What are the symptoms of psoriatic arthritis?
People with severe symptoms of psoriatic arthritis (PsA) often find that they worsen over time, especially without treatment.
There is a risk of permanent joint damage. However, receiving treatment early can prevent or slow the progression of PsA.
People with mild symptoms may continue to experience them without these symptoms significantly worsening.
PsA affects people differently, depending on the following factors:
- which symptoms develop
- the severity of symptoms
- the stage of progression
- the individual
Below are symptoms of PsA that may occur.
Early or mild symptoms may not be clearly visible to most people.
Psoriasis is a major risk factor for developing PsA.
Some symptoms of psoriasis, such as skin and nail changes, will be the same with both psoriasis and PsA.
PsA can cause painful, "sausage-like" swelling in the fingers and toes.
This may occur before changes appear in their joints.
Advanced-stage PsA may involve mutations to the fingers and fingernails.
Severe or advanced PsA can cause permanent damage and deformations in the joints, particularly in the hands and feet.
When imaging is used, people with similar, more advanced stages of PsA may look like this. In this image, the joint pain is indicated in red.
PsA causes pain, swelling, and a feeling of warmth in the joints. There can be swelling in the large joints, which can reduce a person's range of motion.
A person may also experience other symptoms, including:
Lower back pain: Inflammation can develop in the joints between the bones of the spine and in the pelvis. Lower back pain is a common early indication of this.
Swollen fingers and toes: This is a hallmark of PsA, which can cause painful swelling that can make the fingers and toes resemble sausages. Swelling and deformities can appear in the hands and feet before significant joint symptoms appear.
Eye problems: Inflammation can cause redness and irritation in the eyes.
Foot pain: PsA can affect the ligaments and tendons attached to the bones of the foot, leading to pain and swelling, especially toward the back of the heel and in the sole.
How does PsA affect the feet? Learn more here.
Experts do not know exactly what causes PsA, but it likely results from a combination of genetic and environmental factors.
Even if a person has a genetic predisposition, they may not develop psoriatic disease unless they are exposed to another risk factor.
Some of these factors include:
Personal or family history of psoriasis: Either of these can increase the risk of developing PsA. Also, people with psoriasis lesions on the nails are more likely to develop PsA.
Age: PsA is more likely to develop between the ages of 30 and 50, but it can occur at any age.
Infection: Exposure to an infection, such as strep throat, can trigger the onset of symptoms.
Obesity: There is evidence of a link between obesity and PsA. Both health issues involve inflammation and obesity may trigger a psoriatic reaction by putting additional strain on the joints. However, it is not clear whether one condition causes the other.
Smoking: Scientists have noted that smoking is more common among people with psoriasis than those without the condition. However, they have not yet identified an exact link.
Alcohol: There is evidence of a link between excessive alcohol consumption and PsA.
Stress: This can first trigger psoriatic disease, including PsA, or a worsening of existing symptoms.
Trauma: A blow to a joint may trigger an initial flare or cause existing symptoms to worsen.
Learn more about the causes and risk factors of PsA.
Anyone with psoriasis should ask a doctor about the possibility of developing PsA, especially if there is a family history of psoriasis or PsA, symptoms affecting the nails, or a combination.
PsA can be difficult to diagnose, as it can resemble other conditions. However, clues such as a family history or existing psoriasis can help a doctor identify PsA.
PsA affects people differently. For some, symptoms remain mild. Others can experience significant changes to their wellbeing and everyday life as a result of the condition.
However, new forms of treatment can help prevent symptoms from becoming severe.
A doctor will look for:
- swollen and painful joints
- skin and nail changes typical of psoriasis
- patterns of arthritis that characterize PsA
Also, they may use:
X-rays: These can detect joint damage and help monitor PsA progression. However, tissue damage occurs before joint damage, and this may not be visible on an X-ray.
Blood tests: These can help rule out other types of arthritis that have similar signs and symptoms.
A skin biopsy: This can confirm the presence of skin psoriasis, a strong risk factor for PsA.
Treatment will depend on the severity of symptoms, among other factors.
Current guidelines recommend using biologic medications called tumor necrosis factor inhibitors. These drugs work by targeting specific parts of the immune system. They can slow the progression of the disease and reduce the risk of flares and the overall severity of symptoms.
- ustekinumab (Stelara)
- etanercept (Enbrel)
However, since these medications affect the immune system, there may be some adverse effects, and they may not suit everyone.
If a person cannot use a biologic drug, the doctor will recommend another long-term option. This may be an oral small molecule medication, such as tofacitinib (Xeljanz).
Disease-modifying antirheumatic drugs are another long-term option that can slow the progression of the disease and help protect against permanent damage in the joints and ligaments.
Treatments for flares
Additional treatments can help when symptoms flare.
- nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen
- corticosteroid injections, which can relieve pain and swelling
A doctor may recommend a combination of drugs.
PsA can be mild or severe. Severe cases can worsen over time and lead to permanent joint damage. However, new treatments show promise for stopping or slowing the progression of PsA.
Find out more about the long-term outlook for PsA.
Anyone with a family or personal history of psoriatic disease should ask their doctor about the possibility of developing PsA, especially if they also have nail changes and experience any joint pain.
I have had mild PsA for 2 years and I am 35 now. Should I expect to use a wheelchair in a few years’ time?
Symptoms of PsA usually come in cycles of getting worse and improving. Following your doctor’s recommendations will help you avoid the exacerbation periods.
Also, recent biologic medications should help you be able to take control of your PsA and slow or stop the disease progression. By taking these, in combination with regular check-ups, occupational therapy, and taking measures to reduce inflammation, you should be able to reduce the severity of joint damage.Debra Sullivan, PhD, MSN, RN, CNE, COI Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.