What is psoriatic arthritis?

Psoriatic arthritis (PsA) is a chronic and progressive form of inflammatory arthritis. It can cause joint pain, stiffness, and swelling. These symptoms may come and go depending on the severity of your condition.

If you have psoriasis, you’re at risk for PsA. An estimated 30 percent of people who have psoriasis go on to develop this condition. Early diagnosis can help reduce your risk of permanent bone and joint damage.

Keep reading to learn more about the symptoms of psoriatic arthritis, and what you can do to find relief.

PsA in hands and fingers

PsA of the hands or fingers primarily causes stiffness and swelling.

In some cases, your fingers may swell enough to take on a sausage-like appearance (known as dactylitis). About a third of people with PsA experience dactylitis in at least one finger.

Stiff and swollen fingers can make it hard to perform ordinary tasks, like zipping a jacket or unscrewing a jar. If you’re experiencing any of these difficulties for the first time, see your doctor. They may be a result of PsA.

PsA in nails

An estimated 87 percent of people affected by PsA experience nail symptoms. When this occurs, it’s referred to as nail psoriasis.

Nail symptoms include:

  • discoloration, typically yellowing or browning
  • thickening
  • pitting
  • separation of the nail from the nail bed (known as onycholysis)
  • chalky buildup under the nail
  • nail tenderness or pain

Nail psoriasis can resemble a fungal infection. Treatment for a fungal infection is different, so it’s important to find out which condition you’re experiencing. Your doctor can check for a fungal infection by taking a nail skin cell sample and testing it.

In some cases, you may be experiencing both conditions. People with nail psoriasis may be more likely to get a fungal infection.

PsA in feet

If you have PsA, your feet may feel swollen, sore, and stiff. It may be painful to walk or stand for long periods of time, and your shoes may feel uncomfortable.

Other symptoms can include:

  • ankle swelling
  • toe swelling, especially swelling of the big toe (known as dactylitis)
  • pain in the bottom of your heel (known as plantar fasciitis)
  • pain in your Achilles tendon (known as enthesitis or enthesopathy)

These symptoms may come and go, so it’s important to take notice of your symptoms. If left untreated, foot deformity is possible. Your toes may become claw-like, the big toe may elongate, and your foot joints may become permanently stiff.

Your doctor may recommend that you see a physical or occupational therapist. They can develop a set of exercises and stretches to help you avoid stress on your feet, protect your joints, and keep your joints flexible.

PsA symptoms vary from person to person.

Overall, the most common symptoms include:

  • joints that are painful, swollen, and warm
  • stiffness, especially in the morning
  • back pain
  • pain or tenderness
  • reduced range of motion
  • swollen fingers and toes
  • eye problems, including redness, irritation, and sensitivity to light
  • nail changes, such as pitting and cracking
  • fatigue

The most common form of PsA is asymmetric, meaning different joints are affected on each side of your body. Most PsA involves arm or leg joints.

Only about one third of PsA involves the hips and spine.

For hands and fingers

There are a number of things you can do at home to help relieve your symptoms. Once you meet with your doctor, they can make a diagnosis and help you develop a treatment plan suited to your needs.

You may also find relief by:

  • massaging the affected areas
  • applying a hot or cold compress to reduce swelling
  • wearing hand splints to help stabilize and protect your wrist and fingers
  • taking regular breaks when typing or writing
  • performing hand and wrist exercises to help stretch and strengthen the muscles

For nails

In addition to your doctor-approved treatment plan, you should be proactive in your nail care. Nail injury can worsen nail psoriasis and trigger another flare-up, so it’s important to protect your nails and hands.

You should:

  • keep your nails short
  • moisturize nails after soaking
  • wear gloves when doing dishes, housework, or gardening
  • use clear polish, because colored polish could mask signs of disease

You shouldn’t:

  • soak your hands for too long
  • push your cuticles too aggressively, because it might promote tiny tears
  • wear nail polish if you have a nail infection

For feet

In addition to your doctor-approved treatment plan, you can wear shoe inserts to help relieve pressure on your feet, or use a walking aid for added stability.

Wearing the right footwear is also crucial. When selecting a pair of shoes, you should:

  • choose roomy footwear to accommodate any potential swelling
  • opt for open-toed shoes if closed-toed shoes feel too tight
  • select breathable materials for footwear, such as leather or canvas
  • ensure that any shoe option offers proper arch support

There isn’t a single test for psoriatic arthritis. After reviewing your medical history, your doctor will conduct a physical exam and assess your symptoms.

From there, your doctor will work to rule out lookalike conditions and confirm whether your symptoms are the result of psoriatic arthritis.

This may include a combination of:

  • blood tests
  • imaging tests
  • joint fluid tests

Once you’ve been diagnosed, your doctor will work with you to determine how to best relieve any pain, swelling, or stiffness.

Your treatment plan may include one or more of the following:

  • OTC or prescription-strength NSAIDs
  • corticosteroid injections
  • disease-modifying antirheumatic drugs
  • immunosuppressant medications
  • TNF-alpha inhibitors (biologic)
  • interleukin inhibitors (biologic)

Every person with PsA is different. You may need to experiment to find a combination of treatments that works for you.

In extreme cases, your doctor may recommend joint replacement or other corrective surgery.

If you’re experiencing symptoms, make an appointment to see your doctor right away. The sooner you start treatment, the better.

Joint damage can happen quickly. One study reported that up to 50 percent of people with PsA will experience an 11 percent rate of joint erosion in the first two years of the disease.

PsA is a chronic and progressive disease, and as of yet there is no cure. But there are effective treatments, including physical and occupational therapy, to help relieve symptoms.

Research into new kinds of drugs and treatments is ongoing. Check with your doctor about new possibilities.