What Is Psoriatic Arthritis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Psoriatic arthritis is a type of inflammatory arthritis that affects some people with psoriasis — a condition that causes the rapid buildup of skin cells.
It’s considered an autoimmune disease — which means your body’s immune system mistakenly attacks healthy tissue.
People with psoriatic arthritis experience both skin and joint problems. Symptoms may vary, depending on the case.

Usually, skin issues develop first, and the arthritis comes later. But joint problems can occasionally crop up without signs of psoriasis.
There’s no cure for psoriatic arthritis, but there are plenty of therapies to help lessen the discomfort and joint damage.

Common Questions & Answers

Signs and Symptoms of Psoriatic Arthritis

Psoriatic arthritis can cause a broad range of symptoms. Not everyone with the disease experiences the same problems, and some people have issues that are more severe than others.

Symptoms may include:

• Stiff, painful joints
• Redness, heat, or swelling in the tissues surrounding the joints
• Red skin with silvery-white, scaly patches
• Itching or burning of the skin
• Nails that crumble, become pitted, or lift from the nail beds
• “Sausage-like” fingers or toes
• Hand deformities
• Foot, neck, or spine pain
• Trouble bending and reduced range of motion
• Inflammation of the eyes, which can cause irritation and vision problems
• Fatigue

Causes and Risk Factors of Psoriatic Arthritis

Doctors aren’t exactly sure what causes psoriatic arthritis, but they do know it happens when your body’s immune system starts to attack healthy tissue. This faulty process causes an overproduction of skin cells and inflammation in your joints.
Experts believe that both genetic and environmental influences may be to blame for the immune system failure.

Certain factors that may increase your risk include:

• Having Psoriasis Being diagnosed with psoriasis is the greatest risk factor for developing psoriatic arthritis.
• Family History About 40 percent of people with psoriatic arthritis have a family member with psoriasis or arthritis.
• An Infection Having a viral or bacterial infection may activate the immune system and trigger psoriatic arthritis in some people.
• Age Anyone can develop psoriatic arthritis, but it’s more common in those between ages 30 and 50.
• Obesity Being overweight puts more wear and tear on tendons, which may cause inflammation and trigger psoriatic arthritis.

Types of Psoriatic Arthritis

Here are the five different types of psoriatic arthritis:

• Symmetric Psoriatic Arthritis As its name implies, this type affects joints on both sides of your body at the same time. About half of people with psoriatic arthritis have the symmetric kind.
• Asymmetric Psoriatic Arthritis With the asymmetric type, problems don’t develop in the same joints on both sides of the body. It occurs in about 35 percent of people with the disease and often causes more mild symptoms.
• Spondylitis This form of psoriatic arthritis is characterized by pain and stiffness in the neck and spine.
• Arthritis Mutilans People with arthritis mutilans experience deformities in the small joints at the ends of the fingers and toes. This type is considered the most severe form of psoriatic arthritis, but it only affects about 5 percent of people with the condition.
• Distal Psoriatic Arthritis It causes inflammation and stiffness near the ends of the fingers and toes, while also affecting the nails.

How Is Psoriatic Arthritis Diagnosed?

To diagnose psoriatic arthritis, your doctor will probably first perform a physical exam to look for swollen joints; skin or nail changes; eye problems; and joint tenderness.

You may be asked to undergo an X-ray, MRI, ultrasound, or CT scan, so your physician can get a better look at your joints.

Additionally, you might need to have a blood test to rule out other related conditions, such as rheumatoid arthritis, gout, and osteoarthritis. Some doctors will perform a test to analyze a sample of fluid in your joints.
Occasionally, a skin biopsy is also required to confirm a psoriasis diagnosis.

Duration of Psoriatic Arthritis

Psoriatic arthritis is considered a chronic disease.

Symptoms typically worsen over time, but you might experience periods of improvement or remission. Often, these improvements are interrupted by episodes of intensified symptoms, known as “flares.”

Flares may come and go. Some people experience frequent flares, while others rarely have them.

Identifying what prompts your flares can help you avoid the triggers. Common culprits include stress; skipping medications; certain foods; an illness or injury; and lack of sleep.

Treatment and Medication Options for Psoriatic Arthritis

Your treatment plan will depend on the severity of your disease and your overall health.

Medicines
Some therapies for treating psoriatic arthritis include:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve), can help reduce inflammation and pain. While these medicines are available over-the-counter (OTC), your doctor may be able to write you a prescription for a stronger version.
• Disease-Modifying Anti-Rheumatic Drugs (DMARDs) DMARDs are often recommended if your condition doesn’t improve with NSAIDS. They can help slow the progression of the disease and prevent permanent joint damage. DMARDs include methotrexate (Trexall), sulfasalazine (Azulfidine), and leflunomide (Arava).
• Janus Kinase (JAK) Inhibitors Tofacitinib (Xeljanz) was the first of this class of drugs approved for PsA. Because they suppress the immune system, taking these drugs may increase the risk of infection, heart complications, and some cancers.
• TNF-Alpha Inhibitors These drugs help block an inflammatory substance in your body called tumor necrosis factor (TNF). They can lessen pain and improve swollen joints. Common TNF-alpha inhibitors include etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), certolizumab (Cimzia), and golimumab (Simponi).
• Immunosuppressants These work by targeting the immune system. Examples are cyclosporine (Gengraf, Neoral, Sandimmune) and azathioprine (Imuran, Azasan).
• Steroids Steroids can help reduce inflammation quickly. They can be given orally or are sometimes injected right into the problematic joint.
• Selective Co-Stimulation Modulators: Abatacept (Orencia) is a type of immunomodulator. It works by blocking the activity of T-cells, a type of immune cell.
• Phosphodiesterase Inhibitors The drug apremilast (Otezla) works inside inflammatory cells to reduce the activity of an enzyme called phosphodiesterase 4 (PDE4) in your body. It helps reduce swelling and pain.
• Topicals Treatments applied directly to the skin can ease scaly, itchy rashes caused by psoriasis. These therapies come in creams, lotions, shampoos, gels, sprays, or ointments.

Light Therapy
During phototherapy, or light therapy, the skin is exposed to ultraviolet light. It can help reduce psoriasis symptoms.

Surgery
In some cases, surgery may be needed to repair or replace joints that are severely damaged by psoriatic arthritis.

Joint replacement surgery involves removing the diseased joint and replacing it with an artificial prosthesis.

Lifestyle Approaches
Some lifestyle habits that may improve your pain and help you feel better overall include:

• Exercise. Regular physical activity can make your joints more flexible. Try walking, riding a bike, or swimming.
• Maintain a healthy weight. Being overweight can put more strain on your joints, which increases pain. Losing a few extra pounds can relieve this stress and give you more energy.
• Don’t overdo it. Psoriatic arthritis, and sometimes the medicines you take to treat it, can cause extreme fatigue. While being active is important, it’s also vital to rest when you’re tired.

Clinical Trials
Researchers are always testing new therapies to help conditions like psoriatic arthritis. If you’re interested in participating in a clinical trial, visit ClinicalTrials.gov to search for studies in your area.

Prevention of Psoriatic Arthritis

Right now there’s no surefire way to prevent psoriatic arthritis. But research does suggest that people with the condition who seek treatment within six months may develop less damage and experience fewer long-term problems.

Complications of Psoriatic Arthritis

If left untreated, psoriatic arthritis can cause joint damage and disability.

Sometimes, the condition leads to complications, such as:

• High blood pressure
• High cholesterol
• Obesity
• Diabetes
• Heart disease
• Deformities of the hands, feet, or spine
• Eye issues, such a uveitis or conjunctivitis
• Osteopenia or osteoporosis
• Gastrointestinal problems
• Lung disease
• Liver disease
• Gout
• Depression

Research and Statistics: Who Has Psoriatic Arthritis?

Psoriatic arthritis affects about 1.5 million people in the United States.
According to the Arthritis Foundation, about 30 percent of individuals with psoriasis develop psoriatic arthritis.
The condition usually affects those between ages 30 and 50, but it can start at any age, even in childhood. Men and women are equally at risk for having psoriatic arthritis.
Most people develop psoriasis first and then are diagnosed with psoriatic arthritis about 10 to 20 years later.

Related Conditions and Causes of Psoriatic Arthritis

In addition to psoriasis, psoriatic arthritis is associated with a long list of other diseases.

Symptoms of psoriatic arthritis are similar to those of rheumatoid arthritis, gout, and and reactive arthritis (triggered by a bacterial infection).

Psoriatic arthritis is also closely linked to inflammatory bowel disease, especially Crohn’s disease. In fact, research has shown that people with psoriatic arthritis and Crohn’s share similar genetic mutations.

BIPOC and Psoriatic Arthritis

For Black, Indigenous, and People of Color (BIPOC) populations, psoriatic arthritis poses a particular burden.

A study in Clinical Rheumatology found that while African Americans were less likely to have psoriatic arthritis than Caucasians, they had more severe skin involvement and experienced greater psychological impact and impaired quality of life from the condition. The researchers found that Black study participants were also less likely to receive biologic medications than their white counterparts.

Doctors who are not trained to look for skin symptoms of psoriasis in people of color may not be on the alert for psoriatic arthritis in those patients, leading to missed opportunities for diagnosis and treatment. The American Academy of Dermatology notes that while psoriasis in white patients generally appears as red or pink with silvery-white scale, in Hispanic patients it can be salmon-colored with silvery-white scale, while in Black patients it may be violet with gray scale, or dark brown.

A study in the Journal of the American Academy of Dermatology found that Black people, Asian Americans, and Native Americans are 40 percent less likely to see a dermatologist for their psoriasis than non-Hispanic whites, regardless of their health insurance or socioeconomic status.

Resources We Love

Favorite Orgs for Essential Psoriatic Arthritis Info

• Arthritis Foundation

  The Arthritis Foundation provides credible information and resources for those battling psoriatic arthritis. Their site offers opportunities for advocacy and community outreach. We like that you can get personalized exercise advice based on your condition and fitness level.

• National Psoriasis Foundation

  This organization’s site is chock-full of information about psoriasis and psoriatic arthritis. You can request a free electronic psoriatic arthritis kit, which includes a flare tracker to help you manage your disease and pinpoint triggers. Their Navigation Center also offers free and personalized assistance for patients, families, and caregivers.

• American College of Rheumatology

  This long-standing professional membership organization provides breaking news about the latest advances in psoriatic arthritis and other rheumatic conditions. The American College of Rheumatology serves more than 8,400 physicians, health professionals, and scientists worldwide. Their Find a Rheumatologist link lets you locate a doctor who specializes in your condition.

• Spondylitis Association of America

  The Spondylitis Association of America offers resources for those with spondyloarthritis and related diseases, like psoriatic arthritis. From message boards to support groups, this organization has you covered.

• American Academy of Dermatology

  With more than 20,500 members, the American Academy of Dermatology is the largest, most influential dermatology group in the United States. The organization focuses on education and advocacy for a wide range of conditions that affect the skin, including psoriasis and psoriatic arthritis.

• CreakyJoints

  CreakyJoints is a digital community for arthritis patients and their caregivers. They offer education, support, advocacy, and patient-centered research resources for people with all types of arthritis.

• The Skin of Color Society

  This nonprofit works to increase awareness of dermatological issues as they impact the BIPOC community, working to educate physicians and the general public. A “Find a Doctor” database helps people with skin of color — including African Americans, Asians, Hispanics or Latinos, Native Americans and Pacific Islanders — connect with a clinician who is right for them.