Up to 30 percent of people with psoriasis develop psoriatic arthritis, an inflammatory form of arthritis.
Psoriatic arthritis can cause swelling, stiffness and pain in and around the joints, cause nail changes and overall fatigue.
Studies show that delaying treatment for psoriatic arthritis as little as six months can result in permanent joint damage. Early recognition, diagnosis and treatment of psoriatic arthritis are critical to relieve pain and inflammation and help prevent joint damage.
What are the symptoms of psoriatic arthritis?
Psoriatic arthritis can develop slowly with mild symptoms, or it can develop quickly and be severe. Early recognition, diagnosis and treatment of psoriatic arthritis can help prevent or limit extensive joint damage that occurs in later stages of the disease. The disease can develop in a joint after an injury and may seem like a cartilage tear.
Here are common symptoms of psoriatic arthritis:
- Generalized fatigue
- Tenderness, pain and swelling over tendons
- Swollen fingers and toes that look like sausages
- Stiffness, pain, throbbing, swelling and tenderness in one or more joints
- A reduced range of motion
- Morning stiffness and tiredness
- Nail changes—for example, the nail separates from the nail bed and/or becomes pitted and mimics fungus infections
- Redness and pain of the eye, such as conjunctivitis
Psoriatic arthritis usually affects the distal joints (those closest to the nail) in fingers or toes.
You may also experience symptoms in your lower back, wrists, knees or ankle.
In 85 percent of patients, psoriasis occurs before joint disease. If you have been diagnosed with psoriasis, it is important to tell your dermatologist if you have any aches and pains.
There is little connection between your psoriasis severity and psoriatic arthritis severity. Having a severe case of psoriasis does not necessarily mean a person will have a severe case of psoriatic arthritis. A person could have few skin lesions, but have many joints affected by the arthritis.
How is psoriatic arthritis diagnosed?
If you experience joint aches and pains, talk to a doctor about diagnosis and treatment. Working with primary-care doctors or dermatologists often is the first step in diagnosing psoriatic arthritis, but psoriatic arthritis patients should consider seeing a rheumatologist, a doctor who specializes in arthritis. Read more about rheumatology and how to find a rheumatologist.
There is no definitive test for psoriatic arthritis. The diagnosis is made mostly by your doctor's observations and by a process of elimination. Your doctor will need your medical history, particularly your history with psoriasis, and may perform a physical examination, blood tests, MRIs and X-rays of the joints that have symptoms to diagnose psoriatic arthritis.
The symptoms of psoriatic arthritis are similar to those of three other arthritic diseases: rheumatoid arthritis, gout and reactive arthritis.
Rheumatoid arthritis generally involves joints symmetrically distributed on both sides of the body, and it may produce bumps under the skin that are not present in psoriatic arthritis. However, some forms of psoriatic arthritis look very similar. However, having psoriasis on the skin and nail changes are usually indicators of psoriatic arthritis.
To rule out rheumatoid arthritis, your doctor may test for a certain antibody, called a rheumatoid factor, that is normally present in rheumatoid arthritis. The rheumatoid factor is not usually found in the blood of psoriatic arthritis patients.
A person can have rheumatoid arthritis and psoriatic arthritis, but that is rare.
Likewise, it is possible to have gout along with psoriasis and psoriatic arthritis. If you have an excruciatingly painful attack in a joint, particularly in the big toe, you may want to have a test for gout. Your health care provider will want to examine fluid drawn from the affected joint for elevated serum uric acid levels, which would indicate gout.
However, people with psoriatic arthritis can have elevated serum uric acid levels, too, and not have gout. Taking a low-dose aspirin or increased skin cell turnover also can cause high serum uric acid levels.
It is important to distinguish between the two forms of arthritis, because they may be treated with different medications. Learn more about the differences between gout and psoriatic arthritis.
What kind of psoriatic arthritis do I have?
Just like psoriasis, psoriatic arthritis ranges from mild to severe. Your rheumatologist will consider how many joints are affected before determining a treatment plan. Even a small number of inflamed joints, however, can have a profound impact on pain and function and factors into the treatment decisions.
Mild psoriatic arthritis is sometimes referred to as oligoarticular, meaning it affects four or fewer joints in the body.
Severe psoriatic arthritis is often referred to as polyarticular, meaning it affects four or more joints.
Spondylitis refers to inflammation of the spinal column. This occurs in some individuals with psoriatic arthritis. The main symptoms are inflammation with stiffness of the neck, lower back and sacroiliac joints. Spinal arthritis makes joint motion in these areas painful and difficult.
Enthesitis refers to inflammation of entheses, the site where ligaments or tendons insert into the bones. Common locations for enthesitis include the bottoms of the feet, the Achilles' tendons, and the places where ligaments attach to the ribs, spine and pelvis. It is unique to psoriatic arthritis and does not occur with other forms of arthritis like rheumatoid arthritis or osteoarthritis. Enthesitis can make the tissues in the affected area become ropey (known as fibrosis) or solid (known as ossification or calcification).
Dactylitis, or "sausage digits," refers to inflammation/swelling of an entire finger or toe. It happens when the small joints and entheses of the surrounding tendons become inflamed. Dactylitis is another distinguishing indicator of psoriatic arthritis. Usually dactylitis involves a few fingers and/or toes, but not in a symmetrical pattern (different toes and fingers are affected on different sides of the body).
Psoriatic arthritis also can affect the joints of your arms and legs, including the elbows, wrists, hands and feet.
Treatments for psoriatic arthritis range from oral medications that reduce inflammation and swelling to biologic drugs that are injected or infused, and target specific parts of your immune system to combat psoriatic arthritis symptoms and slow joint damage. Learn more about psoriatic arthritis treatments.
What about children with psoriatic arthritis?
According to the Arthritis Foundation, approximately 294,000 children under the age of 18 are affected by some type of pediatric arthritis, including psoriatic arthritis. Psoriatic arthritis causes pain, stiffness and swelling in and around the joints and occurs in up to 30 percent of individuals with psoriasis. Children are more likely to experience the onset of psoriasis and psoriatic arthritis simultaneously than adults, and arthritis may precede the skin disease in up to half of children who have it.
Psoriatic arthritis can develop at any time, but it most commonly appears between the ages of 30 and 50. According to the American Academy of Dermatology, a peak period of pediatric onset is age 11 to 12 in both boys and girls.
As with psoriasis, genes, the immune system and environmental factors are all believed to play a role in the onset of the disease.
As with adults, early recognition, diagnosis and treatment of psoriatic arthritis are critical to relieve pain and inflammation and help prevent progressive joint damage.
What should I do if I have psoriatic arthritis?
Psoriatic arthritis is a chronic, progressive disease that can lead to permanent joint damage if treatment is delayed. Like psoriasis, psoriatic arthritis is associated with other comorbidities. The good news is that treating your disease can lower your risk of developing some comorbidities, like cardiovascular disease.
This makes the relationship you have with your doctor particularly important. To receive the highest standard of specialized care for your joints and connective tissues, people with psoriatic arthritis should consider seeing a rheumatologist. This is a doctor who specializes in arthritis. You can ask your current health care provider to refer you to a rheumatologist. A doctor referral can help you get into a rheumatologist more quickly. You also can search the Health Care Provider Directory to find a rheumatologist near you.
What kind of services are there for those with psoriatic arthritis?
Psoriatic arthritis (PsA) is a serious illness that has a similar impact on quality of life to that of rheumatoid arthritis (RA), another inflammatory arthritis.
Despite sharing similarities with RA—including painful symptoms and disease prevalence of approximately 1 million people—there are significantly fewer resources for those living with PsA than there are for those with RA.
These inequalities in health resources, combined with not enough research and a misunderstanding of PsA symptoms among patients and medical professionals, have led to an unacceptable status quo: PsA diagnosis is often delayed, symptoms are not treated effectively, information on how best to manage the disease often conflicts, and there is a lack of understanding of how the disease impacts those diagnosed.
In June 2014, the National Psoriasis Foundation launched the largest realignment and expansion of its psoriatic arthritis program since the agency began serving this community nearly 20 years ago.
Driven by NPF's new strategic plan, the PsA Project focuses on four areas of impact:
- Decreasing the time to diagnosis;
- Helping those with PsA better manage their disease;
- Reducing barriers to health care and treatments;
- Improving understanding of PsA symptoms, disease management and impact on patient quality of life among health care providers.
Through the PsA Project, the NPF intends to:
- Reduce the average time of diagnosis of psoriatic arthritis from four years to one year;
- Increase by 50 percent the number of people with PsA who are receiving the right treatment to 62 percent total;
- Reduce from 50 to 30 percent the number of people who report psoriatic arthritis is a problem in their everyday lives;
- Double the number of health resources available to people diagnosed with PsA;
- Increase by 50 percent the number of NIH-funded scientists studying psoriatic disease to 42 scientists to boost care, improve treatment, and find a cure for psoriatic arthritis.
To accomplish our aggressive goals, we need you. If you, or someone you love, is affected by psoriatic arthritis, tell us about your experience.