Psoriatic Arthritis

Sore joints, stiff mornings and stubborn skin flare-ups. Psoriatic arthritis can appear in multiple areas at once. The sooner you understand what’s causing your symptoms, the sooner you can start feeling like yourself again.

At Banner Health, our rheumatologists and dermatologists work together to give you clear answers, reduce your pain and create a treatment plan that fits your everyday life.

What is psoriatic arthritis?

Psoriatic arthritis is a chronic autoimmune disease that causes pain, swelling and inflammation in your joints along with other symptoms. It is a type of inflammatory arthritis linked to psoriasis.

Psoriasis is a skin and nail disease. It causes red, scaly patches, often on the elbows, knees or scalp. These thick, scaly areas are called plaques. It can also change how your fingernails and toenails look. Around 1 in 3 people with psoriasis also develop psoriatic arthritis. 

Common symptoms of psoriatic arthritis

Psoriatic arthritis can look different from person to person. Some people have mild symptoms that come and go. Others have stronger flare-ups that affect daily life. You may notice joint symptoms, skin symptoms or both. 

Joint symptoms 

• Pain, stiffness or swelling in one or more joints
• Stiffness that feels worse in the morning or after resting
• Warmth or tenderness in the affected joints
• Swollen fingers or toes that look like small sausages (called dactylitis)
• Pain in the lower back (spondylitis), heels or bottom of the feet (like near your Achilles tendon)

Skin and nail symptoms

• Red, scaly patches on the skin (psoriasis plaques)
• Itchy or burning skin
• Dry or cracked skin that may bleed
• Pitted, cracked or thick fingernails and toenails
• Nails that lift away from the nail bed

Other symptoms

• Fatigue (tiredness)
• Eye redness or pain

Types of psoriatic arthritis 

Health care providers classify psoriatic arthritis into five main types based on which joints are affected and how symptoms appear. The main types are:

• Symmetric psoriatic arthritis: This type is similar to rheumatoid arthritis because it affects many joints on both sides of the body. It often involves the hands, wrists, knees or feet.
• Asymmetric psoriatic arthritis: This type affects up to five joints, but the same joints may not be affected on both sides. It can involve large joints like the knees, ankles or wrists.
• Distal interphalangeal (DIP) predominant: This type mainly affects the joints near your nails in your fingers and toes. It is often linked to nail problems such as pitting, ridging, or separation.
• Spondylitis (psoriatic arthritis of the spine): This type affects the spine and the joints between the vertebrae. It can cause pain and stiffness in the neck, lower back or hips.
• Arthritis mutilans: This rare but severe form of psoriatic arthritis usually affects the small joints of the fingers and toes. It can cause serious joint damage and deformity.

What causes psoriatic arthritis?

The exact cause of psoriatic arthritis is not fully known. It happens when the body’s immune system overreacts, causing swelling in the joints and skin. Some things can increase your risk, including:

• A family history of psoriasis or psoriatic arthritis
• Already having psoriasis, especially with nail changes
• Infections (like strep or HIV, stress and injuries that may trigger a flare
• Being between the ages 30 and 50, though it can happen at any age

When should you see a provider for psoriatic arthritis?

Talk with a health care provider if you:

• Have psoriasis and notice joint pain or stiffness
• Have swelling in your fingers or toes
• Feel joint stiffness that lasts more than 30 minutes in the morning
• Notice nail changes along with joint symptoms

Complications of psoriatic arthritis

Psoriatic arthritis can cause lasting damage if not treated early. It can also increase your risk for other health problems, including:

• Inflammatory bowel disease
• Heart disease
• High blood pressure (hypertension)
• Metabolic syndrome
• Diabetes
• Gout
• Anxiety and depression 

How is psoriatic arthritis diagnosed?

There is no single test for psoriatic arthritis. Your health care provider will look at your symptoms, medical history and test results together. Many tests are used to help rule out other conditions first. 

You might need:

• A physical exam of your joints and skin
• Blood tests to check for inflammation and help to rule out other conditions, such as rheumatoid arthritis
• Imaging tests, such as X-rays, MRI scans or ultrasound of the joints in the hands and feet
• A joint fluid test to rule out gout or an infection

Imaging tests can also help show changes linked to psoriatic arthritis. For example, an MRI may show early signs of inflammation (edema) in the joints, especially in the sacroiliac (SI) joints of the lower back. Over time, imaging may also show joint damage or changes such as erosion, or, in some cases, fusion of bones in the spine.

If your care provider suspects psoriatic arthritis, they may refer you to a rheumatologist for further care. You may also be referred to a dermatologist for skin symptoms or a physical therapist if joint movement is affected.

How is psoriatic arthritis treated?

There is no cure for psoriatic arthritis but treatment can help manage symptoms and protect your joints. The goal is to reduce inflammation, ease pain, prevent joint damage and help you feel your best. 

Medications

• Anti-inflammatory drugs to reduce pain and swelling 
• Corticosteroids to treat inflammation
• Disease-modifying antirheumatic drugs (DMARDs) to slow joint damage
• Biologic therapies to target parts of the immune system
• Over-the-counter (OTC) and prescription medications to treat psoriasis
• Vitamins and minerals such as calcium and vitamin D to support bone health 

Lifestyle support

• Regular physical activity to keep joints flexible
• Physical therapy to improve muscle and joint function
• Maintaining a healthy weight to reduce joint stress
• Stress management, which may help reduce flare-ups
• Cold therapy or heat therapy

Surgery

Joint surgery is rare. However, if a joint has been seriously damaged, your provider may recommend surgery to replace it with an artificial joint made of metal, ceramic or plastic.

Living with psoriatic arthritis

Psoriatic arthritis is a lifelong condition but many people live full, active lives with the right care. You may have periods when symptoms improve (remission) and times when they flare up. 

Small steps can help you feel more in control:

• Take medications as prescribed 
• Stay active with low-impact exercises
• Eat a diet rich in fruits, vegetables, whole grains and healthy fats
• Manage stress with deep breathing, meditation or time with loved ones
• Protect your sleep
• Keep your appointments with your care team

How Banner Health can help

If you notice joint pain, stiffness, or swelling, especially with skin rashes or nail changes, see your health care provider or a Banner Health specialist. Getting treatment early can help you feel better and protect your joints for years to come.

At Banner Health, our rheumatologists and dermatologists work together to take care of the whole you. We will help you understand your symptoms, make a treatment plan you can follow and support you all the way.

Make an appointment with a Banner Health provider today.

Frequently asked questions

How is psoriatic arthritis different from rheumatoid arthritis and osteoarthritis?

All three conditions affect your joints but they happen for different reasons. Psoriatic arthritis is related to psoriasis (a skin condition) and it affects both your skin and joints. Rheumatoid arthritis usually affects the same joints on both sides of your body and doesn’t cause skin problems. Osteoarthritis occurs due to wear and tear on your joints over time. It doesn’t involve the immune system or cause skin issues.

Can psoriatic arthritis go away?

It is a lifelong condition but treatment can help control symptoms and prevent joint damage. There is no cure for psoriatic arthritis.

What triggers psoriatic arthritis flare-ups?

Triggers may include stress, illness or changes in medication or diet.

Is psoriatic arthritis serious?

It can be serious if not treated but early diagnosis and treatment can help manage symptoms and protect your joints.

What kind of doctor treats psoriatic arthritis?

A rheumatologist is the main specialist for psoriatic arthritis. A dermatologist helps with the skin side of the condition. Working with both provides the most comprehensive care.