The 10 Most Common Signs and Symptoms of Psoriatic Arthritis (With Images)

Most people think of psoriasis as a condition that only affects the skin. While that’s true, about 1 in 4 people who have psoriasis can develop another condition called psoriatic arthritis (PsA). This is an autoimmune, inflammatory condition that affects the joints, tendons, and sometimes the eyes. So it’s important to keep an eye out for symptoms if you have psoriasis. 

Psoriatic arthritis is different for everybody. In general, PsA is psoriasis rash plus joint pain and swelling. But, other symptoms can occur, too.  

1. Joint pain or swelling

Psoriatic arthritis causes pain, swelling, and stiffness in the joints. It tends to be worse in the morning. PsA commonly affects the hands, but it can affect any joint in the body.

Here are some photos of joint swelling from psoriatic arthritis. 

2. Skin rashes (psoriasis)

There are a few different types of psoriasis rashes. Red, scaly patches on the scalp, elbows, and knees are the most common. This is called plaque psoriasis. Psoriasis rashes can happen anywhere, including on the scalp, genitals, and buttocks.

Here’s a picture of plaque psoriasis in different skin tones. 

Scaly patches cover the knees of a person with plaque psoriasis.

Red, scaly patches cover the back of a person with plaque psoriasis.

3. Changes in the nails

Nail psoriasis can cause many different changes. They include color changes, ridges, tiny pits, or nails that appear crumbly. You may also see changes in the skin underneath the nails.

Here are some photos showing the different nail changes in psoriatic arthritis.

Psoriatic arthritis causes thickened and discolored nails.

Nail pitting and discoloration can happen with psoriatic arthritis.

4. Pain and inflammation where tendons connect to bones

Entheses are areas where tendons connect to bone. Psoriatic arthritis can cause inflammation and pain in these areas, which is called enthesitis. The most commonly affected are at the back of the heel, elbows, and spine. 

5. Pain and inflammation in the cartilage between the rib cage

This inflammation is called costochondritis. It causes chest pain that feels achy or pressure-like, and the area is usually very tender to touch. This pain might get worse when your rib cage expands to take a deep breath in or with movement of your arms.

6. Swelling of an entire finger or toe

This is also called “sausage digit” or dactylitis. In addition to swelling, it can also cause redness and warmth. It’s different from joint swelling because it affects the entire finger or toe.

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• You can’t prevent or treat psoriatic arthritis with your diet alone. But you may notice a difference in your symptoms with a few diet changes.

Here’s a photo that shows two digits almost completely swollen from psoriatic arthritis.

7. Low back pain and stiffness

Psoriatic arthritis commonly causes back pain and stiffness throughout the spine. In particular, inflammation in the sacroiliac joints (where the pelvis meets the spine in the low back) is very common. This is called sacroiliitis.

8. Mid-back or neck pain and stiffness

This is due to inflammation in the spine itself (spondylitis). It commonly occurs with the low back pain of sacroiliitis, but it can occur alone about 25% of the time.

9. Eye inflammation

Psoriatic arthritis and psoriasis can cause a few different types of eye problems. These include blepharitis (inflammation of the eyelid) and conjunctivitis (inflammation of the eyelid lining). 

Uveitis is a less common symptom of psoriatic arthritis. It’s due to inflammation of the uvea, which leads to:

• Eye pain

• Redness of the eye

• Sensitivity to light

• Blurry vision

10. Fatigue

Untreated inflammation in the body can make you feel run down, even when you get a decent night’s rest. So fatigue is a common symptom of most autoimmune conditions, including psoriatic arthritis.

What are the symptoms of a psoriatic arthritis flare?

A psoriatic arthritis flare is when symptoms temporarily get worse. Worsening rashes and joint pain are common during flares, but any of your symptoms can get worse. Sometimes new symptoms can also show up. 

PsA flares can be triggered by infection, stress, and smoking. But they are different for everyone, since everyone has their own specific symptoms of PsA and their own triggers.  

What are the early warning signs of psoriatic arthritis?

The early signs of psoriatic arthritis are the same as the symptoms listed above. Studies show that the earlier you get a PsA diagnosis and treatment, the better you’ll do in the long run. So it’s important to be aware of the early warning signs.

If you have psoriasis and develop any of these other symptoms, talk with your dermatologist or primary care provider. They can refer you to a rheumatologist (autoimmune specialist) who can determine if your symptoms are due to PsA or something else.

Is there anything I can do to prevent psoriatic arthritis?

If you have psoriasis, you’re probably wondering if there’s anything you can do to decrease your chances of getting psoriatic arthritis. Researchers aren’t sure why some people with psoriasis go on to develop PsA whereas others don’t. As of now, there are no medications that can prevent the development of psoriatic arthritis. But there are a few ways to keep your joints healthy as you age:

• Stop smoking, if you smoke: Some research suggests that quitting smoking can improve psoriasis and decrease the chance of getting PsA in general, but the evidence is mixed. There are other health benefits of smoking cessation, too. 

• Maintain a balanced weight: A large study showed a link between carrying excess weight and an increased risk of developing PsA if you have psoriasis. So it can help to do your best to maintain a balanced weight through a nutritious diet and exercise.

• Keep moving: Speaking of exercise, experts recommend regular exercise for all people and especially those with arthritis. 

• Be aware of joint pain and other symptoms: It’s important to pay attention to your body and let your healthcare team know if you experience new symptoms. Having psoriasis means you’re at greater risk for psoriatic arthritis, and the earlier it’s diagnosed and treated, the better.

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Written by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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Images used with permission from VisualDx (www.visualdx.com).