Psoriatic Arthritis: A Complete Guide to Symptoms, Diagnosis, and Treatment

Key Takeaways

Psoriatic arthritis (PsA) affects about 30% of people with psoriasis
Joint symptoms may appear before, after, or simultaneously with skin symptoms
Early diagnosis and treatment can prevent permanent joint damage
PsA can affect joints, tendons, the spine, and even fingers and toes
Modern treatments—especially biologics—are highly effective for most people
Without treatment, PsA can cause significant disability and joint destruction

Psoriatic arthritis is a double challenge: an inflammatory joint condition that occurs in people with psoriasis, the chronic skin condition characterized by red, scaly patches. Managing PsA means addressing both the skin and joint components of the disease.

The good news is that treatments have improved dramatically in recent years. Early diagnosis and appropriate therapy can prevent joint damage and help people with PsA live full, active lives.

What Is Psoriatic Arthritis?

Psoriatic arthritis is a chronic inflammatory arthritis that occurs in some people with psoriasis. It’s classified as a seronegative spondyloarthropathy—meaning it shares features with conditions like ankylosing spondylitis and doesn’t show rheumatoid factor in blood tests.

The Psoriasis Connection

About 30% of people with psoriasis develop PsA
Joint symptoms appear after skin symptoms in ~85% of cases
In ~15% of cases, joint symptoms come first or simultaneously
The severity of skin disease doesn’t predict who will develop PsA
Even people with very mild skin psoriasis can develop severe PsA

Who Gets It?

Equal prevalence in men and women
Usually develops between ages 30-50
Can start at any age, including childhood
Risk is higher if you have psoriasis and a family history of PsA
Certain genes increase susceptibility

Types of Psoriatic Arthritis

PsA presents in several different patterns, and people may have features of more than one type:

Symmetric Polyarthritis

Similar presentation to rheumatoid arthritis
Affects multiple joints on both sides of the body
Commonly involves small joints of hands and feet
Most common form (~50% of cases)

Asymmetric Oligoarthritis

Affects fewer than 5 joints
Different joints on each side
Often larger joints: knee, ankle, wrist
May be milder but can progress

Distal Interphalangeal Predominant

Primarily affects the small joints at the ends of fingers and toes
Often associated with nail changes
Distinctive for PsA (rare in RA)
About 5-10% of cases

Spondylitis

Involves the spine and sacroiliac joints
Causes back pain and stiffness
Symptoms worse in morning, improve with activity
Similar to ankylosing spondylitis
About 20% of cases

Arthritis Mutilans

Most severe form (rare, ~5%)
Causes significant bone destruction
Can lead to telescoping fingers
Results in permanent deformity
Fortunately, much less common with modern treatment

Recognizing the Symptoms

Joint Symptoms

Pain and swelling:

Joints are painful, swollen, and warm
May be red or purple
Different pattern than osteoarthritis

Morning stiffness:

Stiffness lasting 30+ minutes in the morning
Improves with activity
Worse after periods of inactivity

Dactylitis (sausage digits):

Entire finger or toe swells uniformly
Distinctive for PsA
Very useful for diagnosis
Can be quite painful

Enthesitis:

Inflammation where tendons attach to bone
Common sites: heel (Achilles), bottom of foot (plantar fascia), elbow
Often misdiagnosed as tendinitis or plantar fasciitis
Key feature that distinguishes PsA from RA

Skin and Nail Symptoms

Psoriasis:

Red, scaly patches (plaques)
Common sites: scalp, elbows, knees, lower back
May be hidden: scalp, umbilicus, between buttocks
Can be mild and easily overlooked

Nail changes:

Pitting (small depressions in nail surface)
Onycholysis (nail separating from nail bed)
Discoloration (yellow-brown)
Thickening
Present in ~80% of people with PsA
Strong predictor of who with psoriasis will develop PsA

Systemic Symptoms

Fatigue (often significant)
Eye inflammation (uveitis)
Inflammatory bowel disease (increased risk)
Cardiovascular disease (increased risk)

Diagnosis

There’s no single test that confirms PsA. Diagnosis is based on clinical assessment, medical history, and supporting tests.

What Your Doctor Will Assess

Presence of psoriasis (current or past, even mild)
Family history of psoriasis or PsA
Pattern of joint involvement
Presence of dactylitis or enthesitis
Nail changes
Response to NSAIDs

Tests

Blood tests:

Rheumatoid factor: Usually negative in PsA
Anti-CCP antibodies: Usually negative
ESR and CRP: May be elevated (inflammation markers)
HLA-B27: Positive in some, especially with spine involvement

Imaging:

X-rays: May show erosions, new bone formation
MRI: Detects early inflammation before X-ray changes
Ultrasound: Shows inflammation in tendons and joints

Why Early Diagnosis Matters

PsA can cause irreversible joint damage within the first two years of disease. Early, aggressive treatment can:

Prevent structural damage
Preserve joint function
Improve long-term outcomes
Achieve remission or low disease activity

If you have psoriasis and develop joint symptoms, see a rheumatologist promptly.

Treatment Options

Goals of Treatment

Reduce pain and inflammation
Prevent joint damage
Maintain function and quality of life
Manage skin disease
Achieve remission or minimal disease activity

First-Line Treatments

NSAIDs:

Help with pain and mild inflammation
Not disease-modifying
May be sufficient for very mild PsA

Physical therapy:

Maintains strength and flexibility
Important throughout treatment
Helps prevent disability

Disease-Modifying Treatments (DMARDs)

For most people with PsA, disease-modifying treatment is needed to prevent damage.

Traditional DMARDs:

Methotrexate: Most commonly used; helps both joints and skin
Sulfasalazine: May help peripheral joints
Leflunomide: Alternative to methotrexate

Biologic therapies: Biologics have transformed PsA treatment. Options include:

TNF inhibitors:

Humira (adalimumab)
Enbrel (etanercept)
Remicade (infliximab)
Simponi (golimumab)
Cimzia (certolizumab)

IL-17 inhibitors:

Cosentyx (secukinumab)
Taltz (ixekizumab)
Siliq (brodalumab)

IL-12/23 inhibitors:

Stelara (ustekinumab)

IL-23 inhibitors:

Tremfya (guselkumab)
Skyrizi (risankizumab)

JAK inhibitors:

Xeljanz (tofacitinib)
Rinvoq (upadacitinib)
Oral medications (not injections)

Choosing Treatment

Treatment selection depends on:

Severity of disease
Which areas are affected (skin, joints, spine, entheses)
Other health conditions
Insurance and cost considerations
Patient preference (pills vs. injections)

Many people achieve excellent control of both skin and joint disease with modern treatments.

What If Treatment Stops Working?

It’s common to switch biologics if one isn’t effective or loses effectiveness over time. Having multiple options means most people can find an effective treatment.

Living with Psoriatic Arthritis

Exercise and Movement

Regular exercise is crucial
Low-impact activities: swimming, cycling, walking
Strength training helps support joints
Flexibility exercises maintain range of motion
Work with a physical therapist initially

Diet and Lifestyle

Maintain a healthy weight (reduces joint stress)
Anti-inflammatory diet may help
Don’t smoke (worsens disease and reduces treatment effectiveness)
Limit alcohol (interacts with some medications)
Manage stress (can trigger flares)

Protecting Your Joints

Pace activities
Use assistive devices when helpful
Avoid repetitive stress on affected joints
Listen to your body and rest when needed

Managing Flares

Flares happen even with good treatment. During flares:

Rest the affected joints
Apply ice for inflammation
Contact your rheumatologist if severe
Take prescribed medications as directed

Frequently Asked Questions

Can PsA go into remission?

Yes. With modern treatments, many people achieve remission (no symptoms, no active inflammation) or minimal disease activity. This is more likely with early, aggressive treatment.

Will I definitely get PsA if I have psoriasis?

No. About 70% of people with psoriasis never develop PsA. However, you should be aware of joint symptoms and report them to your doctor promptly.

Can you have PsA without skin psoriasis?

Yes, in about 15% of cases, joint symptoms appear before any skin symptoms. Some people have very mild psoriasis that hasn’t been diagnosed, and occasionally PsA occurs without ever developing skin disease.

Is PsA worse than rheumatoid arthritis?

They’re different diseases with different patterns. PsA can be as severe as RA and, in some ways, is more complex because it involves skin, entheses, and spine in addition to joints. However, treatments are highly effective for both conditions.

Can PsA be prevented?

Currently, there’s no proven way to prevent PsA in people with psoriasis. Research is ongoing to identify high-risk individuals and test preventive treatments.

How does PsA affect life expectancy?

Untreated PsA is associated with increased cardiovascular disease risk and can affect life expectancy. With proper treatment and management of cardiovascular risk factors, people with PsA can have normal life expectancy.

Want to learn more about inflammatory joint conditions? Read our comparison of rheumatoid arthritis vs. osteoarthritis or explore our conditions hub.

Last medically reviewed: February 2025

Medical Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. If you have psoriasis and joint symptoms, please consult a rheumatologist for proper evaluation.