The 5 Types of Psoriatic Arthritis

Psoriatic arthritis is a long-term inflammatory disease that happens when your immune system attacks your joints and skin. But where the symptoms appear on your body depends on which of the five types of psoriatic arthritis you have.

It’s possible to have more than one type, and your psoriatic arthritis pattern can change over time.

Asymmetric Psoriatic Arthritis

This type is usually mild. Its defining feature is that swelling and discomfort are limited to just one side of your body, mostly often in the knee, hip, fingers, or toes. About 1 in 3 people with psoriatic arthritis have this kind.

Other signs of the asymmetric form include:

  • Red, scaly patches of skin
  • Trouble moving or flexing joints as much as before
  • Stiff joints in the morning

Symmetric Psoriatic Arthritis

This is the most common type, and affects about half of people with the condition. It strikes matching pairs of joints. You may have it in both knees, hands, or feet, or left and right sides of your hips.

Symmetric psoriatic arthritis may be mistaken for rheumatoid arthritis, another autoimmune disease that also affects both sides of the body equally. One way to tell the two diseases apart is that usually only psoriatic arthritis makes your fingers or toes swell so much that they look like sausages.

Symptoms of symmetric psoriatic arthritis are similar to those you get with the asymmetric pattern. They include morning stiffness and rashes on the skin.

Distal Psoriatic Arthritis

"Distal" means away from the center. So this type of psoriatic arthritis crops up in the tips of your fingers and toes.

It’s sometimes confused with osteoarthritis, which usually happens in older people when the cushioning cartilage that keeps bones from rubbing against each other breaks down.

Along with stiffness, pain, and swelling, distal psoriatic arthritis may change the way your nails look. Signs include:

  • Pitting
  • Discolored spots
  • Lifting from the nailbed

Continued

Spondylitis

Constant back pain is one hallmark of this type. Your neck also might feel stiff and hurt. It happens when the joints between the vertebrae in your spine get inflamed.

Spondylitis also can affect connective tissue, such as in the ligaments, or be linked to arthritis in the joints of the arms, hips, legs, or feet.

Other symptoms include:

  • Stiffness in your shoulders
  • Weakness in arms and legs
  • Headaches
  • Problems with your bladder or bowels

Arthritis Mutilans

This is the most severe and rarest type of psoriatic arthritis. Fewer than 1 in 20 people have this pattern. It damages the small joints and tissues in the ends of your hands and feet. It may shorten your fingers and toes because of bone loss in the joints. Sometimes, it can affect your neck and back.

Other signs of arthritis mutilans include:

  • Lots of pain and stiffness in the hands and feet
  • Loss of range of motion
  • Changes in the nails
  • Disfigured fingers and toes

Treatments

No matter your type of psoriatic arthritis, the goal of therapy is to tame your inflammation, ease discomfort, and prevent joint damage and disability. Your doctor may recommend one of these medications or combinations of them based on how severe your condition is, where you have symptoms, and other things:

  • Disease-modifying antirheumatic drugs (DMARDs)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Immunosuppressants
  • TNF-alpha inhibitors
  • Topical medicine for rashes

If your joints are seriously damaged, your doctor may suggest joint replacement surgery.

Home and Lifestyle Remedies

Take care to protect your joints during everyday activities. For example, close your car door with your body, not just with your fingers. Or carry heavy bags with two hands instead of one. Other tips include:

WebMD Medical Reference Reviewed by David Zelman, MD on April 29, 2019

Sources

SOURCES:

Psoriasis.org: “Psoriatic arthritis, an inflammatory form of arthritis, affects about 30 percent of people with psoriasis.”

Cleveland Clinic: “Psoriatic Arthritis.”

Arthritis Foundation: “What is Psoriatic Arthritis?”

Rheumatoid Arthritis Support Network: “PsA Symptoms: What Symptoms Should Alert Me of PsA?”

U.S. National Library of Medicine: “Psoriatic Arthritis.”

Enthesis.org: “Distal Interphalangeal Joint Disease in Psoriatic Arthritis.”

Mayo Clinic: “Psoriatic Arthritis.”

Spondylitis.org: “Treatment of Ankylosing Spondylitis and Related Diseases.”

UpToDate: “Diagnosis and differential diagnosis of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults.”

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