Psoriatic arthritis (PsA) and psoriasis are types of psoriatic disease. PsA causes joint pain and stiffness, and psoriasis mainly involves the skin, but they often occur together.
Both conditions are long term. Psoriasis becomes more aggravating during flares and can worsen over time if left untreated.
PsA can cause joint damage, leading to permanent damage. It often worsens over time, but the outlook will vary between individuals.
This article explores the link between psoriasis and PsA. It also looks at the causes, symptoms, and treatments of each condition.
Immune responses that lead to inflammation in the body cause the symptoms of both conditions:
- In plaque psoriasis, inflammation causes skin cells to
renew too quickly, resulting in a scaly rash on the skin with characteristic silvery plaques.
- In PsA, inflammation causes joint pain and stiffness. It can affect one joint or more and may lead to long-term joint damage.
- In both conditions, a person may also have eye inflammation, known as uveitis, and pitted or crumbling psoriatic nails.
Psoriasis and PsA often affect the same people, but not always.
Experts do not know precisely how many people with psoriasis will develop PsA, but research has suggested it is between
Of these, 68% will have psoriasis before PsA symptoms appear. In around 15% of individuals, symptoms of psoriasis and PsA appear at the same time. In 17% of those with PsA, arthritis occurs before skin symptoms.
Meanwhile, some people have PsA without psoriasis.
The severity of psoriasis does not predict whether someone will develop PsA.
Both psoriasis and PsA can:
- cause discomfort
- affect a person’s quality of life
- affect their mental health and self-esteem
People with PsA, psoriasis, or both may also have a higher risk of metabolic syndrome, including:
Treatment for PsA and psoriasis can help ease symptoms and reduce the risk and severity of flares. Some treatments are similar, such as the use of biologic drugs. However, some target PsA or psoriasis specifically.
Psoriasis and PsA are related but differ in many ways.
Diagnosis for PsA usually involves a process of elimination and includes a thorough:
- evaluation of symptoms
- family history
- physical examination
- sometimes, imaging tests and biopsies
This table shows some similarities and differences between PsA and plaque psoriasis, the most common form of psoriasis.
|Plaque psoriasis and PsA||Plaque psoriasis only||PsA only|
|Causes and risk factors||• inflammation|
• genetic factors
• a history of psoriatic disease
|• physical trauma to the skin||• a personal history of psoriasis, especially with nail psoriasis or uveitis|
• a family history:
• psoriasis affecting a
• some medications
• alcohol and tobacco use
• infections that involve inflammatory processes
|• physical trauma to the skin|
• exposure to sunlight
|• physical trauma to a joint|
• heavy lifting
• infectious diarrhea
|Common symptoms||• uveitis|
• nail psoriasis
|• itchy, silvery plaques on the skin|
• other skin changes for other types of psoriasis
|• joint pain and stiffness|
• swollen, or “sausage,” fingers or toes (dactylitis)
• inflammation in tendons and ligaments where they meet a joint (enthesitis)
• back pain (spondylitis or axial PsA)
|Diagnosis||For both PsA and psoriasis, the doctor ||A doctor will: |
• ask the person about their symptoms and family history
• examine the symptoms
• take a skin biopsy to confirm psoriasis
|The doctor will |
• ask about symptoms
• ask about any history of psoriatic disease in the individual or their family
• do a physical examination, including checking for dactylitis and enthesitis
• recommend imaging tests, such as an X-ray, MRI, or ultrasound scan
• do blood tests to rule out other forms of arthritis or causes of joint pain
|Treatment||• systemic drugs, |
• various lifestyle remedies
• counseling and treatment for mental health complications
|• moisturizers and emollients|
• topical corticosteroids
• other topical applications
• light therapy
• methotrexate injections and pills
|• nonsteroidal anti-inflammatory drugs (NSAIDs)|
• disease-modifying antirheumatic drugs (DMARDs)
• methotrexate pills and injections
• corticosteroid injections, in some cases
|Outlook||• lifelong condition|
• remission is possible with treatment
|• remission occurs in ||• can worsen over time|
• reduced mobility and functionality
|Complications||• physical discomfort |
• reduced quality of life
• higher risk of cardiovascular problems
• negative effect on mental health
• adverse effects of treatment
|• severe itching|
• secondary infections
• effect on physical appearance
|• reduced mobility|
• chronic pain
• higher risk of metabolic syndrome, including obesity and type 2 diabetes
• changes to the shape of fingers, toes, and joints
It is not always possible to prevent psoriasis or PsA, but some measures may help reduce the risk of flares or more severe symptoms.
Some tips a person can consider include:
- maintaining a moderate weight
- taking steps to avoid injuries and infections
- finding ways to manage stress and anxiety
- speaking with a doctor if any medications appear to worsen symptoms
- avoiding smoking
- limiting alcohol consumption
- following an anti-inflammatory diet or a varied diet that contains plenty of fruits and vegetables
- exercising regularly
- following a doctor’s recommendations and the treatment plan
It is also important for people with psoriasis to:
- cover the skin and hydrate well in cold weather
- avoid sun exposure and use air conditioning in warm or sunny weather
- bathe or shower in warm water, not hot water
Here are some questions about psoriasis psoriasis vs psoriatic arthritis.
Are psoriatic arthritis and psoriasis the same?
Both conditions are psoriatic diseases. A person who has psoriatic arthritis will often have psoriasis, but they are not the same disease. PsA affects the joints, but psoriasis causes skin lesions.
Which comes first, psoriasis or psoriatic arthritis?
What are the early signs of psoriatic arthritis?
A person who develops PsA may already have nail psoriasis and skin symptoms. Early signs of joint involvement include swelling in the fingers, toes, or both, known as dactylitis. There may also be pain and tenderness where the tendons and ligaments meet a joint, known as enthesitis.
Can you have psoriasis without psoriatic arthritis?
It is common to have psoriasis without psoriatic arthritis. Research suggests only
Psoriasis and PsA are both types of psoriatic disease. They are immune-mediated, and symptoms occur due to inflammation. They are different diseases but have several factors in common.
Psoriasis causes skin symptoms, but PsA causes pain and stiffness in one or more joints. However, people with PsA often also have psoriasis.
A person with either condition can have uveitis, an eye infection, or nail psoriasis. People with both nail psoriasis and skin symptoms may have a higher risk of developing PsA.
Treatment is available for both conditions. Some therapies are the same for both, while others are specific to the disease. PsA and psoriasis are lifelong conditions, but treatment can help move them into remission, when symptoms improve or resolve for a while.