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Psoriatic arthritis (PsA) is a type of inflammatory arthritis related to psoriasis. Approximately one-third of people with psoriasis are affected by psoriatic arthritis. PsA generally affects the joints and the areas where ligaments and tendons connect to bones.
Psoriatic arthritis and psoriasis are autoimmune conditions — conditions that occur when the immune system mistakenly attacks healthy tissues, such as your skin and joints. Inflammation from the body’s overreacting immune response leads to symptoms of psoriasis and PsA.
Psoriatic arthritis is distinct from osteoarthritis, which is caused by the normal wear and tear of aging, rather than inflammation. Psoriatic arthritis is caused by several factors. Researchers have identified dozens of genetic variants that may make a person more likely to develop psoriasis and PsA.
Most scientists believe that genetics and environmental factors both contribute to psoriatic arthritis, but they’re still working to understand exactly why a person develops the condition. Researchers believe that environmental factors — a physical injury, a virus, or an infection like strep throat — may trigger the development of psoriatic arthritis for some people who are genetically predisposed. These are all situations that set off an immune response.
Having psoriasis is the primary risk factor for developing psoriatic arthritis. Psoriatic arthritis affects about 30 percent of people with psoriasis, according to the National Psoriasis Foundation. Psoriatic arthritis usually develops in people between the ages of 30 and 50. However, not everyone with psoriatic arthritis receives a psoriasis diagnosis first. Between 10 percent and 15 percent of people with psoriatic arthritis experience joint symptoms without ever having skin symptoms.
Having a family history of psoriasis or psoriatic arthritis is another risk factor. Whereas being female is sometimes a risk factor for other autoimmune conditions, psoriatic arthritis affects all genders equally.
How Would You Know If Psoriasis Was Progressing to Psoriatic Arthritis?
Watch dermatologist Dr. Raja Sivamani talk about how you can tell if your psoriasis is progressing to psoriatic arthritis.
00;00;00;00 - 00;00;24;04
Eric Peacock
How would someone with psoriasis know whether their condition is progressing to psoriatic arthritis?
Dr. Sivamani
Yeah, this is a really important question. Psoriatic arthritis is an interesting one because it can show up before your skin psoriasis shows up. It can show up during or it can show up after. So there's no rhyme or reason to, it has to go one way. or it has to go another way.
00;00;24;07 - 00;00;41;18
Dr. Sivamani
I also tell a lot of my residents and medical students that we read things in a textbook, but the patients don't read the textbook, so they come in doing whatever they want to do. So when it comes to arthritis, this is known as an inflammatory arthritis. What does that mean? It's different from osteoarthritis, which is the classic arthritis.
00;00;41;18 - 00;01;04;09
Dr. Sivamani
You know you're doing a lot of work. You're starting to feel run down, and your joints get really tired or painful from a long day's worth of work. Inflammatory arthritis is the opposite. And what you have there is, if you're sitting still, or sitting in a car, driving for a long amount of time, or you're resting, getting up after a night's rest, your joints start to stiffen up, which is the opposite of overuse kind of arthritis.
00;01;04;16 - 00;01;28;25
Dr. Sivamani
Here what happens is, as you start to move, your joints start to become more fluid and less painful, but if you have prolonged stiffness, and I don't want to just call it morning stiffness. I mean, if you have a long drive in the car to and from work, sometimes you need some time to warm up. If you're finding yourself taking 30 minutes, especially if it's an hour to two hours to really loosen up those joints or you're having pain, that's important to talk to your doctor about.
00;01;29;00 - 00;01;48;10
Dr. Sivamani
Psoriasis can really affect any of the joints of the hands, on the feet, and you really have to, you know, just pay attention to that, and sometimes you can get swelling on just one particular digit, as we say, like one finger or one toe, but the hidden area of psoriasis is your back, your lower back, the sacral, what we call the sacroiliac joints.
00;01;48;13 - 00;02;07;25
Dr. Sivamani
And so, if you have this just constant back pain that seems to really stiffen up on you, and takes you some time to loosen that up, and that's one that really affects people with driving as well, because you're just sitting there for long periods of time. And, you know, when you get out of the car, if you're like, “Oh man, this is really painful, or this is really stiff,” that's another thing to pay attention to,
00;02;07;25 - 00;02;22;16
Dr. Sivamani
and your doctor can do x-rays or just go through history to think about, “Hey, is psoriasis arthritis starting to become an issue for me?” And so, those are some of the things that you want to pay attention to.
Your dermatologist or primary care physician may refer you to a rheumatologist if you have symptoms of psoriatic arthritis. A rheumatologist is trained to diagnose and treat joint and tendon symptoms, while a dermatologist is focused on the skin symptoms of psoriasis and other skin conditions. Early diagnosis and treatment of psoriatic arthritis are associated with better outcomes.
A rheumatologist will conduct a physical exam and take a medical history. Your doctor will check to see if your joints are swollen or tender. They will likely pay special attention to your fingers and toes. They may recommend various tests to look for signs of psoriatic arthritis and to rule out other possible causes.
There is no single test for diagnosing psoriatic arthritis. A rheumatologist will need to look at several factors before making a diagnosis. A final diagnosis will be based on your symptoms and the results of various tests.
A rheumatologist may order an imaging test to look for signs of psoriatic arthritis. X-rays can detect severe bone changes that can be caused by psoriatic arthritis, and they are most effective at diagnosing later-stage PsA. They’re not as good at detecting early-stage psoriatic arthritis.
Ultrasound and magnetic resonance imaging (MRI) may also be used to look for inflammation of joints and tendons. These tests can detect early changes in psoriatic arthritis, such as inflammation in the tendons or the joints of the back and pelvis. They can also help rule out other possible diagnoses.
No specific blood test can confirm a psoriatic arthritis diagnosis. Instead, blood tests are used to detect inflammation and rule out other types of arthritis. Below are some types of blood tests your doctor may order:
Biopsies are sometimes used to help confirm a diagnosis of psoriatic arthritis or rule out other conditions. Your doctor may perform the following types of procedures:
Psoriatic arthritis causes joint pain, swelling, and stiffness. Psoriatic arthritis symptoms may be mild or have a severe impact on quality of life. Below are some psoriatic arthritis symptoms to look out for.
Also referred to as “sausage digits,” dactylitis is a painful, red or purple swelling in the fingers and toes. It’s often the first symptom of psoriatic arthritis.
People with psoriatic arthritis may have enthesitis, a condition characterized by pain or tenderness where ligaments and tendons attach to bone. Enthesitis most frequently occurs in the heels and bottoms of the feet, though it can also affect the elbows, knees, and ribs.
White spots, flaking, pitting (shallow or deep dents on your nails), or lifting of the nail bed may also be symptoms of psoriatic arthritis. Up to 90 percent of people with psoriatic arthritis experience nail changes, much more frequently than people who only have skin psoriasis.
Itchy, scaly, red, purple, or silvery lesions appear prior to the onset of psoriatic arthritis in approximately 75 percent of people with psoriatic arthritis. Psoriasis plaques can appear on the skin 10 to 20 years before joint symptoms.
Not all psoriatic arthritis symptoms affect the skin and joints. Other possible symptoms include uveitis (an inflammatory eye condition more often associated with a positive HLA-B27 test result), inflammatory intestinal diseases, and general symptoms such as fatigue.
Psoriatic arthritis can be broken into five categories defined by the impacted joints. It’s possible to have more than one type of psoriatic arthritis.
An estimated 35 percent of people with psoriatic arthritis have this type. Asymmetric oligoarthritis typically involves five or fewer joints. It’s known as asymmetric arthritis because it typically doesn’t affect both sides of the body in the same place. For example, it might appear in only one knee or one elbow.
Symmetric polyarthritis is one of the most common types of psoriatic arthritis — half of all people with PsA are estimated to have this type. Symmetric polyarthritis affects five or more corresponding joints on both sides of the body. This type of psoriatic arthritis is similar to rheumatoid arthritis, but it can be differentiated by a few factors, including a negative RF blood test.
Psoriatic arthritis that affects the lower back and spine is a type of spondylitis (also called spondyloarthritis). About 5 percent of people with psoriatic arthritis have spondylitis and will have a positive HLA-B27 test.
Distal arthritis causes inflammation and stiffness in the distal interphalangeal joints, those closest to the tips of fingers and toes. According to Cleveland Clinic, this type affects about 10 percent of people with psoriatic arthritis, usually men. Nail changes are also common with distal arthritis.
Arthritis mutilans is the rarest and most severe type of psoriatic arthritis. This form of PsA attacks joints in the hands and feet, causing deformities and impaired movement.
There is no cure for psoriatic arthritis, but different treatment options can control disease activity, reduce symptoms, and protect joint mobility. Treatment generally aims to manage pain, reduce inflammation, and slow disease progression. Below are the main classes of medications used to treat psoriatic arthritis.
Traditional disease-modifying antirheumatic drugs, or DMARDs, help reduce joint damage, slow disease progression, and relieve symptoms by suppressing the immune system. These include:
Biologics, sometimes called biologic DMARDs, target specific proteins that contribute to inflammation in psoriatic arthritis. They may be prescribed when traditional DMARDs are ineffective. Biologic DMARDs block certain proteins in the body that maintain inflammation. The following biologics are FDA-approved for treating psoriatic arthritis:
Ustekinumab (Stelara)
Spesolimab-sbzo (Spevigo)
Abatacept (Orencia)
Biosimilars are available for certain biologic medications. Biosimilars are highly similar to previously approved biologic medications, but they are often more affordable. They are used to treat psoriatic arthritis in the same way as the original biologic. Talk to your dermatologist if you’re interested in learning more about them.
Janus kinase (JAK) inhibitors block enzymes that contribute to the inflammatory process in autoimmune conditions. These are typically used when other treatments haven’t been effective. FDA-approved JAK inhibitors for psoriatic arthritis include:
Other treatments used to manage psoriatic arthritis include:
For mild cases of psoriatic arthritis, nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to manage symptoms like pain and swelling. NSAIDs work best for people who have psoriatic arthritis with spondylitis. Common NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve).
Physical therapy can help manage psoriatic arthritis. For severe joint damage, surgery may be appropriate. Lifestyle changes like eating a healthy diet and quitting smoking can also help.
When someone has more than one health condition at the same time, the conditions are known as comorbidities. Cardiovascular diseases are the most common condition present in combination with psoriatic arthritis. Diabetes and metabolic dysfunction-associated steatotic liver disease (previously known as nonalcoholic fatty liver disease) are other conditions that many people have in addition to psoriatic arthritis.
MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 131,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.
Do you have psoriatic arthritis? What symptoms did you first notice? Share your experience in the comments below, or start a conversation on your Activities page.
Florentina Negoi, M.D.
attended the Carol Davila University of Medicine and Pharmacy in Bucharest, Romania, and is currently enrolled in a rheumatology training program at St. Mary Clinical Hospital.
Learn more about her here.
Alison Channon
has nearly a decade of experience writing about chronic health conditions, mental health, and women's health.
Learn more about her here.
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I was diagnosed with PsA in August 2023 that affects my lower back from hip to hip and includes my hips along with my feet and hands. My rheumatologist put me on Otezla which didn’t work at all. I… read more
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