Jennifer Freeman, MD
Jennifer Freeman, MD

Doctor of Medicine (M.D.) in 2008 from UT Health San Antonio, Surgeon at TRACC Dallas

Sep 27, 2018 8 min read

PsA Symptoms: What are the First Signs of Psoriatic Arthritis?

Arthritis, by definition, is characterized by the breakdown of the cartilage within the joints. If you are suffering from any type of arthritis, this is the general cause of the pain and stiffness in your joints. With over 100 types of arthritis, the top three most common are osteoarthritis, rheumatoid arthritis, and psoriatic arthritis. In this article, we will discuss the third most common type of arthritis: psoriatic arthritis (PsA).

PsA doctor

 

What is Psoriatic Arthritis?

PsA is a form of arthritis affecting individuals who also suffer from psoriasis. Psoriasis is a chronic skin condition affecting 2% of the population. The classic symptoms of psoriasis are red, patchy skin with silvery scaling. PsA is characterized by skin inflammation (psoriasis) combined with joint inflammation. Up to 30% of people who have psoriasis will develop psoriatic arthritis according to the National Psoriasis Foundation. In most cases, psoriasis develops first and then PsA develops in later years. However, in approximately 15% of the cases, arthritis develops prior to psoriasis, making diagnosis of PsA very difficult.

psoriasis

The onset of PsA in most individuals occurs in their 40s and 50s. Men and women are about equally affected. While PsA affects individuals worldwide, the prevalence of the condition is greater in North America and Europe.

How is PsA differentiated from rheumatoid arthritis and osteoarthritis? Osteoarthritis is characterized by inflammation of the joints, breakdown of joint cartilage, and bone rubbing on bone, which causes pain and limited mobility. Rheumatoid Arthritis (RA) is a more severe form of arthritis in that your joints and your organs are ultimately attacked by your autoimmune system. PsA is also a chronic autoimmune disorder. While many of the arthritic symptoms of PsA appear in the joints, symptoms of the condition can also appear in other parts of the body, including the eyes, heart, lungs, and kidneys. Most often, PsA presents itself within the hands, feet, and spine. This type of arthritis shares many of its symptoms with other arthritic conditions, including ankylosing spondylitis, reactive arthritis, and arthritis associated with Crohn’s disease and ulcerative colitis.

 

What are the Symptoms of Psoriatic Arthritis?

While PsA can have very similar symptoms to other types of arthritis, the main differentiation is the presence of psoriasis in conjunction with joint inflammation. Five patterns of PsA exist, the difference being based on the distribution of affected joints on the body. The five patterns include: symmetric polyarthritis (joint inflammation occurring on both sides of the body equally), asymmetric oligoarthritis (involving different joints on both sides of the body), spondyloarthritis (affecting the spine), distal arthritis (affecting the fingers and toes), and arthritis mutilans (severe arthritis causing deformity in the hands and feet).  Below, we go over the most common symptoms of PsA.

Painful joint swelling

This is the most classic symptom of PsA, or arthritis in general. Because arthritis is characterized by the breakdown of the cartilage within the joints, the joints become inflamed and pain results because  bones rub against other bones. In other words, the inflammation destroys the “padding” that normally exists between the bones inside the joint causing increased friction and as a result — pain. Inflamed joints become painful, swollen, stiff, tender, red, and hot. PsA typically affects the ankles, fingers, toes, knees, and lower back.

Sausage-like fingers or toes

Many people who suffer from PsA experience extreme swelling of the fingers or toes, making them “sausage-like.” The medical term for this condition is called dactylitis – and is indicative of swelling across the entire length of the fingers and toes. This symptom is often a differentiating factor of a diagnosis of PsA over rheumatoid arthritis. Rheumatoid arthritis sufferers usually only experience severe swelling in a single joint.

Back pain

Lower back pain is also very common among PsA sufferers and is caused by a secondary condition called spondylitis. Psoriatic spondylitis presents itself in approximately 20% of individuals with psoriatic arthritis. Spondylitis causes joint inflammation in two areas of the back: the lower back (between the pelvis and the spine) and between the vertebrae. It is the resultant joint inflammation from spondylitis that causes the back pain that many PsA patients endure.

back pain

Pain in your feet

While joint pain is present in osteoarthritis, RA, and PsA, individuals with PsA often experience inflammation and pain in the tendons, especially in the feet. Because PsA can impact the tendons in your feet, two common conditions can result: plantar fasciitis and Achilles tendonitis. Plantar fasciitis is characterized by an inflamed tendon that connects your heel to your toes, causing pain in the bottom of the foot. Achilles tendonitis presents itself as pain in the heel due to inflammation in the tendon that connects your calf muscles to your heel.

Stiffness

It’s common among all types of arthritis sufferers to have stiffness when first waking up in the morning or stiffness after periods of rest. This stiffness makes it hard to move and ‘get-going.’ However, once you start moving, the stiffness eases. The stiffness can be so bad, especially with morning stiffness, that you find it difficult to move your joints, on both sides of the body.

Tendon or ligament pain

While we previously discussed inflammation of the tendons or ligaments in the foot (resulting in Achilles tendonitis or plantar fasciitis), PsA can also cause inflammation in other tendons and ligaments in the body. Enthesitis, described as pain that occurs where tendons or ligaments attach to the bone, is most prevalent in the foot and in the elbow (i.e., tennis elbow).

Skin rashes or nail changes

One of the most distinguishing symptoms of PsA is the presence of psoriasis (itchy, scaly, red skin patches) and changes in the nail bed. While psoriasis is a precursor to PsA, the presence of psoriasis and nail changes (e.g., fingernails lifting from the nail bed; infected looking nails) can help confirm a diagnosis of PsA.

nail fungus

Fatigue

Common in both rheumatoid arthritis and psoriatic arthritis, general feelings of fatigue are a prevalent symptom. The fatigue is mostly caused by the increased level of inflammation going on in the body. In addition, certain medications that individuals with arthritis are typically prescribed may also cause fatigue. Because fatigue limits energy levels and mobility, it can cause secondary complications, such as obesity and mood changes. Around 29% of individuals with PsA have severe fatigue. The Journal of Rheumatology published research citing a link between PsA sufferers and fibromyalgia, which causes severe levels of fatigue.

Reduced mobility

Your range of motion may diminish greatly if you have PsA. Arthritis in general (all types) causes mobility issues due to the pain and inflammation you experience. If you have reduced range of motion, exercise can help loosen up stiff joints. Choose exercises or stretches that focus on your range of motion to get the most benefit.

Eye pain

Many individuals with PsA also experience inflammation of the eyes and around the eyes. This leads to eye redness and eye swelling. This symptom of PsA can also cause secondary conditions, including uveitis(disturbed vision caused by inflammation in the eye) and conjunctivitis (commonly known as pink eye).

conjunctivitis

Anemia

Many individuals who have PsA are also anemic. Anemia is characterized by decreased functionality and volume of fully functioning red blood cells. The symptoms of anemia include fatigue, shortness of breath, paleness, and headaches. Because the anemia in PsA patients is often mild, iron supplements are helpful, easy solutions.

Asymmetrical pain

While there are five patterns of PsA, as mentioned previously, the most prevalent types (4 of the 5) cause asymmetrical pain. This is in contrast to RA, where pain and inflammation affects joints symmetrically. PsA tends to affect larger joints (knees, ankles, legs, and fingertips) – and it tends to affect them asymmetrically (that is affecting one knee, but not the other).

Fingernail and toenail pitting

Fingernail and toenail pitting is a classic symptom of psoriatic arthritis and it tends to affect men more than women. It most often occurs with the distal interphalangeal type of psoriatic arthritis. Pitting of the nails presents itself as small indentations or depressions form in the nail. In some cases, the nail falls off completely. Fingernail and toenail pitting occurs in approximately 5% of individuals with psoriatic arthritis.

nail pitting

Finger deformities

Flexion deformity, sometimes caused by PsA, is when the fingers are pulled out of their natural alignment. This symptom is very characteristic of individuals who have arthritis mutilans, the most severe type of PsA. If finger deformities are left untreated, telescoping fingers can occur, where the bones in the finger are reabsorbed into the body.

deformity

Chest pain/weakness

Cardiac symptoms can occur as a secondary symptom of PsA. According to the National Psoriasis Foundation, individuals with PsA are at a 58% greater risk for severe cardiac problems (e.g., heart attacks) and a 43% greater risk for stroke.

Depression

Another secondary symptom of PsA is mood changes and depression. Reduced mobility and increased pain can be debilitating and cause feelings of hopelessness. Of note, the severity of the conditions of PsA are not necessarily the causes of the depression; rather, how the condition is treated and controlled. Left untreated, individuals with PsA who are in great pain with limited mobility and other complications are more likely to develop resultant depression.

Crohn’s Disease or Irritable Bowel Syndrome

According to a published study in the Annals of the Rheumatic Diseases, individuals who have PsA are more likely to have irritable bowels and be diagnosed with bowel troubles, such as Crohn’s Disease. The reason for this is because the genetic mutations between Crohn’s and PsA are very similar.

crohns

Weight gain or changes in appetite or thirst

Another side effect of PsA is weight gain and increased thirst. Limited mobility can cause weight gain. However, individuals with PsA are at an increased risk of developing Type 2 diabetes and metabolic syndrome, which both lead to increased thirst. If you notice your appetite and thirst levels changing, get checked out by your doctor.

Flares

Symptoms of PsA tend to wax and wane – showing increased and decreased levels of activity or “flares.” Many individuals with PsA have very frequent flares of the condition, while some individuals experience less frequent flares. These types of flares are often seen in individuals who have rheumatoid arthritis.

 

What Happens Next?

If you feel that you or a loved one is suffering from PsA, you should get checked out by your doctor sooner than later. You may experience one or several of the above mentioned symptoms. Only your doctor can make a full diagnosis of PsA, by conducting a physical exam, medical history, laboratory testing, and creating a plan for treatment.

hand psoriasis

If left untreated, PsA can cause serious complications, in addition to the symptoms listed above. With more severe cases of PsA, you may be left with joint deformities, lack of mobility, and secondary conditions that put your overall health at risk.

Even though there is no cure for PsA, with aggressive treatment and monitoring of your condition, you can live a normal life, virtually pain-free.