Psoriatic arthritis is a type of arthritis that causes joint pain and swelling. It is also known as arthropathic psoriasis or psoriatic arthropathy.

Psoriatic arthritis also causes swelling and pain in areas where ligaments and tendons connect to bone. Without treatment, psoriatic arthritis can lead to permanent joint damage.

This article will look at the symptoms, risk factors, and complications of psoriatic arthritis. It will also address treatment options.

Psoriatic arthritis is an autoimmune condition. With autoimmune conditions, the body falsely recognizes healthy tissues as foreign invaders and produces antibodies to attack them. This leads to pain, inflammation, and damage.

According to the National Psoriasis Foundation (NPF), people can develop psoriatic arthritis at any age. However, it is most likely to occur between 30–50 years.

There are different manifestations of psoriatic arthritis. They include:

  • Spondylitis or axial disease: An inflammation of the spinal joints and sacroiliac joints of the lower back affecting 7–32% of people with psoriatic arthritis.
  • Enthesitis: An inflammation of the enthesis, which is the area where the ligament, tendon, or fascia connect to bones, such as those of the feet, back of heels, or hips. This affects about 50% of people with psoriatic arthritis.
  • Dactylitis: Puffy sausage-like swelling of fingers and toes affecting 40% of people with psoriatic arthritis.
  • Peripheral arthritis: Inflammation of the large or small joints of the upper and lower extremities.
  • Skin and nail disease: Nail pitting and separation of the nail from the nail bed. This can occur with discoloration of the nails that may be hard to distinguish from fungal infections of the nail.

Psoriatic arthritis can affect many parts of the body, including:

Feet

Toe joints may be noticeably swollen and tender to touch. This can involve the distal joints, proximal joints, or both. The involvement can be symmetrical or asymmetrical.

People with psoriatic arthritis may experience pain on the bottom of their feet or Achilles tendons due to ligament and tendon inflammation.

Skin

Psoriatic rashes may develop on the knees, scalp, and elbows. The rashes tend to be:

  • itchy
  • flushed
  • flaky
  • painful

Research has found that People of Color tend to have psoriatic arthritis less frequently than people who are white. However, this may be an underestimation due to a disparity in epidemiological studies involving People of Color.

The available research suggests that when People of Color have the condition, they may have less obvious reddening of the skin. Instead, the color may appear purplish or darker.

People of Color may experience more pigmentation on their skin, heavier scaling, and thicker plaque. Psoriatic arthritis may also affect more of their body.

Hands

The same swelling in the toes can also occur in the fingers, with inflammation affecting the distal finger joints more than the proximal joints. This involvement can also be symmetrical or asymmetrical.

Ribs

Because psoriatic arthritis causes ligament and tendon inflammation, people may experience rib pain with this condition.

Elbows

Inflammation and swelling can occur in the elbows. The pain may feel like tennis elbow, with pain from the elbows to the forearms and wrists.

Pelvis

Some people may experience inflammation and stiffness in the pelvis.

Nails

People with psoriatic arthritis might experience changes in the appearance of their nails. The changes could mimic the look of a fungal infection. Changes may appear in the fingernails or toenails.

Eyes

Psoriatic arthritis may also cause eye symptoms, such as:

  • pain
  • itching
  • dryness
  • blurred vision
  • sensitivity to bright light
  • uveitis, which is a serious inflammatory condition occurring in a small percentage of people

Back

Psoriatic arthritis can affect the spine, and this inflammation is known as spondylitis. It can cause neck stiffness and lower back pain.

According to the Spondylitis Association of America, around 20% of people with psoriatic arthritis could develop spondylitis.

Joints

In addition to the hands and feet, various joints in the body may also become swollen and inflamed due to psoriatic arthritis, resulting in stiffness, pain, and tenderness.

It is important to note that this type of arthritis can be very destructive, and a healthcare professional should periodically perform imaging of the joints to assess possible damage.

There is no specific known cause of psoriatic arthritis.

However, according to the American College of Rheumatology, 40% of people with the condition have a relative who has either arthritis or psoriasis. This suggests that there is a genetic component to it.

Psoriatic arthritis may also have links to environmental triggers, such as:

  • stress
  • infection
  • acute injury
  • trauma

There is currently no cure for psoriatic arthritis. However, medications can help slow down disease progression and reduce the symptoms.

Medical treatment

A person should seek medical treatment as early as possible. Typically, the most appropriate treatment should develop as part of consultation between the primary care physician, dermatologist, and rheumatologist.

Treatment will also depend on the severity of the symptoms, the degree of physical damage, and whether the disease has only impacted peripheral parts of the body or has reached the spine.

People with mild psoriatic arthritis may find relief with nonsteroidal anti-inflammatory drugs (NSAIDs).

If the condition does not respond to NSAIDs, a doctor may suggest:

A doctor may recommend surgery in cases where there is severe damage.

When psoriasis is also present, a doctor may suggest:

  • topical creams and lotions
  • exposure to sunlight or UV light
  • immunosuppressants

Lifestyle changes

Exercise and movement play an essential part in psoriatic arthritis treatment. Exercising can help maintain mobility and flexibility and reduce stiffness in the joints. People can try activities such as walking, swimming, or cycling to strengthen and protect their joints.

A person can manage symptoms at home by:

  • performing strengthening and flexibility exercises
  • using hot and cold therapy to help with inflammation and swelling
  • using braces and splints to support the joints

There is no specific test for psoriatic arthritis as a doctor will need to make a clinical diagnosis. A rheumatologist is an ideal specialist for this purpose.

A rheumatologist will ask the person about their medical history, including whether or not they have previously had psoriasis.

As well as carrying out a physical examination, they may order tests to help verify a diagnosis of psoriatic arthritis and rule out other causes.

These tests may include:

The symptoms of psoriatic arthritis can resemble those of other forms of arthritis, which can make confirming a diagnosis challenging. Having skin or nail changes, in addition to other symptoms, may indicate the presence of psoriatic arthritis.

A unique symptom of psoriatic arthritis is enthesitis, which refers to tenderness in the areas where tendons and ligaments connect to bones.

Some of the risk factors for developing psoriatic arthritis include:

  • Age: The condition is more likely in people aged 30–50 years.
  • Family history: Genes may play a role in the development of psoriatic arthritis.
  • History of psoriasis: Around one-third of people with psoriasis develop psoriatic arthritis.

People with psoriatic arthritis have a higher chance of developing other serious conditions, such as:

Untreated psoriatic arthritis could lead to permanent joint damage and a loss of joint function.

To discover more evidence-based information and resources for arthritis, visit our dedicated hub.

Psoriatic arthritis can look a lot like other types of arthritis. Therefore, it is important to see a doctor for a correct diagnosis and begin the appropriate treatment.

A person should see a doctor if they have psoriasis with arthritis-like symptoms, such as joint pain and swelling. Early treatment can help limit complications of the condition, such as joint damage.

Psoriatic arthritis can severely affect a person’s quality of life. Signs indicating a person’s condition may be progressing more aggressively include:

There is currently no cure for the condition, but people can manage their symptoms with a specialist’s help. Early treatment may prevent severe damage to the joints by slowing disease progression.

Making certain lifestyle changes can help reduce pain and swelling and make it easier to live with the condition. These changes include:

  • incorporating low impact exercises
  • resting during flare-ups
  • finding and avoiding arthritis triggers
  • maintaining a moderate weight

Early diagnosis is vital to help slow disease progression and prevent permanent joint damage.

Since there is currently little understanding of the specific causes of psoriatic arthritis, healthcare professionals can do very little to prevent it.

What is the difference between psoriasis and psoriatic arthritis?

Both psoriasis and psoriatic arthritis are autoimmune conditions. This means that the immune system becomes overactive as if it is attacking an infection, but instead, it attacks the body’s own cells. In the case of psoriasis, this affects the skin, whereas, in psoriatic arthritis, the impact is more often on the joints. However, psoriatic arthritis can also sometimes impact the skin.

People with psoriasis have a higher chance of developing psoriatic arthritis than people without the condition. Around 30% of people with psoriasis develop psoriatic arthritis. However, having severe psoriasis does not necessarily mean that someone will also have severe psoriatic arthritis.

What is the difference between psoriatic arthritis and rheumatoid arthritis?

Rheumatoid arthritis (RA) is also an autoimmune disease. It may present similarly to psoriatic arthritis, for example, by affecting the joints and causing swelling. This can make it hard to tell the difference between the two conditions. However, psoriatic arthritis typically affects the distal joints near the nail bed, whereas RA does not.

Psoriatic arthritis also presents with asymmetric swelling of the joints. It can cause sausage-like swelling of the fingers and toes and present with psoriasis-like skin symptoms. RA does not present in this manner.

In addition, in blood test results, a person with RA will have cyclic citrullinated peptide or rheumatoid factor blood markers. In contrast, only a minority of psoriatic arthritis patients will have these markers in their blood.

What is the best diet for psoriatic arthritis?

There is no special psoriatic arthritis diet. However, eating a healthy diet can help strengthen the body as it copes with the condition. Foods such as fish rich in omega-3 and healthy fats like nuts and olive oil can be particularly helpful. A person should eat lean meats and plenty of vegetables.

The Medical Board of the NPF also recommends that people with both psoriasis and psoriatic arthritis take vitamin D supplements.

Psoriatic arthritis is an autoimmune condition that can affect the joints and spine. Symptoms can be mild, moderate, or severe. It often occurs in conjunction with psoriasis.

Psoriatic arthritis can also affect other parts of the body, such as the skin, nails, and eyes.

Without treatment, the condition can cause joint damage and dysfunction and lead to other serious health complications.

However, early treatment can slow its progression and help a person manage the symptoms.