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

PsA affects roughly 30 percent of people with psoriasis, and it’s most common in people between the ages of 35 to 45. There’s no connection between the severity of psoriasis and the severity of PsA.

PsA typically develops after the onset of psoriasis, but some people develop joint pain before they notice any skin-related symptoms.

Here are 11 symptoms to watch for if you think you might have PsA.

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

The joints connect bones within the body, including in 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
  • 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.

Treatment for inflamed joints due to PsA may include medications, physical therapy, or other methods to help relieve discomfort.

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

Nail pitting is more common in those who have PsA and those who are over age 40.

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 are a predictor of joint disease and arthritis. Psoriasis itself can also affect the nails, making them look like they have a fungal infection.

About 50 percent of people with psoriasis and around 80 percent of people with PsA develop nail changes, sometimes known as nail psoriasis.

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Photography by DermNet New Zealand

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 to be 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.

It’s important to keep your nails short if you’re experiencing separation, but don’t overclip them. Simply clip off the affected portion as the new nail comes in.

Onycholysis can go away if the underlying cause is treated.

Photo by DermNet New Zealand

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 percent of people with PsA will develop psoriatic spondylitis.

Common symptoms of spondylitis include:

  • lower back pain (lumbar and lumbosacral)
  • muscle pain
  • eye inflammation
  • hip pain
  • fatigue

In some cases, the sacroiliac (SI) joints of the pelvis actually fuse together.

Spondylitis treatment usually targets pain and inflammation to help reduce symptoms. Some possible treatments include:

Your doctor may also recommend lifestyle measures, such as:

PsA may begin in smaller joints, such as those of the 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 percent 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.

Photography by DermNet New Zealand

People with PsA may experience eye problems, such as inflammation and redness. Symptoms of eye inflammation include:

  • red eyes
  • itchy eyes
  • dry eyes or feeling of grit or sand in the eyes
  • difficulty focusing or blurred vision
  • pain or sensitivity, especially to bright light
  • floaters, or small specks, lines, or other shapes in your field of vision

If you develop new or large floaters along with 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 and 25 percent of people with PsA develop uveitis.

Symptoms of uveitis include:

  • eye pain
  • eye redness
  • lid swelling
  • blurry vision
  • floaters in your field of vision
  • sensitivity to light or photophobia
  • enlargement of the conjunctival vessels or hyperemia
  • unexplained visual changes

If you notice these symptoms, it’s important to seek medical care right away. Early diagnosis is important in preventing complications like:

Treatments include oral medications or eye drops to reduce pain and inflammation.

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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:

Symptoms include:

  • impaired joint movement
  • joint stiffness, especially after not using the joint for an extended period
  • joint swelling
  • a grating sensation in the joint with movement

Treatment options include:

  • NSAIDs
  • exercise
  • reduced use of the joint
  • medications like DMARDs and sulfasalazine (Azulfidine)
  • steroid injections
  • surgery

Enthesitis can also involve the elbow, causing something similar to tennis elbow. Symptoms of enthesitis affecting the elbow include pain, tenderness, and trouble moving your elbow.

Symptoms include:

  • elbow pain that gradually worsens
  • pain from the outside of the elbow to the forearm and wrist
  • a weak grip
  • increased pain when shaking hands or squeezing an object
  • pain when lifting something, using tools, or opening jars

Treatments can include:

Always check with your doctor before beginning a new treatment or exercise program.

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, a thickening of the tissue layer beneath the skin in the hands and wrist
  • Volkmann’s contracture, or lack of blood flow to the forearm that causes muscle shortening

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

Fatigue is a common symptom in people with PsA. You may begin to have difficulty making it through the day without taking a nap.

According to a 2007 study, up to 50 percent of people with skin conditions report having moderate to severe fatigue, while 25 percent experience severe levels of fatigue.

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

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

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

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