11 Early Signs of Psoriatic Arthritis

Psoriatic arthritis (PsA) is a type of inflammatory arthritis. It affects some people with psoriasis, which causes red, scaly patches to form on the skin.

PsA affects roughly 20% of people with psoriasis, most commonly in people ages 40-59. A 2022 study suggests that in people with psoriasis, the worse their symptoms are, the more they have a greater chance of developing PsA.

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1. Joint pain or stiffness

PsA causes inflammation in the joints, which can cause pain, tenderness, and stiffness. You might feel this in just one joint or several.

PsA usually affects:

• knees
• fingers
• toes
• ankles
• lower back

Symptoms of pain and stiffness may disappear at times and then return and worsen at other times. When symptoms subside for a time, it’s known as remission. When they worsen, it’s called a flare-up.

2. Joint swelling or warmth

The joints connect bones within the body, including the feet, ankles, knees, hips, wrists, and more. They’re surrounded by soft tissues that cushion the bones on either side. When fluid accumulates in the tissues, swelling can occur.

Joint swelling may be accompanied by:

• stiffness
• pain
• an irregular shape of digits in chronic cases

Swelling in the joints due to inflammation is a common sign of PsA. Inflamed tissue produces heat, so your joints may also feel warm to the touch.

Learn how to take care of your joints with PsA.

3. Pitted nails

Changes to your nails, such as pitting, may be an early sign of PsA. Pitted nails appear bumpy or dented.

Nail symptoms, sometimes called nail psoriasis, occur in 80% of all people living with PsA, and nail pitting specifically affects 68% of people.

Symptoms of pitted nails include:

• depressions in the fingernails or toenails
• changes in nail color (discoloration)
• changes to nail shape (deformation)
• thickening of the nails

Evidence shows that psoriatic changes in the nails predict joint disease and arthritis. Psoriasis can also affect the nails, making them look like a fungal infection.

Learn more about treatment for nail pitting.

4. Nail separation

Nails that fall off or separate from your nail bed may also be a sign of PsA. This is called onycholysis.

Onycholysis can happen with or without pitting, though the presence of transverse grooves, or grooves that run horizontally across the nail, appears strongly correlated with PsA.

If you experience onycholysis, your nail will begin to peel off the nail bed. Depending on the cause, it may also become yellow, greenish, purple, white, or gray. Onycholysis is not usually painful.

Learn more about treatment for onycholysis and nail psoriasis.

5. Lower back pain

PsA can lead to a condition called spondylitis. This causes swelling in the joints, especially in the spine.

According to the Spondylitis Association of America, 20% of people with PsA will develop psoriatic spondylitis.

Learn more about the symptoms of and treatment for psoriatic spondylitis

6. Swollen fingers or toes

PsA may begin in smaller joints, such as fingers or toes, and progress from there.

Spondylitis may be accompanied by dactylitis or swelling of the toe or finger joints. This is sometimes called “sausage fingers.”

Dactylitis is estimated to affect up to 50% of patients with PsA and is uncommon in other types of arthritis, except gout or pseudogout.

When caused by PsA, dactylitis may affect individual digits differently. For example, your left hand may be swollen while your right is not.

Unlike other types of arthritis, PsA tends to make your entire finger or toe appear swollen rather than just the joint.

Learn more about the treatment for dactylitis.

7. Eye inflammation

People with PsA may experience eye problems, such as inflammation and redness.

If you develop new or large floaters and flashing lights in your field of vision, it may be a sign of a medical emergency. Seek immediate treatment from a qualified medical professional.

You may also experience uveitis or inflammation of the middle layer of the eye called the uvea. Between 7-25% of people with PsA develop uveitis.

If you notice these symptoms, seeking medical care right away is important. Early diagnosis is essential in preventing complications like:

• glaucoma
• cataracts
• optic nerve damage
• permanent vision loss

Learn more about how PsA can affect your eyes.

8. Foot pain

Pain in the feet or ankles may be an indication of PsA.

People with PsA often develop enthesitis, or pain in the places where tendons attach to bones. This tends to appear as pain, swelling, and tenderness. The most common locations for enthesitis include the:

• Achilles tendon
• foot
• knee
• pelvis
• elbow
• shoulder

Enthesitis affects about 35% of people living with PsA.

Learn more about the treatment for PsA enthesitis.

9. Reduced range of motion

One possible sign of PsA is a reduced range of motion in your joints. You might find it harder to extend your arms, bend your knees, or bend forward.

You may also have problems using your fingers effectively. This can lead to problems for people who work with their hands in any way, including typing and drawing.

When the joint becomes permanently fixed or unable to move beyond a certain point, it’s known as a contracture deformity. This can lead to complications such as Dupuytren’s contracture and Volkmann’s contracture, which is the lack of blood flow to the forearm that causes muscle shortening

Prevention involves a range of motion exercises prescribed by a doctor or done with a physical therapist.

10. Fatigue

About 28% of people living with PsA experience severe fatigue. You may have difficulty making it through the day without taking a nap.

In the case of PsA, fatigue may be due to symptoms or complications like:

• inflammation
• chronic pain
• anemia
• reduced physical fitness
• increased weight or obesity
• fibromyalgia
• underlying sleeping issues
• diabetes
• anxiety and depression

Learn about treatment for PsA fatigue.

11. Skin problems

Among people living with PsA, 85% will experience a rash before they experience any joint symptoms.

It will look similar to a psoriasis rash, meaning there will be plaques that look like silver or white scales on top of red patches.

Learn more about identifying and treating PsA rash.

At what age does psoriatic arthritis start?

PsA often begins between the ages of 30 and 50.

Where does psoriatic arthritis usually start?

In 60-80% of cases, the disease will affect the skin for about 10 years before it starts to affect the joints.

How is early psoriatic arthritis diagnosed?

Many people are diagnosed when they present with apparent symptoms affecting the skin or joints and test negative on the rheumatoid factor (RF) blood test.

PsA is usually diagnosed when patients present with psoriasis skin lesions and rheumatoid factor (RF)-negative inflammatory arthritis. Those who have a history of psoriasis may be diagnosed sooner.

Not everyone with psoriasis develops PsA, but it’s essential to be aware of its symptoms if you have psoriasis.

Treating PsA early can help you avoid further damage, so mention any new or unusual joint symptoms during your medical visits.

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