Psoriatic arthritis (PsA) is a chronic inflammatory condition. It causes swollen, stiff, and painful joints. People with PsA can also experience the itchy, scaly, and painful skin lesions of psoriasis.

PsA symptoms can be debilitating. They can make it difficult for someone to sleep, work, and take part in activities they enjoy. Psoriasis is the greatest risk factor in developing PsA.

Getting treatment for PsA can help reduce disease activity and relieve symptoms.

Read on to learn why PsA can be so painful and how to manage it.

In a 2018 review of research, scientists found that people with PsA report high levels of pain and functional disability. This affects their ability to work and do day-to-day activities. It may also affect their sleep, fatigue levels, and overall quality of life.

When researchers asked people from eight countries to rank the effects of PsA, pain was the most impactful. PsA may cause pain in the joints, the skin, and other body parts.

Pain and other symptoms tend to worsen during a flare, which is when the condition is active. Flares may last a few weeks or months.

In PsA, the immune system targets healthy tissues. This causes chronic inflammation and tissue damage. Some common symptoms include:

  • joint swelling, stiffness, tenderness, and pain
  • painful swelling of entire fingers or toes
  • back pain and limitation of motion
  • pain in the heel or sole of the foot
  • fatigue

Chronic inflammation can eventually cause permanent joint damage and disability.

Many people with PsA also have symptoms of psoriasis, including itchy and painful skin lesions.

People with PsA are also at increased risk of inflammation in other body parts, including the eyes and the digestive system. This can add to their discomfort.

There is little research into PsA and weather. According to the National Psoriasis Foundation, some people with PsA find that it worsens during the winter. Other people notice no difference in their symptoms from one season to another.

It is possible that having less exposure to UV light from the sun during winter may increase disease activity in PsA. When UV light hits the skin, the body produces vitamin D. Some 2017 research has linked low vitamin D to psoriasis and PsA. Research from 2021 on people in China with PsA determined that those who had more sunlight exposure due to their jobs were less likely to experience worsening symptoms in the winter.

Some experts believe that changes in atmospheric pressure may also play a role. Atmospheric pressure drops when a cold front is approaching. This may cause the joints to painfully expand.

Dry, cold air may also dry out the skin and aggravate psoriasis symptoms.

Doctors use two main types of medication to treat PsA: disease-modifying antirheumatic drugs (DMARDs) and symptomatic drugs. DMARDs may help reduce disease activity and relieve symptoms, while symptomatic drugs target symptoms alone.

Doctors may prescribe a combination of both.

DMARDs for PsA include:

  • conventional DMARDs, such as methotrexate (Otrexup (PF), Xatmep, Trexall), sulfasalazine (Azulfidine, Azulfidine EN-tabs)
  • newer DMARDs, such as apremilast (Otezla)
  • biologics, including:
    • adalimumab (Humira)
    • certolizumab pegol (Cimzia)
    • etanercept (Enbrel)
    • golimumab (Simponi)
    • infliximab (Remicade)
    • guselkumab (Tremfya)
    • ustekinumab (Stelara)
  • interleukin 17 inhibitors, including:
    • brodalumab (Siliq)
    • ixekizumab (Taltz)
    • secukinumab (Cosentyx)
  • T cell inhibitors, including abatacept (Orencia)
  • oral small molecules, including tofacitinib (Xeljanz)

Symptomatic medications for PsA include:

  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen
  • corticosteroid injections, which may quickly reduce inflammation in the joints
  • topical therapies, such as creams, for skin symptoms

The American College of Rheumatology and National Psoriasis Foundation also recommends regular, low impact exercise for people with PsA.

Other interventions may also help reduce pain or other symptoms, such as:

  • physical therapy
  • occupational therapy
  • massage therapy
  • acupuncture
  • weight loss

This section answers some common questions about pain and PsA.

What is the pain like with PsA?

People with PsA typically experience joint pain along with stiffness and swelling in one or more joints. They may also feel pain in the spine and where tendons and ligaments attach to the bone, which can cause stiffness in the neck, back, and hips. Stiffness may feel worse in the morning or after rest.

How bad is PsA pain?

Psoriatic arthritis pain can vary in severity depending on the amount of inflammation and the number and location of the painful joints. The pain can be debilitating and affect a person’s ability to complete daily tasks.

How do you stop PsA pain?

Some medications, such as NSAIDs and corticosteroid injections, can help reduce pain and other symptoms during a flare. Other medications, called biologics, can help lessen symptoms while reducing disease activity.

PsA causes painful joint and skin symptoms, which can reduce quality of life and interfere with daily activities. The pain tends to be worse when the condition is active.

Doctors may prescribe one or more DMARDs to reduce disease activity and relieve symptoms such as pain. They may also recommend pain-relieving treatments such as NSAIDs, corticosteroid injections, or topical therapies.

People with PsA should talk with a doctor about how pain and other symptoms affect them. This can help inform their treatment options.