Psoriatic arthritis is a type of inflammatory arthritis that occurs in people with psoriasis, an autoimmune condition affecting the skin. It causes swelling, stiffness and pain in the joints as well as nail changes and overall fatigue.
Psoriatic arthritis can be difficult to diagnose in its early stages but it’s important to identify and treat it quickly. Early treatment helps relieve symptoms, improve quality of life, and potentially slow down the progression of joint damage that can occur if the disease advances untreated.
Joint Pain
One of the most common early symptoms of psoriatic arthritis is persistent joint pain, swelling, and stiffness (Mayo Clinic). This pain often affects the large joints like the knees, ankles, elbows, and wrists, but can also impact smaller joints like those in the hands and feet.
The joint pain of psoriatic arthritis tends to be asymmetric, meaning it occurs on just one side of the body rather than symmetrically on both sides. The pain and stiffness tend to be worse when joints are at rest, and improves with movement. Psoriatic arthritis joint pain may also alternate between periods of flare ups and remission.
It’s important to note that psoriatic arthritis joint pain can occur even in people who do not have skin psoriasis. The joint symptoms may precede the skin lesions in some cases. Persistent joint pain, swelling, and stiffness, especially when asymmetric and alternating between flares and remission, can be an early sign of psoriatic arthritis.
Fatigue
Fatigue is a very common symptom of psoriatic arthritis, with studies showing that up to 80% of people with PsA experience some degree of fatigue (SOURCE). The chronic inflammation associated with PsA can contribute to feelings of tiredness and lack of energy (SOURCE). This type of fatigue is different than normal tiredness after a long day – it is often described as an overwhelming, debilitating exhaustion that affects your ability to perform daily activities.
Psoriatic arthritis fatigue can range from mild to severe. You may feel generally run down or constantly drained. Simple tasks like grocery shopping, cleaning or caring for your family may wipe you out. This fatigue can be mentally exhausting as well, making it hard to concentrate or be productive. Unlike normal tiredness which gets better with rest, psoriatic arthritis fatigue may persist even when you get adequate sleep.
If you are experiencing new, unexplained and persistent fatigue along with other psoriatic disease symptoms like joint pain, stiffness or skin changes, be sure to contact your doctor. Finding the right treatment can help manage inflammation and greatly improve psoriatic arthritis fatigue.
Joint Redness and Warmth
One early symptom that should prompt suspicion of psoriatic arthritis is redness and warmth over the joints, especially when it is confined to one side of the body. Unlike regular aches and pains, the joints affected by psoriatic arthritis often become noticeably red and feel warm to the touch. This occurs when the immune system mistakenly attacks the joints, causing inflammation. According to the Mayo Clinic [“results”][0][“url”]}>, this redness and warmth is a hallmark feature of inflammatory types arthritis like psoriatic arthritis.
Some people first notice the redness and warmth before feeling any arthritic pain or stiffness. The joints most likely to develop redness and warmth are those in the hands, wrists, elbows, knees, ankles and feet. If you notice persistent redness and warmth in these joints, particularly if it is asymmetric and predominately affecting one side, be sure to point this symptom out to your doctor during your appointment. Redness and warmth in your joints in combination with other psoriatic symptoms should prompt referral to a rheumatologist for further evaluation for psoriatic arthritis.
Swollen Fingers/Toes
One early sign of psoriatic arthritis is dactylitis, also known as “sausage digit.” This refers to swelling in the fingers or toes that causes them to appear sausage-like. Dactylitis is caused by inflammation of the tendons and soft tissues of the digits. According to the National Psoriasis Foundation, dactylitis affects roughly 40-50% of people with psoriatic arthritis[1]. It often presents before any joint damage is apparent.
Dactylitis most commonly affects the middle joint of the fingers or toes, though it can occur in the wrist, ankles, and feet as well. The swelling and inflammation is often asymmetric, meaning it appears on just one finger or toe at a time, rather than symmetrically on both sides. Dactylitis causes stiffness, pain, and limited mobility in the affected digits. If you notice sausage-like swelling in your fingers or toes, it is important to see a doctor promptly, as it may be an early red flag for psoriatic arthritis[2].
Nail Changes
Nail changes are a common early sign of psoriatic arthritis. The most frequent nail manifestations are pitting, grooves, and detachment of the nail from the nail bed (onycholysis).
Pitting appears as small depressions or holes in the nail surface and gives the nail a spotted look. These pits are caused by defects in nail growth. Pitting occurs in up to 50% of those with psoriatic arthritis[1].
Nail grooves are furrows or channels that run vertically down the nail. They may be deep or superficial lines. Grooves are present in around 25% of psoriatic arthritis patients[2].
Onycholysis refers to separation of the nail from the nail bed. The nail becomes detached from the skin underneath. This occurs when inflammation damages the nail matrix. Onycholysis is seen in approximately 10-15% of those with psoriatic arthritis[3].
Getting early treatment for psoriatic arthritis can help prevent permanent nail deformities. See a doctor if nail changes accompany joint pains.
Lower Back Pain
Lower back pain is a common symptom of psoriatic arthritis. About 30-50% of people with psoriatic arthritis will experience pain and stiffness in their lower back caused by inflammation of the joints in the spine 1. This is known as axial arthritis or spondylitis. The lower back is commonly affected before other areas of the spine.
Lower back pain from psoriatic arthritis often comes on slowly and worsens over time. It can range from mild to severe. The pain and stiffness tend to be worse in the morning and improve with movement and activity. However, prolonged sitting or standing can also aggravate the pain. Lower back pain from psoriatic arthritis may switch between sides or stay on one side consistently.
If you have lower back pain along with other symptoms of psoriatic arthritis like joint swelling and skin changes, be sure to see a rheumatologist. Getting an early and accurate diagnosis is key to preventing permanent spinal joint damage. Treatment for psoriatic spondylitis aims to relieve pain, improve function, and slow the progression of the disease.
Signs you may be at risk for psoriatic arthritis
If you experience any symptoms of psoriatic arthritis, it’s important to schedule an appointment with your doctor to get an evaluation. The earlier psoriatic arthritis is diagnosed, the better the outcome with treatment. You should see a doctor if you have:
- Joint pain, swelling, or stiffness that persists for more than 2 weeks (https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/symptoms-causes/syc-20354076)
- Redness or warmth over joints
- Swollen fingers or toes that look like sausages
- Morning joint stiffness lasting over 30 minutes
- New pitting, ridges, or separation of the nails (https://www.healthline.com/health/psoriatic-arthritis-early-signs)
- Fatigue that is not relieved by rest
- Lower back pain, especially with joints affected elsewhere
Don’t dismiss unexplained joint pain or wait and see if it goes away. The sooner psoriatic arthritis can be diagnosed, the better the outcome with early treatment to relieve symptoms and slow disease progression. See a doctor right away if you have psoriasis and develop any joint pain or swelling.
Medical Disclaimer
The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional
