Psoriasis affects up to 3% of people worldwide with up to 40% of this group also having PsA.Both psoriasis and PsA areautoimmune diseases, conditions where the body’s immune system attacks its healthy tissues.
Copyright 2017 American College of American
Symptoms of PsA can affect any part of the body and will range from mild to severe. PsA often alternates betweenflare-up periods(periods of high disease activity) and periods of remission (while the disease is mild or inactive).
There is no cure for PsA, so the focus is on controlling disease symptoms and preventing joint damage. Untreated PsA can cause deformed joints, reduced mobility, and evendisability. Uncontrolled inflammation also increases the risk of cardiovascular morbidity and mortality.
How Psoriatic Arthritis Affects the Body
Inflammation is the way the body protects and repairs itself from foreign substances.Characteristics of inflammation include redness, heat, swelling, pain, and loss of function. Inflammation may cause fevers, joint and muscle pain, extreme fatigue, skin symptoms, and organ dysfunction.
PsA inflammation often affects larger joints and thedistal jointsof the fingers and toes. The distal joints are the first knuckles at the top of the fingers and toes.
PsA Affects People Differently
No people with PsA are affected the same. Some people with the condition might only have peripheral joint disease where only their hands, wrists, knees, and other large joints are affected. The research shows that peripheral joint disease in PsA is quite common and often symmetrical (affecting both sides) and polyarticular (affecting multiple joints).
Verywell / Theresa Chiechi
Many people with PsA have skin involvement while others don’t have any skin symptoms or psoriasis. It is more common to have skin symptoms with PsA, but there are people with PsA who don’t have skin symptoms. In up to 80% of people with PsA, skin disease usually precedes joint disease.
Other effects of PsA include:
Not everyone with PsA will experience all the possible effects of the condition. Each person will experience a different combination of symptoms and severity.
An Invisible DiseaseAn invisible illness is a condition in which a person does not exhibit external visible signs or symptoms of that condition. PsA is considered an invisible disease because many of its symptoms and effects cannot be seen.Chronic fatigue is one of the most invisible symptoms of this condition. High levels of inflammation are often to blame for extreme levels of fatigue. Fatigue can also be associated with medications used to treat the condition. Research shows that fatigue is a major problem with PsA, leading to negative effects on quality of life.Other invisible symptoms of PsA might include joint and muscle pain, blurry vision, anxiety, depression, reduced range of motion, back pain, andanemia.
An Invisible Disease
An invisible illness is a condition in which a person does not exhibit external visible signs or symptoms of that condition. PsA is considered an invisible disease because many of its symptoms and effects cannot be seen.Chronic fatigue is one of the most invisible symptoms of this condition. High levels of inflammation are often to blame for extreme levels of fatigue. Fatigue can also be associated with medications used to treat the condition. Research shows that fatigue is a major problem with PsA, leading to negative effects on quality of life.Other invisible symptoms of PsA might include joint and muscle pain, blurry vision, anxiety, depression, reduced range of motion, back pain, andanemia.
An invisible illness is a condition in which a person does not exhibit external visible signs or symptoms of that condition. PsA is considered an invisible disease because many of its symptoms and effects cannot be seen.
Chronic fatigue is one of the most invisible symptoms of this condition. High levels of inflammation are often to blame for extreme levels of fatigue. Fatigue can also be associated with medications used to treat the condition. Research shows that fatigue is a major problem with PsA, leading to negative effects on quality of life.
Other invisible symptoms of PsA might include joint and muscle pain, blurry vision, anxiety, depression, reduced range of motion, back pain, andanemia.
Joint Distribution
Asymmetric vs. SymmetricArthritis causes inflammation of the joints. Different types of arthritis, including PsA, affect the bodysymmetrically or asymmetrically. Symmetric arthritis affects the same joints on both sides of the body, whereas asymmetric affects the joints on one side of the body.
Asymmetric vs. Symmetric
Arthritis causes inflammation of the joints. Different types of arthritis, including PsA, affect the bodysymmetrically or asymmetrically. Symmetric arthritis affects the same joints on both sides of the body, whereas asymmetric affects the joints on one side of the body.
Bone Damage
Sometimes, bone or joint damage might require reconstructive surgery of knees, ankles, or hips. Surgical goals include restoring function so that disability doesn’t affect the ability to work, care for yourself, and your quality of life.
Arthritis mutilans is also known for destroying the small joints of the hands. If not treated, it can lead to permanent disability.
PsA can also cause spinal damage that restricts movement and can cause significant pain. Talk to your doctor if you are experiencing back pain, swelling, or stiffness.
What Psoriatic Arthritis Looks Like
Stiffness and/or Swelling in the Large Joints
Peter Dazeley / Getty Images.
Joint stiffness and swelling are the main symptoms of PsA. These two symptoms can affect any part of the body, but they often affect the large joints of the knees or hips.
Involvement of the large joints can impair activities of daily living in people with PsA.Activities of daily living include things like grooming, bathing, getting dressed, walking and climbing steps, and safety and emergency responses.
Swollen Fingers and Toes
psoriatic arthritis.DermNet /CC BY-NC-ND
DermNet /CC BY-NC-ND
PsA may also affect the smaller joints of the fingers and toes. These joints can get so swollen they cause the digits to appear sausage-like, a hallmark symptom called dactylitis.
According to the National Psoriasis Foundation, 40% of people living with PsA experience dactylitis.This symptom doesn’t just inflame the joints of the fingers and toes; it causes the entire finger or toe to swell up.
Foot Pain
PsA can affect the feet, from the ankles to the toes. This is because people with PsA often develop enthesitis. This can cause pain, swelling, and tenderness in the heels, midfoot, and toes.
Eye Changes
Elizabeth Fernandez / Getty Images.
Psoriatic Arthritis Rash/Skin Changes
Irina Gulyayeva / Getty Images
PsA rashes arepsoriasis plaques. Rashes appear as red patches with silvery-white scales on the skin. Skin rashes might burn, itch, hurt, or bleed.
These rashes might come and go. It is very possible to have long periods where a person’s skin is clear.
Psoriatic Arthritis Rash: Symptoms and Treatment
Nail Changes
A large number of people with PsA will have nail symptoms. According to a study reported in 2017, up to 80% of people with PsA will have nail involvement.
Changes to your nails, including pitting (bumpy or dented nails),onycholysis(when nails separate from the nail bed), and nail discoloration are all nail changes that can affect people with PsA. Psoriasis can also affect the nails, causing them to look like they may be infected.
Less-Visible Symptoms
PsA is known for causing symptoms that are not so easy to see. These might include lower back pain, fatigue, joint pain, reduced range of motion, and anemia.
Lower Back Pain
Because PsA can affect the spine, it can lead toback pain. According to the Arthritis Foundation, PsA spine involvement (axial arthritis) occurs in up to 50% of people with PsA.
Features of axial back pain include:
Fatigue
Fatigue is a common symptom of PsA. It often makes it harder to do even the simplest activities of daily living. This type of fatigue might include a general feeling of tiredness and exhaustion that might make it harder to get through the day without resting or napping.
Joint Pain
PsA usually affects the knees, lower back, hips, ankles, fingers, and toes. Pain might disappear at times or return and worsen at other times. When your symptoms improve, you might be experiencing a period of remission. When symptoms become worse, you might experience a period of flare-up.
Reduced Range of Motion
PsA can affect therange of motionin your joints. Reduced range of motion can make it hard to bend or extend the arms or legs, or even bend forward. You may also have problems using your fingers, which can make it harder to perform certain tasks, including typing and writing.
Anemia
PsA can lead to low red blood cell counts and a condition called anemia. Anemia is a condition where your blood has fewer red blood cells than normal. It can lead to symptoms such as fatigue, dizziness, chest pain, shortness of breath, and pallor.
People with conditions like PsA that cause high levels of inflammation often develop a condition calledanemia of chronic diseaseor anemia of inflammation. With this type of anemia, you may have normal or increased iron in body tissues, but low iron in the blood. This is because inflammation prevents the body from storing iron to make enough healthy red blood cells.
Coping With PsA
The best ways to successfully manage PsA are through medical care from your doctor and with healthy lifestyle habits. The little things you are doing every day will add up and affect how you feel overall. These might include:
A Word From Verywell
Psoriatic arthritis is a lifelong condition with no cure. The outlook for most people with the condition can be positive. However, that requires early diagnosis and aggressive treatment, and monitoring of both joints and skin. This is the best way to slow down the disease, prevent joint damage and disability, and improve your overall quality of life.
If you develop symptoms of psoriatic arthritis, contact your doctor right away. They can order testing to accurately diagnose you and get you on a treatment plan.
13 SourcesVerywell 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.Rech J, Sticherling M, Stoessel D, et al.Psoriatic arthritis epidemiology, comorbid disease profiles and risk factors: results from a claims database analysis.Rheumatol. Adv. Pract., 2020;4(2). doi:10.1093/rap/rkaa033Harvard Medical School.Understanding acute and chronic inflammation.Acosta Felquer ML, FitzGerald O.Peripheral joint involvement in psoriatic arthritis patients.Clin Exp Rheumatol. 2015 Sep-Oct;33(5 Suppl 93):S26-30.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):423-441. doi:10.1007/s40265-014-0191-yVigener-Buxel CB, Langer HE, Werner SG, et al.AB0849 fatigue in psoriatic arthritis – prevalence and impact in daily rheumatologic outpatient care.Annals of the Rheumatic Diseases.2020;79:1732. doi:10.1136/annrheumdis-2020-eular.5653MedlinePlus.Psoriatic arthritis.Bell L, Murphy C, Wynne B, et al.Acute presentation of arthritis mutilans.J Rheumatol.; 2011;38(1):174–175. doi:10.3899/jrheum.100579Belasco J, Wei N.Psoriatic arthritis: What is happening at the joint?Rheumatol Ther. 2019;6(3):305-315. doi:10.1007/s40744-019-0159-1Krakowski P, Gerkowicz A, Pietrzak A, et al.Psoriatic arthritis - new perspectives.Arch Med Sci. 2019;15(3):580-589. doi:10.5114/aoms.2018.77725National Psoriasis Foundation.Classification of psoriatic arthritis.Sobolewski P, Walecka I, Dopytalska K.Nail involvement in psoriatic arthritis.Reumatologia. 2017;55(3):131-135. doi:10.5114/reum.2017.68912Axtell B.Psoriatic arthritis and back pain. Arthritis Foundation.Weiss G, Ganz T, Goodnough LT.Anemia of inflammation.Blood. 2019;133(1):40-50. doi:10.1182/blood-2018-06-856500
13 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.Rech J, Sticherling M, Stoessel D, et al.Psoriatic arthritis epidemiology, comorbid disease profiles and risk factors: results from a claims database analysis.Rheumatol. Adv. Pract., 2020;4(2). doi:10.1093/rap/rkaa033Harvard Medical School.Understanding acute and chronic inflammation.Acosta Felquer ML, FitzGerald O.Peripheral joint involvement in psoriatic arthritis patients.Clin Exp Rheumatol. 2015 Sep-Oct;33(5 Suppl 93):S26-30.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):423-441. doi:10.1007/s40265-014-0191-yVigener-Buxel CB, Langer HE, Werner SG, et al.AB0849 fatigue in psoriatic arthritis – prevalence and impact in daily rheumatologic outpatient care.Annals of the Rheumatic Diseases.2020;79:1732. doi:10.1136/annrheumdis-2020-eular.5653MedlinePlus.Psoriatic arthritis.Bell L, Murphy C, Wynne B, et al.Acute presentation of arthritis mutilans.J Rheumatol.; 2011;38(1):174–175. doi:10.3899/jrheum.100579Belasco J, Wei N.Psoriatic arthritis: What is happening at the joint?Rheumatol Ther. 2019;6(3):305-315. doi:10.1007/s40744-019-0159-1Krakowski P, Gerkowicz A, Pietrzak A, et al.Psoriatic arthritis - new perspectives.Arch Med Sci. 2019;15(3):580-589. doi:10.5114/aoms.2018.77725National Psoriasis Foundation.Classification of psoriatic arthritis.Sobolewski P, Walecka I, Dopytalska K.Nail involvement in psoriatic arthritis.Reumatologia. 2017;55(3):131-135. doi:10.5114/reum.2017.68912Axtell B.Psoriatic arthritis and back pain. Arthritis Foundation.Weiss G, Ganz T, Goodnough LT.Anemia of inflammation.Blood. 2019;133(1):40-50. doi:10.1182/blood-2018-06-856500
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.
Rech J, Sticherling M, Stoessel D, et al.Psoriatic arthritis epidemiology, comorbid disease profiles and risk factors: results from a claims database analysis.Rheumatol. Adv. Pract., 2020;4(2). doi:10.1093/rap/rkaa033Harvard Medical School.Understanding acute and chronic inflammation.Acosta Felquer ML, FitzGerald O.Peripheral joint involvement in psoriatic arthritis patients.Clin Exp Rheumatol. 2015 Sep-Oct;33(5 Suppl 93):S26-30.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):423-441. doi:10.1007/s40265-014-0191-yVigener-Buxel CB, Langer HE, Werner SG, et al.AB0849 fatigue in psoriatic arthritis – prevalence and impact in daily rheumatologic outpatient care.Annals of the Rheumatic Diseases.2020;79:1732. doi:10.1136/annrheumdis-2020-eular.5653MedlinePlus.Psoriatic arthritis.Bell L, Murphy C, Wynne B, et al.Acute presentation of arthritis mutilans.J Rheumatol.; 2011;38(1):174–175. doi:10.3899/jrheum.100579Belasco J, Wei N.Psoriatic arthritis: What is happening at the joint?Rheumatol Ther. 2019;6(3):305-315. doi:10.1007/s40744-019-0159-1Krakowski P, Gerkowicz A, Pietrzak A, et al.Psoriatic arthritis - new perspectives.Arch Med Sci. 2019;15(3):580-589. doi:10.5114/aoms.2018.77725National Psoriasis Foundation.Classification of psoriatic arthritis.Sobolewski P, Walecka I, Dopytalska K.Nail involvement in psoriatic arthritis.Reumatologia. 2017;55(3):131-135. doi:10.5114/reum.2017.68912Axtell B.Psoriatic arthritis and back pain. Arthritis Foundation.Weiss G, Ganz T, Goodnough LT.Anemia of inflammation.Blood. 2019;133(1):40-50. doi:10.1182/blood-2018-06-856500
Rech J, Sticherling M, Stoessel D, et al.Psoriatic arthritis epidemiology, comorbid disease profiles and risk factors: results from a claims database analysis.Rheumatol. Adv. Pract., 2020;4(2). doi:10.1093/rap/rkaa033
Harvard Medical School.Understanding acute and chronic inflammation.
Acosta Felquer ML, FitzGerald O.Peripheral joint involvement in psoriatic arthritis patients.Clin Exp Rheumatol. 2015 Sep-Oct;33(5 Suppl 93):S26-30.
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):423-441. doi:10.1007/s40265-014-0191-y
Vigener-Buxel CB, Langer HE, Werner SG, et al.AB0849 fatigue in psoriatic arthritis – prevalence and impact in daily rheumatologic outpatient care.Annals of the Rheumatic Diseases.2020;79:1732. doi:10.1136/annrheumdis-2020-eular.5653
MedlinePlus.Psoriatic arthritis.
Bell L, Murphy C, Wynne B, et al.Acute presentation of arthritis mutilans.J Rheumatol.; 2011;38(1):174–175. doi:10.3899/jrheum.100579
Belasco J, Wei N.Psoriatic arthritis: What is happening at the joint?Rheumatol Ther. 2019;6(3):305-315. doi:10.1007/s40744-019-0159-1
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
National Psoriasis Foundation.Classification of psoriatic arthritis.
Sobolewski P, Walecka I, Dopytalska K.Nail involvement in psoriatic arthritis.Reumatologia. 2017;55(3):131-135. doi:10.5114/reum.2017.68912
Axtell B.Psoriatic arthritis and back pain. Arthritis Foundation.
Weiss G, Ganz T, Goodnough LT.Anemia of inflammation.Blood. 2019;133(1):40-50. doi:10.1182/blood-2018-06-856500
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