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What are psoriatic arthritis symptoms and signs?

In most patients, the psoriasis precedes the arthritis by months to years. There can be tiny pitting nail changes of the finger and toenails. The type of psoriatic arthritis depends on the distribution of the joints affected. Accordingly, there are five types of psoriatic arthritis: symmetrical, asymmetric and few joints, spondylitis, distal interphalangeal joints, and arthritis mutilans.

The arthritis frequently involves the knees, ankles, and joints in the feet. Usually, only a few joints are inflamed at a time. The inflamed joints become painful, stiff, swollen, hot, tender, and red. There is usually loss of range of motion of the involved joints. Sometimes, joint inflammation in the fingers or toes can cause swelling of the entire digit, giving them the appearance of a "sausage." Joint stiffness is a common symptom and is typically worse early in the morning. Less commonly, psoriatic arthritis may involve many joints of the body in a symmetrical fashion, mimicking the pattern seen in rheumatoid arthritis. Psoriatic arthritis can also cause inflammation of the spine (spondylitis) and the sacrum, causing symptoms like pain and stiffness in the low back, buttocks, neck, and upper back. Occasionally, psoriatic arthritis involves the small joints at the ends of the fingers. A very destructive, though less common, form of arthritis called "mutilans" can cause rapid damage to the joints. Fortunately, this form of arthritis is rare in patients with psoriatic arthritis.

Patients with psoriatic arthritis can also develop inflammation of the tendons (tendinitis), tendon insertion points on bone (enthesitis), and around cartilage. Inflammation of the tendon behind the heel causes Achilles tendinitis, leading to pain with walking and climbing stairs. Inflammation of the chest wall and of the cartilage that links the ribs to the breastbone (sternum) can cause chest pain, as seen in costochondritis.

Aside from arthritis and spondylitis, psoriatic arthritis can cause fatigue and inflammation in other organs, such as the eyes, lungs, and aorta. Inflammation in the colored portion of the eye (iris) causes iritis, a painful health condition that can be aggravated by bright light as the iris opens and closes the opening of the pupil. Corticosteroids injected directly into the eyes are sometimes necessary to decrease inflammation and prevent blindness. Inflammation in and around the lungs (pleuritis) causes chest pain, especially with deep breathing as the lungs expand against the inflamed areas, as well as shortness of breath. Inflammation of the aorta (aortitis) can cause leakage of the aortic valves, leading to heart failure and shortness of breath.

In a majority of patients, psoriatic arthritis causes swelling and inflammation of the fingers and pitting and ridges in the fingernails.
In a majority of patients, psoriatic arthritis causes swelling and inflammation of the fingers and pitting and ridges in the fingernails.

Acne and nail changes are symptoms commonly seen in psoriatic arthritis. Pitting and ridges are seen in fingernails and toenails of 80% of patients with psoriatic arthritis. Interestingly, these characteristic nail changes are observed in only a minority of psoriasis patients who do not have arthritis. Acne has been noted to occur in higher frequency in patients with psoriatic arthritis. In fact, a syndrome exists that features inflammation of the joint lining (synovitis), acne, pustules on the feet or palms, thickened and inflamed bone (hyperostosis), and bone inflammation (osteitis). This syndrome is, therefore, named by the eponym SAPHO syndrome.

Return to Psoriatic Arthritis

See what others are saying

Comment from: Naomi, 65-74 Female (Patient) Published: August 03

I have had arthritis and psoriasis for many years; but was not diagnosed with psoriatic arthritis until last year when two toes started swelling up and turning numb. I had a lot of spinal stiffness and pain in my neck and lower back, hands and 1 knee. I have been going to a wonderful chiropractor who has really helped me with the stiff neck and back. I started taking turmeric for inflammation and my test levels have really dropped. I also take tart cherry capsules and it has relieved most of my pain. I can't take any of the biologics because I have had cancer. I am trying to get a prescription for Otezla to slow down the joint damage.

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Comment from: Cobbled, 65-74 Male (Patient) Published: May 29

I am 71 years old. Psoriasis started on my knees and elbows about six years ago. It has gradually disappeared. Last month I had to visit emergency in the hospital for pain in my hip. Doctors were unable to diagnose psoriatic arthritis. They thought I had a fall. They did blood tests and found that my white blood cell count was above normal. I also had a temperature. Morphine was injected twice and the pain eventually subsided. My blood is back to normal. X-rays of my hip showed no arthritis. My pelvic bone wasn't examined. That is where the pain is. Concurrently I have had gentle pain in my knee that could be related. Now, a month later, the other hip is seizing up.

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