Table of ContentsView AllTable of ContentsEarly PsADisease ProgressionSlowing Down PsA

Table of ContentsView All

View All

Table of Contents

Early PsA

Disease Progression

Slowing Down PsA

Psoriatic arthritis(PsA) is a type of inflammatory arthritis that often affects people who already havepsoriasis. PsA will get worse with time and a person can have periods of remission, where they won’t have any symptoms, and periods of flare-ups, where skin and/or joint symptoms are active and progressive.

When you are first diagnosed, yourrheumatologistwill want to determine the stage of the disease—mild, moderate or severe. Determining the seriousness of PsA, helps your healthcare provider figure out the best treatment course and how to best monitor progress.

Mild PsA, often seen in early PsA, will cause pain and stiffness, but it will not affect your ability to perform daily activities.Moderate PsA, seen within a few years of diagnosis, will affect your quality of life, as pain and limited range of motion can make it harder to perform some activities of daily living. Last, severe PsA, seen in people who have lived with PsA for a long time, will have the greatest impact on your quality of life as it will drastically restrict day-to-day activities.

The majority of the time, PsA begins years after the presentation of psoriasis symptoms. Up to 40 percent ofpeople with psoriasis eventually go on to develop PsA.

There are several risk factors that make it more likely for a person with psoriasis to develop PsA. These include:

Much like other types ofinflammatory arthritis,PsA usually starts with pain and swelling in one or more joints, usually the smaller joints, such as the fingers and toes. You may also have swelling in larger joints, including the knees, ankles, and shoulders. PsA almost always causesenthesitis, which is inflammation of where tendons insert into bone (such as at the Achilles' tendon). PsA can also cause a condition calleddactylitis, where a finger or toe is so swollen it looks like a sausage.

Additional signs a person may experience in the early phases of PsA include:

Symptoms of Psoriatic Arthritis

PsA will progress differently for each person. Without appropriate treatment, the disease will worsen and affect more joints on both sides of the body.  As the disease progresses, you will experience periodic flare-ups of disease symptoms.

Extended periods ofinflammationmay eventually cause bone erosion (loss of bone). Joint space may also begin to narrow, which will make it harder to move. In the small joints of the fingers and toes, it is possible to see clear joint damage.

Joint damage makes it harder to enjoy activities, perform day-to-day tasks, and causes pain. Additionally, without physical activity joints may become stiff and muscles weak.

Later Stages of PsA

Joint problems are not the only symptoms associated with progressing PsA.  As the disease progresses, PsA can start to impact your daily life and cause severe fatigue and debilitatingskin symptoms. In addition, PsA is associated with a number of complications all related to inflammation.

Fatigue:Up to 50 percent of people with PsA live with some fatigue and at least 30 percent complain of severe fatigue that affects them on a daily basis.

Skin Symptoms:PsA rash presents as thick, red, silvery patches of skin.Patches are usually dry, itchy and sore, and can develop anywhere on the body—but the knees, elbows, low back, hands and feet are usually the most affected.

Spine Symptoms: As many as 40 percent of people with PsA have spine involvement, this according to a 2017 study reported in the medical journal,Annals of the Rheumatic Diseases.Pain results when there is inflammation of the joints between the vertebrae, a condition calledpsoriatic spondylitis. Inflammation may also affect the joints between the spine and pelvis, calledsacroiliitis.

Eye Inflammation: A condition calleduveitisthat affects the eye’s middle layer can cause pain, floaters (dark specks or strings drifting across the eyes), and blurry vision from long-standing PsA inflammation. According to the Arthritis Foundation, 7%–25% of people with PsA will have uveitis.

Arthritis Mutilans: Up to 5 percent of people will developarthritis mutilans, a severe form of the disease that affects the joints of the hands and feet.The condition will cause the joints to erode and shorten and the skin around those joints to contract, causing permanent damage.Biologic drug treatmentcan prevent this type of joint damage.

Hearing Loss: Research reported inThe Journal of Rheumatologyfinds strong evidence for inner ear damage in people with PsA. The 2017 study of mostly men PsA patients found 60 percent of the patients were experiencing hearing loss related to damage in the inner ear and/or the auditory nerve. Such damage eventually leads to hearing loss and balance problems.

There is no cure for PsA and joint damage cannot be reversed.However, the disease can be slowed down, and treatment works best when it is started in the early stages of the disease.

Psoriatic Disease Drugs in the Pipeline

In addition to drug therapy, you will want toavoid putting stress on joints. The following things can help:

A Word From Verywell

Pain and inflammation can be difficult to manage and living with both can have an effect on your emotional health. When emotional health is left unchecked, PsA eventually leads to depression, anxiety, and difficulties in coping with day-to-day life. Ask your healthcare provider about locating a PsA support group or a therapist who can help you to learn coping skills especially if you find you are struggling with the emotional challenges of your health.

19 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Mease PJ, Armstrong AW.Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis.Drugs. 2014;74(4):423-41. doi:10.1007/s40265-014-0191-y

Sobolewski P, Walecka I, Dopytalska K.Nail involvement in psoriatic arthritis.Reumatologia. 2017;55(3):131-135.  doi:10.5114/reum.2017.68912

American College of Rheumatology.Psoriatic arthritis.

Giannelli A.A Review for Physician Assistants and Nurse Practitioners on the Considerations for Diagnosing and Treating Psoriatic Arthritis.Rheumatol Ther. 2019;6(1):5-21.  doi:10.1007/s40744-018-0133-3

Husni ME.Psoriatic arthritis.

Krakowski P, Gerkowicz A, Pietrzak A, et al.Psoriatic arthritis - new perspectives.Arch Med Sci. 2019;15(3):580-589.  doi:10.5114/aoms.2018.77725

Paine A, Ritchlin C.Altered Bone Remodeling in Psoriatic Disease: New Insights and Future Directions.Calcif Tissue Int. 2018;102(5):559-574.  doi:10.1007/s00223-017-0380-2

Lee S, Mendelsohn A, Sarnes E.The burden of psoriatic arthritis: a literature review from a global health systems perspective.P T.2010;35(12):680-9.

Cleveland Clinic.Psoriasis.

Jadon DR, Sengupta R, Nightingale A, et al.Axial Disease in Psoriatic Arthritis study: defining the clinical and radiographic phenotype of psoriatic spondyloarthritis.Ann Rheum Dis. 2017;76(4):701-707.  doi:10.1136/annrheumdis-2016-209853

Arthritis Foundation.Beyond joints: how psoriatic arthritis affects the body.

Genetics Home Reference. US National Library of Medicine.Psoriatic arthritis.

Amor-dorado JC, Barreira-fernandez MP, Pina T, Vázquez-rodríguez TR, Llorca J, González-gay MA.Investigations into audiovestibular manifestations in patients with psoriatic arthritis.J Rheumatol. 2014;41(10):2018-26.  doi:10.3899/jrheum.140559

Cedars Sinai.Psoriatic arthritis.

Ayhan E, Kesmezacar H, Akgun I.Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis.World J Orthop. 2014;5(3):351-61.  doi:10.5312/wjo.v5.i3.351

Cuchacovich R, Perez-alamino R, Garcia-valladares I, Espinoza LR.Steps in the management of psoriatic arthritis: a guide for clinicians.Ther Adv Chronic Dis. 2012;3(6):259-69.  doi:10.1177/2040622312459673

Klingberg E, Bilberg A, Björkman S, Hedberg M, Jacobsson L, Forsblad-d’Elia H, Carlsten H, Eliasson B, Larsson I.Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study. Arthritis Res Ther. 2019 Jan 11;21(1):17. doi: 10.1186/s13075-019-1810-5

Moroz A.Treatment of pain and inflammation. Merck Manual Consumer Version.

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