Psoriatic arthritis (PsA), an inflammatory form of arthritis, affects about 30 percent of people with psoriasis.
Psoriatic arthritis is a chronic, inflammatory disease of the joints and the places where tendons and ligaments connect to bone. The immune system creates inflammation that can lead to swelling, pain, fatigue and stiffness in the joints.
PsA can start at any age, but often appears between ages 30 and 50. For most people, it starts about 10 years after psoriasis begins. While it is less common, people can develop psoriatic arthritis without having psoriasis.
Though there is no cure, there are a growing range of treatments available to help stop the disease progression, lessen pain, protect joints and preserve range of motion. Left untreated, psoriatic arthritis can cause permanent joint damage. For people who have or suspect they may have psoriatic arthritis, it is extremely important to work with a rheumatologist (arthritis doctor) to find the right treatment plan.
Early recognition, diagnosis and treatment of psoriatic arthritis are critical to relieve pain and inflammation and help prevent joint damage. Furthermore, delaying treatment by as little as six months can result in permanent joint damage, according to studies
What are the symptoms of psoriatic arthritis?
PsA can develop slowly with mild symptoms, or it can develop quickly and be severe – each case is different. Early recognition, diagnosis and treatment of psoriatic arthritis is key in preventing or limiting extensive joint damage that occurs in later stages of the disease. Some may develop PsA in a joint after an injury (which may appear to be a cartilage tear).
Here are the common symptoms of psoriatic arthritis:
- Tenderness, pain and swelling over tendons
- Swollen fingers and toes that sometimes resemble 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 or becomes pitted, mimicking fungus infections
- Redness and pain of the eye (uveitis)
There is little connection between psoriasis severity and PsA severity. Having a severe case of psoriasis does not necessarily mean you will have a severe case of psoriatic arthritis. You could have few skin lesions but many joints affected by 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 providers or dermatologists often is the first step in diagnosing psoriatic arthritis, but people with psoriatic arthritis should consider seeing a rheumatologist, a doctor who specializes in arthritis.
To find a rheumatologist near you, contact NPF’s Patient Navigation Center. We offer the world's first, personalized support center for psoriatic disease, and we can help you find a specialist in your area who understands PsA. Read more about rheumatology and how to find a rheumatologist.
Unfortunately, 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 talk with you about your medical history, particularly any history with psoriasis, and may perform a physical examination, blood tests, MRIs and X-rays of the joints that have symptoms to diagnose PsA.
NPF is determined to create a psoriatic arthritis diagnostic test as the first step on the road to a cure. A diagnostic test will dramatically reduce the guesswork and the long delays in reaching a diagnosis and beginning treatment – delays that can result in irreparable damage. Read more about the work we're doing on the PsA Diagnosis Project and how you can help.
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. Some forms of PsA 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 people with psoriatic arthritis.
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 get tested for gout. Your health care provider will 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.
If you think you might have psoriatic arthritis, learn more by taking this short five-question screener. You can print your results and share them with your health care provider. Our screener is based on the Psoriasis Epidemiology Screening Tool. Your doctor may use other types of tests to diagnose you.
Where does psoriatic arthritis occur?
Just like psoriasis, psoriatic arthritis ranges from mild to severe. Your rheumatologist (a doctor specializing in arthritis) 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.
Psoriatic arthritis can occur anywhere that you have a joint or where your ligaments and tendons connect to bone. There are locations that are more common for people to experience psoriatic arthritis symptoms:
Spondylitis refers to inflammation of the spinal column. 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 PsA 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 or 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. Typically, dactylitis involves a few fingers and/or toes, but not in a symmetrical pattern –PsA affects different toes and fingers on different sides of the body.
What about children with psoriatic arthritis?
According to the Arthritis Foundation, nearly 300,000 children in the United States are affected by some type of pediatric arthritis, including psoriatic arthritis. 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.
Check out NPF's Our Spot, designed specifically for pediatric patients.
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, PsA is associated with other comorbidities (related health conditions). The good news is that treating your PsA can lower your risk of developing some comorbidities, like heart disease.
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.
The risk of comorbidities makes your relationship with your doctor particularly important. To receive the highest standard of specialized care for your joints and connective tissues, you should see a rheumatologist (a doctor who specializes in arthritis).
Ask your health care provider to refer you to a rheumatologist. Sometimes it takes a while to schedule an initial visit with a rheumatologist, but a doctor referral may help shorten the waiting period. To find a rheumatologist near you, contact NPF’s Patient Navigation Center. Our patient navigators can help you find a specialist in your area who understands psoriatic arthritis and can help you prepare for your appointement.
What kind of services are there for those with psoriatic arthritis?
Psoriatic arthritis 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.
- There is a lack of understanding of how the disease impacts those diagnosed.
While these issues regarding diagnosis and treatment are commonplace, there are resources to help those who are at risk of PsA. We are here to help you with medical advice and treatment options. Visit our Patient Navigation Center today to get the information you need, support options and to be connected with a navigator today.
Last updated by the National Psoriasis Foundation