Psoriasis is a chronic, inflammatory condition that leads to changes in the skin. In some cases, it can lead to psoriatic arthritis (PsA), which affects the joints.

A person with PsA may have swollen, inflamed joints, reduced movement, fatigue, and nail changes. Many people also experience skin symptoms.

PsA is a form of arthritis that can also affect people without psoriasis. Psoriasis and PsA both result from an immune system issue. There is growing evidence of a link between the two conditions, and doctors refer to them jointly as psoriatic disease.

Keep reading to learn about the symptoms and complications of PsA and when to speak with a doctor.

The most common symptoms of PsA are:

Swollen and painful joints

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The hands of a male with Psoriatic Arthritis showing deviation of ulnar metacarpal joints. Jacques Hugo/Shutterstock

PsA can lead to pain and swelling in any joint in the body and in the entheses, where tendons and ligaments insert into bones. The joints and entheses may also be warm to the touch, and the skin over them may appear flushed.

PsA most often affects the hands, fingers, feet, toes, knees, ankles, and spine. However, it can also affect the neck, wrists, and elbows.

PsA in the finger usually affects the joint closest to the nail.

Swelling in arthritis happens when either the lining of the joint or the tissues that surround the joint become inflamed. When this happens, more inflammatory cells and proteins enter the area around the joint or tendon, which further increases pressure, discoloration, and swelling.

The symptoms can vary in severity among individuals. In some people, arthritis and tendonitis may affect one or two joints, but others might experience more severe changes throughout the body.

Stiffness and reduced movement

Many people experience stiffness, particularly in the morning or after prolonged rest. It can occur in any joint, with or without pain, and it can limit movement.

Although there are many possible causes of temporary stiffness, stiffness that continues for longer than an hour could be a sign of inflammatory arthritis, such as PsA.


As with other types of inflammatory arthritis, PsA can lead to fatigue.

About 50% of people with PsA report experiencing fatigue, with 30% describing it as severe, according to a 2017 review.

People with PsA may be more prone to other conditions, including anemia, obesity, diabetes, sleep problems, depression, and anxiety. These, too, can lead to fatigue.

Nail changes

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Abnormal nails with multiple erythematous plaque with thick silvery scale in case Psoriasis. Tis forThan/Shutterstock

PsA can trigger changes in the fingernails and toenails, known as nail psoriasis.

These include:

  • pits, or small depressions
  • detachment from the nail bed
  • discoloration

If the nail detaches from the nail bed, a person develops onycholysis, a lifting-up of the nail that can resemble a nail fungal infection.

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A person with psoriasis who notices changes in their nails should speak with a doctor, who may suggest screening for PsA.

Swollen fingers and toes

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Hand of a psoriasis patient close-up. Psoriatic arthritis. Joint deformation and inflammation on the skin. Iri-s/Shutterstock

One symptom that is specific to PsA is dactylitis, which causes swollen, “sausage-like” fingers and toes.

However, many other symptoms of PsA can resemble those of three other arthritic diseases: rheumatoid arthritis, gout, and reactive arthritis.

Lower back pain

Some people with PsA may develop spondylitis, a condition that involves inflammation of the joints between the bones of the spinal cord or pelvis.

In addition to causing lower back pain, spondylitis can lead to decreased flexibility and changes in posture over time.

Red and swollen eyes

PsA can cause inflammation of the uvea, the middle layer of the eye, which is known as uveitis.

Not only can this lead to pain and redness in the eye, but it can also cause vision problems, such as dark floating spots in the field of vision and increased sensitivity to light.

These symptoms can affect one or both eyes, and they may appear suddenly or progress gradually over time.

Itchy skin

Rashes are a common symptom of PsA.

Typically, these rashes present as patches of itchy, dry skin with silvery-white scales, also known as plaques.

While PsA rashes can appear anywhere on the body, they are most common on the elbows, knees, lower back, and scalp.

Chest pain

In some cases, PsA can cause chest pain.

This pain is often due to a condition called costochondritis, which is the inflammation of the cartilage that connects the ribs to the breastbone.

People with PsA also have a higher risk of developing heart disease, which can cause chest pain, among other symptoms, and require immediate medical attention.

Due to the severity of these conditions, people with PsA who experience chest pain should talk with their doctor to determine the cause and the best course of treatment.

PsA can lead to joint damage, reduced mobility, and depression.

People with psoriatic disease may also have a higher risk of several other conditions. These include heart disease, type 2 diabetes, obesity, non-alcohol-related fatty liver disease, depression, and anxiety.

Anyone with PsA who notice symptoms of these conditions should speak with a doctor as soon as possible.

Current guidelines for the treatment of psoriasis recommend regular screening for these conditions, as they can affect the life expectancy and quality of life of a person with PsA.

Heart disease

People with PsA have a higher risk of developing heart disease, along with high blood pressure, high cholesterol levels, and obesity.

Studies suggest that PsA can increase plaque buildup in the arteries, which can narrow the blood vessels and make it more difficult for the heart to pump blood throughout the body. This plaque accumulation can also increase the risk of heart disease and stroke.

PsA also contributes to chronic inflammation, which is another risk factor for heart disease.

Type 2 diabetes

Some research suggests that people with PsA may have a higher risk of developing type 2 diabetes.

According to a 2020 review, this could be due to increased levels of inflammation, which can impair the body’s ability to use insulin to regulate blood sugar levels.

Many other factors can also influence a person’s risk of developing type 2 diabetes, including their diet, lifestyle, and medical history.


People with PsA are more likely to have excess body weight, with some research estimating that up to 45% of people with PsA have obesity.

Although they do not fully understand the connection between PsA and obesity, researchers believe that increased levels of inflammation contribute.

Some of the symptoms of PsA, such as joint pain and fatigue, can also make exercise more difficult, which could contribute to weight gain.

Reaching and maintaining a moderate weight can reduce the amount of stress on a person’s joints and decrease the symptoms of PsA.

Non-alcohol-related fatty liver disease

Chronic inflammation resulting from PsA can damage the liver over time, increasing the risk of non-alcohol-related fatty liver disease.

Furthermore, people with PsA are more likely than people without the condition to have obesity, type 2 diabetes, high cholesterol levels, and high blood pressure, all of which can contribute to the progression of non-alcohol-related fatty liver disease.

Depression and anxiety

Depression and anxiety have a higher prevalence among people with PsA than among the general population.

According to a 2019 review, approximately 1 in 3 people with PsA have at least mild anxiety, while 1 in 5 report having at least mild depression.

Not only can the symptoms of PsA worsen depression and anxiety, but some research suggests that increased levels of inflammation may also contribute.

Although some people may experience improvements in their mood after starting treatment for PsA, this is not always the case. Therefore, it is best to talk with a doctor if these symptoms persist.

A person should see a doctor if they have any new or worsening signs of psoriasis or PsA. If a person has psoriasis, and there is a family history of psoriatic disease, the doctor may recommend testing for PsA.

A physical examination, blood tests, MRI scans, ultrasound scans, and X-rays can help determine whether PsA is present.

Learn more about X-rays and other tests for PsA.

The severity of PsA can range from mild to severe, and it can lead to joint damage and reduce a person’s quality of life.

However, new treatment options are proving effective for managing the condition, especially if the person starts them when the condition is in the early stages.


How do I know if I have PsA or rheumatoid arthritis?


It can be difficult to tell PsA and rheumatoid arthritis apart in the early stages. In either case, you will need to consult a rheumatologist to help identify which arthritis type you have.

Blood tests can help identify one or the other, but this is not always conclusive. Time will eventually show which type you have, as PsA may involve psoriasis plaques on the body or “sausage digits,” and RA will likely have symmetrical arthritic locations, which means that it may affect both hands instead of one.

Debra Sullivan, Ph.D., MSN, RN, CNE, COI Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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