• Erythrodermic psoriasis

Swollen Fingers and Toes 

Inflammation is considered a hallmark feature of PsA and unfortunately doesn’t stop at the joints or skin. PsA is also known for causing a condition called dactylitis—the painful swelling of the fingers and toes. A study in Seminars in Arthritis and Rheumatism reported that 16-49% of people with PsA may have dactylitis. 

Dactylitis is a typical symptom that healthcare providers often look for to determine a PsA diagnosis. Swollen fingers and toes can also be one of the first symptoms you experience if you have PsA.    

This condition is sometimes also called “sausage digits” because the swelling of your fingers and toes can resemble a sausage.  

Enthesitis

Tendons and ligaments are tissues that connect the bones and muscles together. The part of your body where tissue meets your bones is called an enthesis. All together, your tissue, entheses, bones, and muscles make up your joints.

Those who have PsA may experience enthesitis, or inflammation in the entheses. The condition may cause pain, swelling, and stiffness—especially when you move around. It is common to develop enthesitis in an early stage of PsA, but you can experience symptoms at any stage. 

Enthesitis can affect any joint in your body, such as the elbows, knees, hips, and shoulders. However, the most common spot of inflammation is in the enthesis that connects the Achilles tendon to the ankle, which may disrupt the function of your feet and cause discomfort when you walk.

Nail Symptoms

Some people with PsA may notice changes to their nails. Symptoms may include:

• Pitting: Shallow or deep holes or spots in your nails 
• Onycholysis: Separation between the nail and the nail bed
• Ridging: Grooves and lines that start at the base of the nail
• Thickening: Overgrowth of nails, which can make them thick 
• Subungual hyperkeratosis: Build-up of skin cells under the nail 
• Discoloration: Nails can appear white, yellow, red, or brown

Fatigue 

Fatigue is the feeling of physical and mental exhaustion and is a common symptom of several chronic conditions and inflammatory diseases, including PsA. Symptoms may include drowsiness, weakness, and lack of energy or motivation. Studies show that fatigue may be caused by chronic inflammation in the body. 

Some research has found that fatigue may be an underestimated symptom, typically because treatment for PsA often focuses on joint and skin-related symptoms first. However, 50% of people with PsA experience light to moderate fatigue, while 30% of people with PsA have severe fatigue.

Other Symptoms

Some people with PsA may have additional inflammatory symptoms that affect different parts of the body. Symptoms may include:

• Psoriatic spondylitis: Pain, inflammation, and swelling in the spine, neck, and back
• Costochondritis: Tenderness, pressure, or aching in the chest and ribcage
• Uveitis: Inflammation of the eyes that can lead to redness, blurry vision, and light sensitivity

When to See a Healthcare Provider 

Psoriatic joint and skin-related symptoms can progress quickly. If you have pre-existing psoriasis or start to experience PsA symptoms, it’s good practice to check in with your healthcare provider.

If your provider suspects you may have PsA, they will likely work with a rheumatologist (a doctor that specializes in the bones and joints) or dermatologist (a doctor that specializes in the skin) to reach a proper diagnosis. 

Receiving a diagnosis in the early stages of PsA is important and can improve your likelihood of responding well to treatment and preventing long-term joint damage or skin infections. 

A Quick Review

Psoriatic arthritis is a chronic autoimmune condition that causes inflammation in your joints and skin. Symptoms can be painful and progress quickly. You may experience a variety of symptoms including joint pain, skin patches, and fatigue. 

If you have psoriasis and may be at risk for PsA or notice changes in your skin and joints, it’s a good idea to reach out to your healthcare provider for proper testing and diagnosis.