Psoriatic arthritis is a type of inflammatory arthritis that can affect some people who have psoriasis. First signs can include joint pain and swelling. Early treatment can help prevent joint damage.
Psoriatic arthritis (PsA) is an inflammatory form of arthritis that can cause pain and swelling in the joints. It occurs alongside psoriasis, a chronic skin disease.
In this article, we look at the early signs of PsA that people can watch out for, as well as diagnosis, treatment, and outlook.
According to the Arthritis Foundation, around one-third of people with psoriasis develop PsA.
It can take around 10 years for PsA to develop in people with psoriasis, and symptoms of PsA often appear between the ages of 30–50 years. PsA affects all genders equally.
Some people develop PsA without ever developing psoriasis. While the majority of people have psoriasis first and then develop PsA, for some people, PsA symptoms appear before psoriasis symptoms.
The following symptoms can be early signs of PsA:
Joint pain and stiffness
People may experience pain and stiffness in joints throughout their body, in particular:
- the finger joints closest to the nails
People may experience warmth and swelling in the joints, which doctors call peripheral arthritis. They can experience these symptoms on different sides of the body, which is called asymmetrical arthritis. For example, people may have warmth and swelling in the right hand or left knee.
People may have swelling in an entire finger or toe. This may make movement difficult and may feel painful. Doctors call this dactylitis, commonly known as “sausage digit.”
PsA can cause enthesitis, which is inflammation of the entheses. Entheses are connective bands of tissue that join tendons and ligaments to the bone.
People with enthesitis may feel pain in the area where the inflamed entheses are in the body.
People with PsA may have pitted nails. They may also notice cracking and white spots on the nails.
PsA can cause nail disease. The nails may lift and separate from the nail bed.
Lower back pain
People may experience pain or stiffness in the lower back. It may also affect the buttocks.
People may also have a painful, stiff neck or hips. Doctors may refer to this as axial arthritis or psoriatic spondylitis.
Roughly 20% of people with PsA will develop symptoms affecting the spine.
Swollen fingers or toes
People may notice swelling in one or more of their fingers or toes. The medical term for this is dactylitis, or “sausage digit.” The swelling may feel painful.
Swelling of the fingers and toes can be a sign of severe, unmanaged PsA. People will need treatment to ensure no permanent damage to their joints.
Symptoms can affect one or both eyes, and people may experience:
- blurred vision
- sensitivity to light
- irregularly shaped or small pupils
Foot and ankle pain
Inflammation of the entheses commonly affects the feet and ankles. People may have swelling or pain at the back of the heel and across the bottom of the foot.
PsA can affect various parts of the body. People may experience elbow pain if PsA causes inflammation of the tendons in the elbows.
Reduced range of motion
Joint stiffness may affect a person’s range of motion, and people may find their movements more limited. People may also experience more stiffness first thing in the morning.
Some people may also have a low grade fever alongside fatigue.
There is currently no specific diagnostic test for PsA. A doctor will assess symptoms, take a medical history, and carry out a physical examination.
Doctors use tests such as an erythrocyte sedimentation rate (ESR) test to check for inflammation. Inflammation can be elevated in some people with PsA. An ESR involves examining a blood sample in a test tube to see how quickly red blood cells fall to the bottom. Inflammation can cause the proteins in the blood to join together, making the blood cells heavier than usual.
Treatment for PsA depends on a person’s condition and health. Treatment will focus on managing psoriasis as well as PsA. Medications for treating PsA may include the following:
- nonsteroidal anti-inflammatory drugs to reduce inflammation, ease symptoms, and relieve pain
- immunosuppressive drugs, such as methotrexate, to lower inflammation
- biologics to reduce inflammation
- vitamin and mineral supplements, such as calcium and vitamin D, to slow down changes to the bone, such as deformation
Other treatments to help relieve pain and manage the condition may include:
People may find the following tips helpful for managing early symptoms of PsA:
- taking medications as a doctor prescribes
- trying alternative therapies, such as meditation and acupuncture, to help manage pain
- doing regular, low impact exercise, such as swimming, cycling, yoga, and walking
- seeing an occupational or physical therapist if pain or everyday tasks become difficult to manage
- attending annual eye tests, as mild inflammation could be an early sign of PsA
The Arthritis Foundation also suggests the following tips:
- keeping the skin moisturized to help manage psoriasis, and looking for products with aloe vera, jojoba oil, or zinc
- taking short, warm baths with oatmeal or Epsom salts
- using fragrance-free products that do not irritate the skin, including laundry detergents and cleaning products
- wearing loose-fitting cotton clothing to avoid irritating the skin
- eating a nutritious, balanced diet high in anti-inflammatory foods such as fruits and vegetables
- limiting or avoiding foods that are high in sugar, fat, and salt, as these may increase inflammation and fatigue
- stress may worsen symptoms, so trying activities to manage it such as yoga, meditation, walking, listening to music, or joining a support group
- using a warm compress to increase blood circulation and ease joint pain and stiffness
- using a cold compress to constrict blood vessels and reduce swelling
- relaxing the muscles with techniques such as positive visualization or deep breathing
- avoiding smoking and limiting alcohol intake, as these may interfere with medications or cause weight gain
Early treatment of PsA can help prevent joint damage.
Although there is currently no cure for PsA, treatment can help to:
- prevent the condition from progressing
- reduce pain and ease symptoms
- protect the joints
- maintain range of motion
PsA is an inflammatory form of arthritis that may affect some people with the skin condition psoriasis.
Early signs of PsA can include joint pain and stiffness, swollen fingers or toes, and fatigue. PsA can also cause nail changes, eye inflammation, and lower back pain.
If people have any symptoms of PsA, they may wish to contact a doctor for a diagnosis. Early treatment can help prevent joint damage and disease progression.