Some people with psoriasis may develop a condition called psoriatic arthritis (PsA). This can cause them to experience joint pain.
There is a link between psoriasis and joint pain, as PsA is a type of inflammatory arthritis that develops in some people with psoriasis. However, PsA can also occur in those without psoriasis.
This article looks at what PsA is and its possible causes. It also goes over the triggers and symptoms of the condition. Finally, it explains the diagnosis, treatments, when to contact a doctor, and the outlook for PsA.
PsA is a type of inflammatory arthritis that develops in some people with psoriasis. This type of arthritis causes inflammation in the joints and surrounding tissues, leading to symptoms such as:
- pain
- stiffness
- swelling in the affected areas
The severity of PsA can vary widely in individuals and can develop at any time. However, PsA often appears after psoriasis has been present for 5–12 years.
The exact cause of PsA is unknown, but it appears to have a link to the following factors:
- genetic
- environmental
- immune system
- injury or trauma to the tendon or ligaments
People with psoriasis are more likely to develop PsA than those without psoriasis. Around 85% of individuals with PsA have psoriasis. Roughly 30% of those with psoriasis may develop PsA.
Additionally, around 40% of people with PsA have a first-degree relative who also has the condition. This means a biological parent, sibling, or child.
Doctors do not fully understand the link between the two conditions, but some believe psoriasis and PsA may share common risk factors.
When a person experiences PsA symptoms that are more severe than expected, it is known as a flare.
Common triggers of PsA flares include:
- allergies
- alcohol intake (if applicable)
- bacterial infections, such as strep throat
- changes in the weather
- some medications
- skin injuries
- smoking (if applicable)
- strenuous physical activity
- stress
- changes in the gut or skin microbiome
Symptoms of PsA can be similar to those of other types of arthritis, such as rheumatoid arthritis.
PsA can also cause various symptoms that can affect the joints and skin, leading to inflammation.
Joint symptoms
Symptoms affecting the joints may include:
- pain and stiffness, especially in the:
- fingers
- toes
- ankles
- knees
- hips
- spine
- swelling in the joints
- reduced range of motion in the joints
- redness or discoloration and warmth in the affected joints
Skin and nail symptoms
PsA may affect the skin and nails in various ways, including:
- psoriasis symptoms on the skin, such as:
- red, scaly patches in lighter skin
- darker and thicker discoloration in darker skin
- nail changes, such as:
- pitting
- thickening
- separation from the nail bed
Inflammation
PsA can also cause inflammation, such as:
- spondylitis, or inflammation of the spine, that may cause back pain and stiffness
- dactylitis, or inflammation of the fingers or toes that causes them to swell
- tenderness or pain in the tendons or ligaments, especially in the heel or bottom of the foot
Other symptoms
Other symptoms of PsA may include:
- fatigue and a general feeling of being unwell
- changes in the eye, such as:
- redness
- pain
- light sensitivity
Read more about how PsA affects the body.
Diagnosing PsA may seem difficult, especially early in the disease. This is because the symptoms may mimic those of other types of arthritis. Therefore, a doctor may refer a person to a rheumatologist — a specialist in arthritis and other inflammatory conditions — for further evaluation and management.
The process usually starts with taking a thorough medical history and performing a physical examination.
To help confirm the diagnosis, the doctor may also order several diagnostic tests, including blood tests. This can help identify certain inflammation markers and rule out other types of arthritis.
Doctors may carry out imaging tests to help detect joint damage and inflammation, such as:
Treatment options for PsA include the following:
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- for peripheral arthritis, disease-modifying antirheumatic drugs (DMARDs) such as:
- for spine, skin, and peripheral symptoms, biologic medications such as:
- tumor necrosis factor inhibitors
- interleukin inhibitors
- a new class of drugs called Janus kinase (JAK) inhibitors
- physical therapy and exercise
- occupational therapy
- splints or braces
- topical medications
- steroids
- surgery
Doctors tailor treatment options to the individual. The treatment plan will depend on various factors. These include the severity and progression of the disease, whether the symptoms affect the peripheral joints or the spine, and a person’s response to therapy.
Doctors can adjust the treatment plan as the condition changes over time, usually working closely with a rheumatologist or a physician specializing in this field.
If a person thinks they may have PsA, they can speak with a healthcare professional to receive a diagnosis and treatment plan. This can help prevent more severe symptoms and joint damage in the future.
People with psoriasis have a higher risk of developing PsA. Therefore, if a person has the condition and their symptoms are like those of PsA, it is important to consult a doctor.
The outlook for someone with PsA can vary widely depending on the severity of the disease, how well they can manage it, and their overall health.
Getting the medical care and management that feels right for a person can help them live a full life. However, flare-ups can still occur, meaning some individuals’ symptoms may sometimes worsen.
Treatment can help lower inflammation and pain, slow the progression of the disease, and prevent joint damage.
If a person has psoriasis and joint pain, there is a risk of them developing PsA. However, experts suggest that not everyone with psoriasis will develop PsA. Additionally, people with PsA often have no skin symptoms of psoriasis.
Most individuals with PsA can live a full life with treatment and symptom management that feels right for them. However, as PsA is a progressive condition, there is no cure yet.