Psoriatic Arthritis: Symptoms & Signs

Medically Reviewed by Shruthi N, MD on June 24, 2024
Written by Lori M. King, PhD
6 min read

Psoriatic (pronounced saw-ree-a-tuhk) arthritis is a chronic inflammatory arthritis. Anyone can get psoriatic arthritis, but about 33%-50% of people who get it either have psoriasis themselves or have a first-degree family member (mother, father, or siblings) with psoriasis.

Both psoriasis and psoriatic arthritis are autoimmune conditions. This means that your immune system mistakenly attacks your own body tissues. Psoriatic arthritis leads to signs and symptoms in your skin, joints, and nails, as well as fatigue. Read on to learn more.

Psoriatic arthritis can affect any joint in your body, whether that's your large joints, such as your knees and shoulders, or your small joints such as your fingers, toes, back, and pelvis. The most common musculoskeletal psoriatic arthritis symptoms include:

  • Joint pain and stiffness
  • Discoloration or redness near your affected joints
  • Pain or tenderness where your tendons and ligaments attach to your bones, especially at the back of your heel (Achilles tendinitis) or in the sole of your foot (plantar fasciitis)
  • Swelling in your fingers and toes, which your doctor may call dactylitis or "sausage fingers"

Traditionally, psoriatic arthritis has been classified as one of five types based on which of your joints are affected and on which side of your body you have symptoms. The five types include:

Oligoarticular arthritis. This type usually affects two to four joints at the same time on both sides of your body. For instance, you may have swelling and pain in one of your knees and one of your elbows. This is the most common type of psoriatic arthritis.

Polyarticular arthritis. This type looks a lot like rheumatoid arthritis, and it's the second most common type. It usually affects more than five joints at the same time, most often the same joints on both sides of your body. For example, it may affect both of your knees and both of your elbows.

Distal arthritis. This type usually affects the joints near the end of your fingers and toes, though it can affect other joints as well. With this type, you will usually also have symptoms in your fingernails and toenails. For instance, your nails might look discolored, flaky, or pitted.

Spondylarthritis. This type usually affects the joints between the vertebra in your back, as well as the joints in your hips and shoulders.

Arthritis mutilans. This is the rarest and most serious type. It causes inflammation that is so severe, it can cause bone loss (also called osteolysis). Bone loss leads to joint deformities, especially in your hands and feet.

 

You will usually have skin symptoms of psoriasis before joint symptoms, but they may start at the same time. Or you may get arthritis before skin symptoms. Your skin symptoms can be mild or severe, and the severity of your rashes won't necessarily match the severity of your joint symptoms.

The skin symptoms include:

  • Rash plaques. Plaques are rashes that look raised, thickened, and discolored (silver or gray), and they most often form on your knees, elbows, scalp, and lower back. The rash is also scaly and will flake off easily. Your skin may bleed when the scales flake off.
  • Itchy skin
  • Painful skin

About 80%-90% of people with psoriatic arthritis will get nail symptoms. You may get symptoms in your fingernails and toenails that can be uncomfortable or painful. The severity of your nail symptoms often matches the severity of your skin and joint disease.

These symptoms include:

Discoloration of your nail beds (the skin under your nails). The discoloration is often yellow, pink, red, or brown. You may also get splinter hemorrhages, which are thin, red to reddish-brown lines of blood under your nails. They run in the direction of nail growth.

Pitting or denting. Your nails may have pits that are the size of a pin tip or dents that are as big as the tip of a crayon. You may have only a couple of pits or many across your nail.

Nail structure changes. This can include:

  • Horizontal grooves across the surface (Beau's lines)
  • Thinning of the nail that leads to crumbling
  • Separation of your nail from your nail bed (onycholysis)

About 7% of people with psoriatic arthritis will also develop uveitis (pronounced you-vee-eye-tis). Uveitis causes inflammation in the middle layer of your eye. Symptoms of uveitis include:

  • Eye redness or irritation
  • Eye pain
  • Blurred vision
  • Light sensitivity (photophobia)
  • Swollen conjunctiva, which is the thin, clear membrane that covers the inside of your eyelid and the white of your eye

Some people with psoriatic arthritis also:

  • Feel very tired or low energy (fatigue)
  • Have inflammatory bowel disease (IBD), which causes inflammation in your digestive system

Psoriatic arthritis has a variety of symptoms, and they vary from person to person. So, there's no one sign or symptom that will point to psoriatic arthritis.

If you have psoriasis or family members with psoriasis, watch out for the signs and symptoms of psoriatic arthritis. You're looking for a pattern, not just one or two signs or symptoms.

You may be more likely to have a flare-up of symptoms after a triggering event, such as:

  • Stress
  • Infections or injuries
  • Smoking or exposure to tobacco smoke
  • Cold weather
  • Drinking a lot of alcohol

What is the difference between signs of rheumatoid arthritis and psoriatic arthritis?

Both rheumatoid and psoriatic arthritis are autoimmune conditions that cause chronic inflammation of your joints. They have very similar joint symptoms. However, with rheumatoid arthritis, you will usually have symptoms in the same joint on both sides of your body. For instance, you might have symptoms in both wrists at the same time. With psoriatic arthritis, you will usually have symptoms in different joints on both sides of your body. For instance, you might have symptoms in your left wrist and your right knee around the same time. Also, if you have psoriatic arthritis, you will most likely have skin and nail symptoms in addition to joint symptoms.

Having psoriatic arthritis can make you more likely to develop other conditions over time. Some of the most common conditions you may be at increased risk for include:

  • High blood pressure
  • High cholesterol
  • Obesity
  • Diabetes
  • Depression
  • Anemia
  • Muscle weakness

Many of these complications may be the result of the ongoing effects of inflammation. In addition, painful joints and fatigue can make it challenging to be physically active, which also increases your chances of developing obesity, diabetes, high cholesterol, and high blood pressure. Ask your doctor about activities you can do that won't put as much strain on your joints. They may recommend walking, aqua therapy, or yoga as good ways to stay active without stressing your joints.

Go see your doctor if you notice rashes or other skin symptoms or if you have joint pain.

Also, talk to your doctor if you have psoriatic arthritis and you have symptoms that are new, changing, coming on more frequently, or becoming more severe.

Psoriatic arthritis is a long-term inflammatory arthritis. It causes symptoms such as pain, stiffness, redness, and swelling in your joints and where your tendons and ligaments attach to your bones. You may also have skin rashes, pitting and discoloration in your nails, and redness and swelling in your eyes. If you have skin rashes and joint symptoms, go see your doctor. Untreated psoriatic arthritis can make you more likely to have complications, such as diabetes or high blood pressure.

Can lifestyle changes prevent psoriatic arthritis?

It's difficult to say if lifestyle changes can prevent psoriatic arthritis because researchers don't know exactly what causes it. However, making some lifestyle changes can improve your health overall and reduce general inflammation in your body. So, there's good reason to believe that a healthy lifestyle may help prevent all types of arthritis or make management easier if you develop it. Your doctor will likely recommend you:

  • Avoid tobacco products
  • Follow a healthy diet and exercise plan
  • Do low-impact exercise
  • Use equipment that protects your joints when doing any activity that could cause an injury