Psoriatic arthritis (PsA) often — but not always — develops in people who already have psoriasis. Early signs of PsA include finger swelling, eye inflammation, fatigue, nail changes, and joint stiffness.

PsA usually occurs in people who already have psoriasis, but it can also develop independently. It causes joint pain and inflammation.

According to research, between 2% and 4% of Western adults may experience psoriasis, and 20–30% of people with psoriasis will go on to develop PsA. It affects men and women equally and most commonly begins between the ages of 40 and 50 years.

For some people, PsA may start with mild symptoms that develop slowly over a long period of time. For others, PsA symptoms can quickly become severe. Knowing the early signs of PsA is critical for receiving a timely diagnosis and treatment.

This article includes personal stories from an individual with psoriatic arthritis.

Here are some pictures of some early signs and symptoms of PsA.

1. Fatigue

People with psoriasis or PsA can feel tired for long periods. Fatigue is a tiredness that persists regardless of rest. According to one 2017 study, it is the second most common symptom in people with PsA after pain.

A combination of factors may cause fatigue, including chronic inflammation. Certain medications for treating PsA, such as methotrexate and leflunomide, can also cause fatigue.

2. Pitted nails

Research suggests that nail changes occur in 80–90% of people with PsA, compared with 10–55% of people who have psoriasis without arthritis.

Pits are superficial depressions within the nail plate that are a symptom in people with PsA. People may notice that they have pits next to smoother sections of the nail. This indicates past periods of symptom flare-ups.

3. Ridged nails

There is evidence that ridged nails and other nail changes are early signs of joint disease. These nail symptoms may occur several years before arthritic symptoms. This means that it is important that people always talk with their doctor if they experience these nail changes.

4. Onycholysis

Another typical nail symptom of PsA is onycholysis. This is where the nail plate detaches from the nail bed. Another name for such nail changes is nail psoriasis.

Onycholysis may occur alongside pitting or ridged nails. It is not usually painful. As the nail peels from the nail bed, it can turn several different colors, including yellow, white, or purple.

5. Lower back pain

Approximately 2 in 10 people who develop PsA will have symptoms that involve the spine. This is called psoriatic spondylitis and occurs when the joints of the spine swell and sometimes fuse together.

6. Dactylitis

Dactylitis is where a finger or toe swells into a sausage-like shape. This swelling can cause pain in the fingers or toes. Dactylitis may also occur with gout or pseudogout but is less common in other forms of arthritis.

Studies suggest around 3 in 10 people have dactylitis at the time of a PsA diagnosis.

In people with PsA, the swelling involves the entire finger or toe rather than just the area around the joint. It can also impact individual fingers and toes differently. For example, it may only affect one hand or foot.

7. Inflamed eyes

Another early symptom of PsA is for people to experience eye problems. These can include redness and inflammation.

Around 7–25% of people with PsA experience uveitis, which is inflammation in the front of the eye. This can permanently damage the eye without the correct treatment. Other symptoms include:

  • light sensitivity
  • blurry vision
  • loss of peripheral vision
  • eye redness and pain
  • dark, floating spots in the field of vision, known as floaters

8. Joint stiffness in the morning

Joint stiffness can be most intense in the morning or immediately after resting. This stiffness may last for more than 30 minutes, but it should get better by itself over time.

Some people will have periods where they are not stiff at any point during the day, which doctors refer to as remission.

Personal story: My early psoriatic arthritis signs

The early signs of psoriatic arthritis for me included subtle swelling in my thumb and middle finger on opposite hands, accompanied by stiffness in my big toe joint. These symptoms gradually worsened over time, leading to difficulty performing everyday tasks.

9. Enthesitis

The areas of the body where tendons and ligaments attach to a person’s bones are known as entheses. In people with PsA, these areas can become painful and inflamed. Doctors refer to this condition as enthesitis.

Around 60–80% of people with PsA have enthesitis when they receive their diagnosis.

Enthesitis can occur anywhere in the body, including the:

  • Achilles tendons
  • elbows
  • feet
  • knees
  • pelvis
  • shoulders

Treatment may include:

10. Swollen joints

PsA causes joint inflammation. People may experience swelling, pain, and stiffness, or tenderness in the affected joints. It can occur in one or many joints.

Some 30–50% of people who see a doctor for the first time with PsA have swelling, pain, and stiffness in at least one large joint.

PsA can affect any joint around the body, including the:

  • ankles
  • back
  • elbows
  • fingers
  • knees
  • neck
  • shoulders
  • toes
  • wrists

People may also report that their joints feel warm to the touch. They may find that their grip becomes weak or that they have difficulty lifting things.

Healthcare professionals may suggest a number of medications to treat PsA, including:

11. Limited range of motion

Some people will find it more difficult to bend their knees, extend their arms, or manipulate their fingers. This can cause problems with performing day-to-day activities, such as getting dressed or bathing.

Rest and heat therapy can help someone return to their full range of motion. Physical therapy may also help prevent movement problems.

12. Skin irritation

Around 8 in 10 people with PsA have psoriatic skin symptoms before arthritis appears. This is where a person’s skin cells grow too quickly, causing scaly patches on the surface of the skin. In some people with psoriasis, the symptoms may appear on their scalp.

Around 10–15% of people with psoriatic disease develop arthritis before skin psoriasis.

Personal story: My diagnosis journey with psoriatic arthritis

My diagnosis journey with psoriatic arthritis was fraught with challenges. Initially, the focus was on managing psoriasis symptoms, with multiple consultations and ineffective treatments. It wasn’t until later, after experiencing joint pain and stiffness, that a definitive diagnosis of psoriatic arthritis was made. This was alongside later, the discovery of accompanying nonalcoholic fatty liver disease, due to my initial psoriatic arthritis treatment with methotrexate.

It is now in remission and has been for some years now. I continue to take the regular TNF injection.

It is not always possible to prevent PsA from developing.

According to the National Psoriasis Foundation, for many people, PsA may develop around 10 years after they begin to have symptoms of psoriasis. Other people may develop PsA without any signs of psoriasis beforehand. This means that it can be difficult for healthcare professionals to determine who will develop the condition.

Here are some questions people often ask about PsA.

What are six early signs of psoriatic arthritis?

Six early signs of PsA are joint pain and swelling, swollen fingers, nail changes, fatigue, eye inflammation, and enthesitis, which affects the places where the tendons and muscles join the bones. Around 8 in 10 people who develop PsA already have a history of psoriasis, which causes scaly, silvery skin changes.

What causes psoriatic arthritis?

Psoriatic arthritis is a symptom of psoriatic disease, which is also the underlying cause of skin psoriasis. Experts do not know precisely why psoriatic disease happens, but they know it is an inflammatory condition that appears to affect the immune system. It is likely due to a combination of genetic and environmental factors.

Factors that can trigger or worsen symptoms include stress, smoking, obesity, and the use of some medications.

How is PsA different from other types of arthritis?

Psoriatic arthritis stems from psoriatic disease, an inflammatory condition that can affect the skin, joints, and eyes. It often occurs with psoriatic skin lesions, and enthesitis is common.

Osteoarthritis happens when cartilage wears away, leading to bone damage. Rheumatoid arthritis is also an inflammatory type of arthritis that can affect the whole body, but it does not involve psoriatic skin lesions or enthesitis.

If a person has psoriasis, it is important that they be aware of the early signs and symptoms of PsA. This way, they can speak with a healthcare professional immediately when new symptoms arise.

Treating PsA as early as possible can help prevent permanent damage.