Signs Your Psoriasis Could Actually Be Psoriatic Arthritis

Prevent permanent joint damage by catching—and treating—PsA early.

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If you have psoriasis, you may already know that you’re at an increased risk of developing psoriatic arthritis (PsA), an inflammatory arthritis that causes joint pain, swelling, and stiffness. About 30 percent of people who have psoriasis eventually get PsA, according to the National Psoriasis Foundation (NPF).

Most people develop psoriatic arthritis about 5 to 12 years after psoriasis, although it can show up earlier. In fact, in 15 percent of cases, PsA is diagnosed at the same time as psoriasis.

“Psoriatic arthritis is an autoimmune disease, which means your body’s immune system attacks healthy tissue, such as the joints and the skin,” says Leah Elon, MD, a rheumatologist at Harlem Health Center and Queens Health Center in New York City.

If you have psoriasis, there’s no way to tell whether you’ll develop PsA, but knowing the signs can help you catch it early. “Starting treatment early can help prevent joint damage, and improve your symptoms and quality of life,” says Dr. Alon.

Symptoms of Psoriatic Arthritis

In most psoriatic arthritis cases, people tend get psoriasis symptoms, such as red or silvery patches on their skin, before arthritis-type symptoms, says Dr. Alon. “But there are some telltale signs that are unique to people with psoriatic arthritis.” Here are common PsA symptoms:

  • Stiffness. People with PsA tend to be stiff first thing in the morning, or after they’ve been sitting for a long period of time.
  • Sausage-like fingers. Some people with PsA have dactylitis, a sausage-like swelling in their fingers or toes.
  • Pain in tendons or ligaments. People with PsA often develop tenderness or pain where tendons or ligaments attach to bones, called enthesitis. Common areas are at the heel (Achilles tendinitis), the bottom of the foot (plantar fasciitis), and in the elbow (tennis elbow), says Dr. Alon.
  • Nail changes. If you notice that your nails are pulling away from the nail bed or develop pitting, ridges, or a yellowish-orange color, these could be signs of PsA.
  • Eye inflammation. People with PsA may experience redness, irritation and disturbed vision (uveitis) or redness and pain in tissues surrounding the eyes (conjunctivitis, or "pink eye").
  • Painful, swollen joints. PsA can cause swelling in the ankles, knees, fingers, toes, and lower back.
  • Fatigue. People with PsA often feel general feelings of fatigue. This is caused by proteins called cytokines that are released during inflammatory reactions, according to NPF.

“If you are at all concerned that your skin issues, pain, or other symptoms could be psoriatic arthritis, please see a doctor,” says Dr. Alon. Early diagnosis and treatment will help prevent permanent joint damage and reduce the effect the PsA has on your life.