Psoriasis is a chronic inflammatory condition that leads to changes in the skin. In some cases, it can lead to psoriatic arthritis (PsA), which affects the joints.

A person with PsA may have swollen, inflamed joints, reduced movement, fatigue, and nail changes. Many people also experience skin symptoms.

PsA is a form of arthritis that can also affect people without psoriasis. Psoriasis and PsA both result from an immune system issue. There is growing evidence of the link between the two conditions, and doctors refer to them jointly as psoriatic disease.

Keep reading to learn about the symptoms and complications of PsA and when to speak with a doctor.

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The most common musculoskeletal symptoms of PsA are the following.

Swollen and painful joints

PsA can lead to pain and swelling in any joint in the body and in the entheses, where tendons and ligaments insert into bones. The joints and entheses, which are where the tendons and ligaments insert into bones, may also be warm to the touch, and the skin over them may appear flushed.

PsA most often affects the hands, fingers, feet, toes, knees, ankles, and spine. However, it can also affect the neck, wrists, and elbows.

PsA in the finger usually affects the joint closest to the nail.

Swelling in arthritis occurs when either the lining of the joint or the tissues surrounding it become inflamed. When this happens, more inflammatory cells and proteins enter the area around the joint or tendon, which further increases pressure, discoloration, and swelling.

The symptoms can vary in severity among individuals. In some people, arthritis and tendinitis may affect one or two joints, but others might experience involvement of many joints and tendons.

Stiffness and reduced movement

Many people experience stiffness, particularly in the morning or after prolonged rest. It can occurin any joint, with or without pain, and can limit movement.

Although there are many possible causes of temporary stiffness, morning stiffness that continues for more than 45 minutes could be a sign of inflammatory arthritis, such as PsA.

Swollen fingers and toes

One symptom specific to PsA is dactylitis, which causes swollen, “sausage-like” fingers and toes.

However, many other symptoms of PsA can resemble those of three other arthritic diseases, such as rheumatoid arthritis and reactive arthritis.

Rashes are a common symptom of PsA.

Typically, these rashes present as patches of itchy, dry skin with silvery-white scales, also known as plaques.

While PsA rashes can appear anywhere on the body, they are most common on the elbows, knees, and scalp.

PsA can trigger changes in the fingernails and toenails, known as nail psoriasis.

These include:

  • pits, or small depressions
  • detachment from the nail bed
  • discoloration

If the nail detaches from the nail bed, a person develops onycholysis, a lifting-up of the nail that can resemble a nail fungal infection.

A person with psoriasis who notices changes in their nails needs to speak with a doctor, who may suggest screening for PsA.

PsA can cause inflammation of the uvea, the middle layer of the eye, which is known as uveitis.

This can lead to pain and redness in the eye and can also cause vision problems, such as dark floating spots in the field of vision and increased sensitivity to light.

These symptoms can affect one or both eyes and may appear suddenly or progress gradually over time.

A person can develop other symptoms of psoriatic arthritis, including the following.

Fatigue

As with other types of inflammatory arthritis, PsA can lead to fatigue.

A 2024 study investigated drivers of fatigue in patients with psoriasis and psoriatic arthritis.

Researchers found that fatigue was more severe in people with PsA than those with just psoriasis, and both groups experienced more fatigue than the general population. In particular, increased joint pain was linked to higher fatigue levels.

People with PsA may be more prone to other conditions, including obesity, diabetes, sleep problems, depression, and anxiety. These can also lead to fatigue.

Lower back pain

Some peoplewith PsA may develop spondylitis, a condition that involves inflammation of the joints between the bones of the spinal cord or pelvis.

In addition to causing lower back pain, spondylitis can lead to decreased flexibility and posture changes over time.

Chest pain

In some cases, PsA can cause chest pain.

This pain is often due to a condition called costochondritis, which is the inflammation of the cartilage that connects the ribs to the breastbone.

People with PsA also have a higher risk of developing heart disease, which can cause chest pain, among other symptoms, and require immediate medical attention.

Due to the severity of these conditions, people with PsA who experience chest pain need to talk with a doctor to determine the cause and the best course of treatment.

A person needs to speak with a doctor if they have any new or worsening signs of psoriasis or PsA. If individuals have psoriasis and a family history of psoriatic disease, the doctor may recommend testing for PsA.

The following tests can help determine whether PsA is present:

What does a psoriatic arthritis flare-up feel like?

During a PsA flare, symptoms may become more intense and significantly affect a person’s daily life. For example, a person may experience:

  • fatigue
  • like their bones hurt
  • widespread discomfort
  • worsening painful, swollen joints
  • worsening skin disease
  • worsening spinal pain

However, PsA flare-ups can vary widely, while the severity, duration, and specific symptoms can differ from person to person.

What happens if psoriatic arthritis is not treated?

Without treatment, PsA can lead to permanent bone and joint damage. Those with a diagnosis of this condition must receive appropriate treatment.

What is a person’s life expectancy with psoriatic arthritis?

PsA does not usually affect life expectancy, but a person with psoriatic disease may have a higher risk of other conditions, such as:

Psoriatic arthritis (PsA) is a chronic inflammatory condition that can occur alongside psoriasis or independently.

It can affect the muscles, bones, joints, skin, nails, and eyes. People with PsA may experience additional symptoms such as fatigue, lower back pain, and chest pain.

Diagnosis involves physical exams, blood tests, and imaging techniques such as MRI and X-rays. Early treatment is crucial to prevent joint damage and manage symptoms effectively.