In the early stages of psoriatic arthritis, you might only notice occasional joint pain. Over time, you might experience swelling, fatigue, and other symptoms.

Psoriatic arthritis is a type of inflammatory arthritis that affects some people with psoriasis. In psoriasis, the immune system attacks healthy tissues, causing an overproduction of skin cells.

Psoriatic arthritis happens when the immune response also causes joint inflammation.

Like psoriasis, psoriatic arthritis is a chronic condition. It can worsen over time, but you may also have periods of remission where you don’t have any symptoms. It doesn’t have a cure, but treatment can make a difference.

Read on to learn more about the stages of psoriatic arthritis and how it progresses.

Summary of psoriatic arthritis disease progression

Psoriatic arthritis doesn’t have defined stages. Its progression can vary from person to person.

Generally, the early stages of psoriatic arthritis may cause nail changes (such as pitting or shallow ridges) and pain and swelling in one or more of the smaller joints (such as fingers, toes, or ankles). Skin rashes, fatigue, and eye inflammation may also occur.

In later stages, these symptoms become more frequent and severe. Joint mobility and range of motion may be significantly reduced. Fatigue becomes more pronounced.

Bone damage can occur from extended periods of inflammation. Inflammation can also damage other organs, including your heart, eyes, and inner ear.

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In most cases, psoriatic arthritis begins years after the onset of psoriasis symptoms. Psoriasis symptoms include flare-ups of itchy, scaly skin that’s red or purple.

If you have psoriasis, several things can make you more likely to develop psoriatic arthritis. These risk factors include:

  • having psoriasis on your fingernails
  • having a family history of psoriatic arthritis
  • being between 30 and 50 years old
  • having scalp psoriasis

Like other types of arthritis, psoriatic arthritis often starts with pain and swelling in one or more of your joints. It tends to begin in the smaller joints, such as those in the fingers and toes. You might also first notice it in larger joints, such as your knees or ankles.

You may also notice swelling in your fingers or toes. This swelling can affect the entire toe or finger, not just the joint.

Learn more about the early signs of psoriatic arthritis.

Psoriatic arthritis progresses differently for every person who has it. Without treatment, it often begins to affect more joints. It may affect the same joints on both sides of the body. In rare cases, some people experience complete remission without treatment.

As it progresses, you might have periodic flare-ups of symptoms.

Untreated, psoriatic arthritis can cause permanent damage to your bones. Extended periods of inflammation also cause the affected bones to erode. The joint space may also begin to narrow, making it harder to move.

As it progresses, psoriatic arthritis can start to have more of an impact on your daily life. According to a 2017 review, about 50% of people with psoriatic arthritis have moderate to severe fatigue. For nearly 25% of them, the fatigue is severe.

This combination of fatigue, joint pain, and psoriasis symptoms can become isolating for some people, leading to high levels of depression.

Later stage symptoms of psoriatic arthritis can also make it hard to work or maintain an active social life.

While there’s no way to reverse or cure psoriatic arthritis, there are several things you can do to slow its development. These tend to work best when started earlier rather than later.

You may want to consider working with a rheumatologist as well. This is a type of doctor who focuses on autoimmune conditions.

The first step in slowing psoriatic arthritis is controlling joint inflammation. There are several types of medication that can help with this, including:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve), are a good starting place because they’re available over the counter. They help reduce inflammation and pain.
  • Cortisone injections: Cortisone injections target inflammation in a single joint. They work quickly to reduce pain and swelling.
  • Disease-modifying antirheumatic drugs (DMARDs): DMARDs, such as methotrexate (Trexall), leflunomide (Arava), and sulfasalazine (Azulfidine), work to slow the progression of psoriatic arthritis. While this can help prevent permanent joint damage, these drugs have many potential side effects.
  • Biologic agents: Biologics are a new generation of arthritis medications that use genetic engineering to target inflammation in the body. They can slow the progression of psoriatic arthritis and prevent joint damage.

If you have psoriatic arthritis, it’s also important to avoid putting added stress on your joints. This can involve:

  • Weight management: Overweight and obesity put additional stress on your joints.
  • Exercise: Low impact exercise can help you lose weight if you need to, improve your heart health, strengthen your muscles, and increase your range of motion. Low impact exercises include biking, swimming, and yoga.
  • Hot and cold therapy: Applying a heating pad to tense muscles helps them relax, which reduces strain on your joints. You can also apply an ice pack to inflamed joints to help reduce pain and swelling. Just make sure to wrap it in a towel or cloth before applying it to your skin.

How long does a psoriatic arthritis flare last?

Psoriatic arthritis flares can last for weeks or months, depending on the medications you’re taking. Doctors may prescribe low dose prednisone along with other medications, such as methotrexate, to help suppress severe flares.

Will I end up in a wheelchair with psoriatic arthritis?

Severe cases of psoriatic arthritis might affect your ability to walk. In these cases, using a wheelchair can help keep you mobile. However, treatments are available that can help reduce the severity of your symptoms.

What not to do with psoriatic arthritis?

Do not delay treatment for psoriatic arthritis. If left untreated, psoriatic arthritis can get more frequent and more severe.

Experts also recommend getting regular physical activity to increase the flexibility of your joints. Maintaining a moderate weight and limiting or avoiding alcohol can also help you manage psoriatic arthritis.

What should you do with psoriatic arthritis?

Since psoriatic arthritis is an inflammatory condition, eating an anti-inflammatory diet may help keep some of your symptoms under control.

Other lifestyle strategies that can help reduce inflammation include taking certain supplements, like fish oil and curcumin, getting regular physical activity, getting enough sleep, and reducing stress.

Can you live with psoriatic arthritis without medication?

A combination of psoriatic arthritis medications, lifestyle strategies, and complementary, alternative, or natural therapies can be an effective treatment plan for psoriatic arthritis.

Herbal remedies like turmeric, fish oil, and vitamin D may help relieve symptoms. Soaks, creams, oils, and other topical therapies can also help. You might also try massage and acupuncture to relieve muscle tension and reduce stress.

Be sure to talk with your doctor before taking any new supplements or herbal remedies. Some of them can negatively interact with medications. Your doctor can develop a plan that works best for you.

In the early stages of psoriatic arthritis, you might only notice occasional joint pain. But over time, you might experience swelling, fatigue, and other symptoms.

There’s no cure for psoriatic arthritis, but there are ways to manage it effectively. A combination of medication and lifestyle strategies can help you slow its progression and avoid permanent joint damage.