What Does Psoriatic Arthritis Feel Like? Identifying Symptoms

Psoriatic arthritis (PsA) is a chronic (long-lasting) condition that combines the skin-related symptoms of psoriasis with the joint-related symptoms of arthritis.

PsA is an autoimmune disease, meaning it causes your immune system to attack healthy cells in your body.

PsA feels different for everyone. Symptoms can be mild to severe, affecting some or many parts of the body. Most people will have psoriatic plaques and some joint inflammation.

If you have PsA, you likely already know how psoriasis feels. More than 80% of people have psoriasis once PsA symptoms start. For people who develop PsA, it usually occurs about 7-10 years after psoriasis symptoms begin.

Arthritis symptoms could be new to you. Arthritis is an inflammatory disease that causes pain, swelling, and stiffness in your joints.

The pain you feel from PsA depends on whether you:

• Have arthritis symptoms first, followed by psoriasis symptoms
• Have more noticeable symptoms for either psoriasis or arthritis
• Have periods of remission (when symptoms mostly go away) or flare-ups (when symptoms worsen or become more intense)
• Have pain in one or two joints, or more widespread pain in multiple joints
• Have joint pain on one side of your body or both sides (e.g., your right wrist and left knee)
• Have pain mostly in your arms, legs, hands, and feet
• Have pain mostly in your spine, hips, or pelvis

How PsA feels can also change based on whether and how you treat it.

PsA can feel different if you manage your mild symptoms with over-the-counter (OTC) pain relievers and topical creams. For more severe symptoms, prescription medications like corticosteroids (which lower swelling) and immune system-suppressing drugs can help reduce the effects of PsA on your body.

Some people can reduce their symptoms enough to work, exercise, socialize, and care for their families. Others have pain and discomfort that interferes with their day-to-day mobility, making it hard to do fine motor tasks like buttoning a shirt or gross motor tasks like getting in and out of bed. 

There are many different signs of PsA because the disease affects the skin, joints, and other parts of the body.

The most common symptoms are:

• Skin plaques: Psoriasis causes skin cells to grow faster than normal, leading to a buildup of dead skin cells that cluster in thickened, raised patches called plaques. Plaques are most common on the scalp, elbows, and knees. They may be red or have a silver, scaly surface, and they often itch or burn.
• Joint problems: When joints become inflamed, they’re often swollen, painful or tender, warm to the touch, and stiff. Joint problems are common in fingers, toes, arms, and legs, but they can also occur in the back, neck, hips, or pelvis. 
• Swollen fingers or toes: Dactylitis or sausage digit occurs when a finger or toe becomes swollen, red, painful, and unable to bend. It’s a common symptom of PsA that healthcare providers sometimes use to diagnose people with a more severe form of the condition.
• Fatigue: Frequent pain and inflammation, less physical activity, trouble sleeping well at night, and the emotional toll of having a chronic disease can all contribute to how tired you feel daily. About 50% of people with PsA report feeling fatigue, and 30% say it is severe.
• Nail changes: Although people with psoriasis can have problems with their nails, this is more commonly a PsA symptom and may be a sign that your psoriasis is turning into PsA. Symptoms to look for include thickening and crumbling nails, pits (grooves or indentations), and the nail separating from the nail bed.
• Tendon and ligament pain: The tendons and ligaments connecting the bones in your body at your joints are called entheses. In PsA, these tissues can also become inflamed and painful, just like your joints. A common spot for this pain is the back of your heel, especially when you first wake up.

Some people with PsA will have other health complications, especially if they have had the disease for many years and it’s not managed well with treatments or has been left untreated.

Chronic inflammation from PsA can cause:

• Uveitis: PsA inflammation can affect the uvea (the middle of your eye), causing redness, pain, and blurry vision. It’s important to see a healthcare provider right away if you have this symptom because it can cause permanent damage to your vision.
• Inflammatory bowel disease (IBD): PsA can cause stomach problems like diarrhea. If you have PsA, you are also more likely to have IBD, which includes Crohn’s disease and ulcerative colitis. 
• Permanent joint damage: Over time, constant inflammation can cause bones to erode (wear down) and cause abnormal bone growths called spurs. Bone loss and spurs can permanently reduce joint mobility, making joints harder to use.

It’s important to diagnose and treat PsA as early as possible. Some research shows that waiting longer for a diagnosis and treatment leads to more severe symptoms and daily challenges. 

To manage your PsA symptoms and improve your quality of life:

• Work with your healthcare provider to find a treatment plan that relieves pain and reduces inflammation
• Use assistive devices like an electric toothbrush or stylus pen at work and home to make daily tasks easier and protect your joints
• Look for ways to make lifestyle changes, like avoiding or quitting smoking, exercising more regularly, and maintaining a weight that you and your healthcare provider decided was optimal for you
• Find a local or online support group for help in coping with the emotional side effects of PsA
• Reach out to healthcare providers like rheumatologists (doctors specializing in autoimmune diseases), dermatologists (doctors specializing in hair, skin, and nail conditions), and physical or occupational therapists who can help meet all your medical and social needs
• Learn to recognize when your body is telling you to rest or make adjustments, so you can avoid putting stress on your joints
• Keep a journal or track your PsA triggers so you can reduce flares

If you already have psoriasis and begin to notice joint symptoms, you should see your healthcare provider. Even if you don’t have psoriasis, it’s important to speak with a provider if you have any new skin or joint changes.

Some changes to watch for include:

• Skin plaques or severe itching and dryness
• Swollen fingers or toes
• Nail changes like crumbling, pitting, and separation from the nail bed
• Sudden heel or ligament pain

These symptoms aren’t usually urgent, but the sooner you see a healthcare provider, the sooner you can receive treatment. However, uveitis can lead to permanent vision loss, so contact a provider promptly if you’re experiencing redness, pain, and blurry vision. 

Psoriatic arthritis (PsA) is a combination of symptoms from psoriasis and arthritis. You may have inflammation on your skin, joint pain, swelling, and stiffness.

It’s important to recognize the signs of PsA and see a healthcare provider as soon as possible to avoid complications like permanent joint damage.

Managing your symptoms with your healthcare provider can reduce your pain, decrease your inflammation, and help you prevent flares.