Early signs of psoriatic arthritis (PsA) often include mild and occasional soreness and stiffness in the affected joints, fatigue, and a scaly rash. Most people have skin symptoms before joint symptoms, but the opposite is possible.
Psoriatic arthritis (PsA) is a type of arthritis that also involves symptoms of psoriasis. Psoriasis is an inflammatory disease that affects your nails and skin, while arthritis involves inflammation and pain in your joints and entheses (the areas where your tendons and ligaments attach to bones).
PsA gradually damages the affected joints, and its effects cannot be reversed. But treatment may slow down the condition’s progression and improve symptoms. Early diagnosis may improve outcomes, but this depends on recognizing the early signs.
You may have mild and occasional symptoms early on, and they may become more severe and persistent as the condition gradually advances. Here are the most common signs of PsA.
PsA involves joint inflammation, which can manifest as localized pain, tenderness to the touch, and stiffness. You may feel this in one joint or several joints at a time. Unexplained and persistent joint pain or stiffness may signal PsA.
PsA usually affects mainly fingers and toes but could also involve joints in your:
- knees
- ankles
- lower back
Pain and stiffness may come and go and worsen at certain times. When symptoms intensify after a period of improvement, it’s called a flare-up.
Your joints connect bones within your body, including your feet, ankles, knees, hips, and wrists. They’re surrounded by soft tissues that cushion your bones on either side. Inflammation causes fluid to build up in these tissues, which in turn causes swelling.
Joint swelling due to inflammation is a common early symptom of PsA. As the condition progresses, swelling may become more severe and painful.
Joint swelling may be accompanied by:
- difficulty with movement
- pain
- visible damage (for example, in your finger joints)
Inflamed tissue also feels warm to the touch. When you touch an affected joint, you may notice a slight or significant difference in skin temperature.
Changes to your nails, such as pitting, may be an early symptom of PsA. Pitted nails will look bumpy or dented.
Nail symptoms, sometimes called nail psoriasis, occur in about 80% of all people living with PsA, and nail pitting specifically affects 68% of people.
Pitted nails may have the following characteristics:
- depressions or dents
- changes in color (discoloration that doesn’t go away)
- changes in shape (deformation)
- thickening
Psoriatic changes in the nails may
Learn more about treatment for nail pitting.
Nails that
Onycholysis can happen with or without pitting, though the presence of transverse grooves — grooves that run horizontally across the nail — appears to correlate strongly with PsA.
If you experience onycholysis, your nail will begin to peel off the nail bed. In some cases, it may also turn yellow, greenish, purple, white, or gray. Onycholysis is not painful.
Learn more about treatment for nail psoriasis.
PsA can lead to spondylitis, which involves inflammation of the joints in your spine. Inflammation leads to pain, pressure, and limited range of motion. PsA-related spondylitis is more common in the lower back.
According to the Spondylitis Association of America, 20% of people with PsA develop psoriatic spondylitis.
Learn more about the symptoms of and treatment for psoriatic spondylitis.
PsA may begin in smaller joints, such as your fingers or toes, and progress from there.
Swelling of one or more toe or finger joints (dactylitis) is a symptom of PsA. When it occurs in your hands, it usually affects one or two joints and appears asymmetric.
Dactylitis is estimated to affect up to 50% of people with PsA and is uncommon in other types of arthritis.
Psoriatic dactylitis may affect individual digits differently. For example, your left hand may be swollen while your right hand is not.
Unlike other types of arthritis, PsA tends to make your entire finger or toe appear swollen rather than just the joint.
PsA may cause eye-related symptoms such as visible inflammation, including redness.
You may also experience uveitis (inflammation of the middle layer of your eye, which is called the uvea). An estimated 7% to 25% of people with PsA develop uveitis.
If you notice these symptoms, it’s important to seek medical care right away. Early diagnosis is essential in preventing complications such as:
- glaucoma
- cataracts
- optic nerve damage
- permanent vision loss
Learn more about how PsA can affect your eyes.
If you develop new or large floaters and flashing lights in your field of vision, it may be a sign of an emergency. Immediate medical treatment is essential.
People with PsA often develop enthesitis — inflammation in the places where tendons attach to bones. This tends to cause symptoms such as:
- persistent pain
- visible swelling
- tenderness to the touch
- limited range of motion
The most common locations for enthesitis include:
- Achilles tendon
- foot
- knee
- pelvis
- elbow
- shoulder
Enthesitis affects about
One possible symptom of PsA is a limited range of motion in one or more joints. You might find it harder to extend your arms, bend your knees, or bend forward. You might also have problems using your fingers effectively.
When a joint becomes permanently fixed or unable to move beyond a certain point, it’s called contracture deformity.
Preventing limited range of motion involves performing joint mobility exercises with a physical therapist or at home.
Fatigue is a common symptom of PsA. For example, in one small study involving 60 people with PsA,
If you experience fatigue, you might have difficulty making it through the day without taking a nap. And even after resting, you might still feel exhausted.
Many symptoms and complications of PsA can contribute to fatigue, including:
- chronic pain
- anemia
- limited physical activity
- overweight and obesity
- fibromyalgia
- sleep disturbances
- anxiety
- depression
Chronic inflammation associated with PsA may also cause fatigue due to inflammatory cytokines.
Learn about how to manage PsA fatigue.
Among people living with PsA,
With a psoriasis rash, you will notice patches of skin that may look red or pinkish on light skin tones or purple, gray, or dark brown on dark skin tones. These patches will be covered with smaller plaques that look like silver or white scales.
These itchy lesions may develop anywhere on your body but are most likely to be found on your back, scalp, elbows, and knees.
Learn more about psoriatic arthritis rashes.
At what age does psoriatic arthritis start?
PsA may develop at any age, but you may notice the first signs between the ages of 30 and 50 years.
How does psoriatic arthritis usually start?
According to the Arthritis Foundation, in 60% to 80% of PsA cases, the first symptom is a rash. Other symptoms, such as joint stiffness, may take up to 10 years to develop. When joint involvement starts in PsA, it may first affect peripheral joints (those in your arms and legs).
How is early psoriatic arthritis diagnosed?
PsA is usually diagnosed when people present with psoriasis skin lesions and rheumatoid factor (RF)-negative inflammatory arthritis. Those who have a history of psoriasis may receive a diagnosis sooner.
Early symptoms of psoriatic arthritis may include joint pain and stiffness, pitted nails, skin lesions, fatigue, and limited range of motion.
If you have psoriasis, you may be more likely to develop PsA than someone who doesn’t. However, some people develop arthritis before they experience skin symptoms of psoriasis.