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Everyone with Psoriasis Should Know These Early Signs of Psoriatic Arthritis

By Colleen Travers
Reviewed by Ethan T. Craig, M.D.
December 13, 2022

Living with psoriasis means you’re probably no stranger to discomfort, especially during flare-ups. And along the way, perhaps you’ve had other aches, pains, and symptoms that you may have ignored as you focused your efforts on your psoriasis symptom management. But some symptoms—especially if they occur in the joints—deserve attention, as they may be a sign of a related condition: psoriatic arthritis.

“Many people living with psoriasis will see a dermatologist to treat their skin condition, but they don’t mention they have joint pain because they don’t believe it’s connected,” says Diana Girnita, M.D., Ph.D., a board-certified rheumatologist in Irvine, California. “For joint pain, they may see their primary care physician or an orthopedist, but don’t mention their psoriasis, especially if it’s under control. This means that a psoriatic arthritis diagnosis is frequently missed or misdiagnosed for a long time.”

Approximately 1 in 4 people living with psoriasis also develop psoriatic arthritis, which may be treated by a rheumatologist—a doctor who specializes in diagnosing and treating inflammatory conditions such as arthritis. Catching and treating psoriatic arthritis early can help you prevent further pain and complications, such as joint damage.

Here are early warning signs that you may also be dealing with psoriatic arthritis (PsA), and what to do to treat symptoms as soon as possible.

Early Symptoms of Psoriatic Arthritis

If you have the skin symptoms of psoriasis, be mindful of these five telltale symptoms of psoriatic arthritis.

1. Joint Pain

Take note of joint pain or stiffness you experience. This pain can occur in small joints, like those in your hands and feet; larger joints, like the knees and hips; or even joints throughout the spine or pelvis. This can involve many joints at a time, or sometimes only a couple.

“The pain or stiffness may be abrupt, or it could be slow and progressive,” says Brett Smith, D.O., a board-certified rheumatologist at Tennessee Direct Rheumatology and East Tennessee Children’s Hospital, in Knoxville. Either way, let your doctor know about any joint pain, and be sure they know you also have psoriasis.

2. Nail Changes

According to research published in Reumatologia, about 80% of people living with psoriatic arthritis may deal with nail changes. This means that if you have psoriasis and notice your nails changing, that’s typically a strong predictor of psoriatic arthritis.

Mention it to your doctor as soon as you can if you notice nail symptoms such as:

  • Discoloration (yellowish or brownish coloring)
  • Brittleness (breaking or crumbling easily)
  • Nail ridges (grooves in the nail that may be vertical or horizontal)
  • Nail pitting (small indents in the nail)
  • Onycholysis (lifting of the nail)

3. Swelling of the Fingers and Toes

This symptom is clinically referred to as dactylitis, sometimes called sausage digits, sausage fingers, or sausage toes. The entire joint becomes inflamed, causing extreme swelling, Girnita says. Sites where your tendons insert into the bone may also become inflamed. The result can feel uncomfortable, sometimes to the point where it feels as if the joint itself might burst open.

Dactylitis may be acute (temporary) or chronic (lasting a long time). Research published in Seminars in Arthritis and Rheumatism suggests that this type of swelling may affect nearly half of people with psoriatic arthritis, making it one of the most common symptoms.

4. Foot Pain

Inflammation that occurs anywhere a tendon or ligament inserts into a bone is called enthesitis, a symptom that affects approximately one-third of people with psoriatic arthritis.

According to the Arthritis Foundation, your body has more than 100 of these attachment sites. Girnita explains that areas like the heels and Achilles tendon insertion (back of the ankle) may become painful, stiff, or swollen for people with psoriatic arthritis. So, pain in the feet is a common symptom. However, enthesitis can also affect other areas besides the feet, like the elbows, hips, knees, and shoulders.

If you have psoriasis, pain in the feet or other areas could be an early warning sign of psoriatic arthritis instead of a miscellaneous ache or pain. Foot pain doesn’t necessarily mean psoriatic arthritis—see a rheumatologist or a podiatrist for any foot pain you're experiencing so they can make a diagnosis.

5. Eye Inflammation

When inflammation happens inside the eye, it’s called uveitis. The eye may look red, feel painful, and/or have sensitivity to light. Uveitis can also cause blurred vision, and it can affect either or both eyes.

Uveitis may occur in anywhere from 7% to 20% of people who have psoriatic arthritis. It’s often one of the first signs of the condition, according to the National Psoriasis Foundation.

What to Do If You Experience Symptoms of Psoriatic Arthritis

Keep in mind that even if you do all the right things for managing your psoriasis and health, psoriatic arthritis can still happen, Smith says. “Certain groups of people will automatically be at a higher risk, including those with a certain genetic makeup, and those with a family history of psoriatic arthritis,” he notes.

If you spot any of the above symptoms, tell your primary care physician or dermatologist, who can refer you to a rheumatologist.

“When it comes to PsA, this is not a situation where you want to tough out the pain,” Smith says. “The earlier the diagnosis, the better the outcome.”

Treating Psoriatic Arthritis

The right treatment for your psoriatic arthritis may depend on several factors. “Depending on the number of joints involved, most individuals will use an immunosuppressant [or immune-modulating therapy] prescribed by a rheumatologist,” Smith says. These include drugs such as conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and biologics. “An over-the-counter anti-inflammatory, like ibuprofen, may also be recommended for pain control, but this won’t control the arthritis.”

In addition to medication, Girnita adds that lifestyle strategies like exercise and weight management are crucial to controlling symptoms. “Those who are overweight or obese are less likely to respond to medication or more likely to require a higher dose,” she says. “Plus, obesity is linked to ongoing inflammation, which may become exacerbated with PsA.” Regular exercise with psoriatic arthritis can also help reduce joint pain and prevent further damage.

The good news is that if one treatment doesn’t work, there are other options that may be a better fit for you. “There are numerous safe and effective therapies that are strongly encouraged to maintain control of the pain and prevent progression of PsA,” Smith says.

It’s crucial to collaborate with your doctor to monitor your psoriasis, arthritis, and medications. If you or your dermatologist recognizes any of the signs of psoriatic arthritis, talk to your doctor about a potential diagnosis.

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