Psoriatic arthritis is a type of arthritis that can develop in people who have psoriatic disease, which includes the skin condition psoriasis. It is a chronic inflammatory condition that stems from a problem in the immune system.

Psoriatic arthritis (PsA) affects the joints and causes them to become swollen, stiff, and painful. Some people may also experience changes in their nails and general fatigue.

The National Psoriasis Foundation estimates that up to 30% of people with psoriatic skin changes will develop PsA. The American College of Rheumatology suggests the figure may be lower, at 15%.

Treatment can help a person manage PsA. Without treatment, symptoms can worsen over time. Persistent inflammation can result in permanent damage and deformation in the affected joints.

A 2014 study on diagnostic delay found that people who do not receive treatment within the first 2 years of onset will have more severe problems.

A flare-up, flare, or relapse occurs when the symptoms get worse. It is difficult to know when a flare-up will occur, but avoiding some triggers may help prevent them.

Treatment can help manage inflammation and the symptoms it causes. Newer medications, known as biologics, reduce both the risk of a flare and the severity of symptoms if one does occur.

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Early signs of a flare include:

  • pain, throbbing swelling, stiffness, and warmth in the joints
  • a worsening of skin symptoms
  • fatigue
  • tenderness, pain, and swelling in tendons
  • swollen fingers and toes
  • difficulty moving
  • stiffness and tiredness after sleep
  • nail changes

Symptoms and severity can vary widely between individuals. They can be mild and develop slowly, or they can be quick and severe.

Experts do not know what causes PsA to appear, but as with psoriasis, it is a type of psoriatic disease.

The link between psoriasis and PsA

Psoriasis and PsA are not the same conditions, but scientists have found close links between them, and they can occur together.

Many people with psoriatic disease have only skin involvement or only joint problems. Among those who experience both, 70% of people have skin changes first, 15% develop skin symptoms after PsA appears, and for 15% both symptoms appear at the same time.

Genetic factors

Research shows that people with psoriatic disease often have similar genetic features. Specific genetic changes appear to underlie different types of PsA and psoriasis. At least 10% of people may have genes that can lead to psoriasis.

These features can run in families. If a person’s close relative has psoriatic disease, there is a chance they may also develop it. However, not everyone in this situation will develop the condition.

This is because environmental factors also play a role. If a person has the genetic features but no exposure to certain triggers, they are unlikely to develop psoriasis or PsA.

Triggers for initial onset include strep throat or another infectious disease, which may cause an overreaction in the immune system in those who are susceptible.

Triggers for onset and a flare include:

  • stress, which can trigger symptoms and make them worse
  • medications such as lithium, antimalarials, beta-blockers, quinidine, and indomethacin
  • physical stress on the joints, for example, through obesity, which can make inflammation worse
  • smoking
  • injury, such as a blow to the knee

A person who already has PsA may find that symptoms worsen when they change their medication. Other individual triggers might include a lack of sleep, overexertion, or a poor diet.

Avoiding these triggers may help prevent PsA or a flare from starting.

A person should see a doctor if they have:

  • the beginning of joint pain, especially if there is a personal or family history of psoriasis
  • new or worsening symptoms
  • the signs of a new flare

Early treatment of initial symptoms or a flare can help:

  • manage PsA overall
  • reduce the impact of a flare and the severity of symptoms
  • limit permanent joint damage

Depression is a common complication of psoriatic disease. Learn more here.

Treatment can help manage symptoms during a flare and improve the overall outlook of psoriasis and PsA. Following a treatment plan can also help reduce the risk of a flare.

Biologics and alternatives

Guidelines published in 2019 recommend prescribing a tumor necrosis factor inhibitor, which is a type of biologic drug, as first-line therapy for most people with a new diagnosis of PsA.

Long-term use of biologics can help:

  • prevent flares
  • reduce the severity of symptoms during flares
  • prevent long-term damage

They work by targeting specific parts of the immune system.

However, biologics are not suitable for everyone, especially those who are prone to frequent infections.

In these cases, a doctor may prescribe methotrexate, or apremilast (Otezla), which a person can take by mouth. These types of medication are known as oral small molecule drugs.

Another option is tofacitinib (Xeljanz).


Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, reduce inflammation, pain, and swelling. A person can apply them to the skin or take them by mouth.

If this is not effective, a doctor can prescribe a stronger pain relief medication.

People with PsA should always ask their doctor before taking NSAIDs or other over-the-counter drugs, as there may be adverse effects or interactions with other medications.


Steroid treatment can help reduce inflammation, swelling, and pain during a flare. They are available as a topical treatment to apply on the skin, in tablet form, or a doctor may inject the drug directly into the joint.

Long-term use can lead to adverse effects, so a doctor will only prescribe steroids during a flare and when symptoms are severe.


Disease-modifying antirheumatic drugs (DMARDs) suppress substances in the body that cause inflammation. They can help to limit joint damage, reduce pain, and slow the progression of PsA.

Adverse effects include:

Long-term side effects include:

  • increased risk of infection
  • fatigue
  • liver damage

DMARDs are a long-term option that can help manage PsA overall.

During a flare, a person may benefit from:

  • getting medical help as soon as symptoms appear
  • following their current treatment plan
  • getting enough rest and sleep
  • reducing activity levels
  • doing low impact exercise, such as tai chi, yoga, and swimming, unless it will worsen symptoms
  • following a balanced diet
  • limiting alcohol intake, if relevant
  • limiting stress, where possible

Smoking can make symptoms worse and increase the risk of long-term problems. Guidelines published in 2018 strongly recommend that people with PsA who smoke join a smoking cessation program.

These strategies can also help reduce the risk of cardiovascular disease, high blood pressure, diabetes, and other health conditions that can occur alongside PsA.

Learning as much as possible about PsA, its effects, and the treatment options available can help a person feel in control of their situation and equip them to take an active role in staying as well as possible.

A 2018 systematic review concluded that the following natural remedies might help people with psoriasis:

Physical therapy may also help.

In 2018, some experts noted that vitamin D supplementation may help some people with psoriasis and PsA, as long as they work with a doctor and incorporate it as part of an overall treatment plan. However, more research is needed.

What natural remedies might help with PsA? Find out here.

Here are some questions people often ask about PsA.

What does a PsA flare feel like?

Early signs of a PsA flare include fatigue together with throbbing pain, swelling, and stiffness in the joints. The tendons may also be painful. In addition, a person may notice swelling in the fingers and toes and worsening skin symptoms.

What aggravates PsA?

Triggers for a flare include smoking, mental or physical stress, injury, some medications, illness, and infection.

How do you calm a PsA flare?

Ways of reducing inflammation and pain include the use of NSAIDs such as ibuprofen and corticosteroids. A doctor may prescribe the long-term use of DMARDs or biologics to reduce the risk of a flare and lessen the symptoms if they occur.

PsA is a type of psoriatic disease that can lead to joint problems, fatigue, and other symptoms. Symptoms can worsen during a flare.

Getting an early diagnosis, starting treatment as soon as possible, and knowing and avoiding triggers can help reduce the number of flares and the severity of symptoms.

A doctor can help manage a flare by prescribing or adjusting medication. Following the doctor’s instructions about medication and lifestyle measures can also help an individual manage a flare.

In the long term, new biologic drugs and other therapies are showing promise for reducing flares, managing symptoms, and possibly slowing the progress of PsA.