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Psoriatic Arthritis: Symptoms, Causes, Diagnosis & Treatment

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Psoriatic arthritis is related to psoriasis. This can affect your joints and be responsible for issues like joint deformity and joint pain.

Written byDr. Sneha Kannan

Medically reviewed byDr. Anshul Varshney

Published At March 9, 2020
Reviewed AtMay 29, 2026

What Is Psoriatic Arthritis?

A few people with psoriasis can develop psoriatic arthritis (PsA). Psoriasis is a skin and scalp condition. This causes red patches of skin with silvery scales. Some people develop joint issues after having skin problems. Sometimes, joint problems begin before skin lesions.

Though the global prevalence of this is relatively low, a large number of people from developing countries suffer from this. Even 3.3 million people in the United States alone suffer from this.

Types of Psoriatic Arthritis?

The types of psoriatic arthritis are:

  1. Symmetric PsA: Almost half of the cases belong to this group. Similar joints on both sides of your body are affected. This type causes rheumatoid arthritis.

  2. Asymmetric PsA: This is the second most prevalent type affecting almost 35% patients. This type affects the joints of one side of your body.

  3. Distal interphalangeal predominant PsA: This affects almost 10% of the patients. Your joints near your nails are affected by this type.

  4. Spondylitis PsA: This type of arthritis damages your spine.

  5. Psoriatic arthritis mutilans: This is a rare and severe type that aggressively damages your bones. Psoriatic arthritis mutilans causes a crooked appearance and shortening of your hands and legs.

However, this classification is based on 1973. The current classification says psoriatic arthritis has the following types;

  • Peripheral Arthritis: Involvement of joints in the hands, feet, knees, wrists, and other peripheral joints.

  • Axial Disease: Involvement of the spine and sacroiliac joints, causing back pain and stiffness.

  • Enthesitis: Inflammation where tendons or ligaments attach to the bone, commonly affecting the heels or elbows.

  • Dactylitis: Diffuse swelling of an entire finger or toe, often called sausage digits.

  • Skin Psoriasis: Presence of psoriatic skin lesions of varying severity.

  • Nail Disease: Nail pitting, thickening, discoloration, or nail separation.

This is the GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) classification based on involvement of the disease.

classification based on involvement of the disease.

What Are the Signs and Symptoms of Psoriatic Arthritis?

Common features include:

  • Enthesitis: Pain and inflammation where tendons or ligaments attach to the bone, especially around the heels, soles, or elbows.

  • Dactylitis: Swelling of an entire finger or toe, giving a sausage-like appearance.

  • Morning stiffness and fatigue are common, especially after rest.

  • Nail pitting, nail thickening, or nail separation may occur.

  • Some patients develop lower back pain due to spinal involvement.

Spondylitis PsA results in back pain and stiffness, and pain in the hips, knees, elbows, feet, wrists, and toes. Symmetric PsA commonly affects five or more joints on both sides of the body, while asymmetric PsA affects fewer than five joints on either side of the body. Psoriatic arthritis mutilans results in joint deformation.

Diagnostic criteria used in psoriatic arthritis include:

  • CASPAR (Classification Criteria for Psoriatic Arthritis) Criteria: Uses features like psoriasis, nail changes, negative rheumatoid factor, dactylitis, and imaging findings.

  • GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) Recommendations: Help assess joint, skin, nail, spinal, and enthesitis involvement for diagnosis and treatment planning.

What Causes Psoriatic Arthritis?

Psoriatic arthritis is an autoimmune disease. As your body's immune system attacks its own cells, the immunological response results in inflammation in the joints and overproduction of skin cells. Mostly, genetics and environmental factors seem to play a role.

Risk Factors:

  1. Psoriasis.

  2. A family history of psoriatic arthritis.

  3. If you are between 30 and 50.

  4. Viral or bacterial infection in people with family history of psoriasis.

How Is Psoriatic Arthritis Diagnosed?

The doctor will examine the joints to look for signs of swelling, check the nails for pitting, and will check for tenderness around the soles of your feet and heels. There is no specific test that can diagnose psoriatic arthritis. The doctor usually performs various tests to rule out all other conditions that can result in similar symptoms, such as rheumatoid arthritis or gout. The following tests might be needed:

  1. X-rays - The changes in the joints can be seen in psoriatic arthritis and not in other types of arthritis.

  2. Magnetic resonance imaging (MRI) - Here, strong radio waves and magnetic fields are used to produce detailed images of the joints and surrounding structures. The tendons and ligaments are checked using an MRI.

  3. Rheumatoid factor (RF) - This blood test detects the presence of RF, which is an antibody present in the blood of rheumatoid arthritis patients. In PsA patients, this antibody is absent.

  4. Joint fluid test - The fluid from the affected joint will be collected by your doctor using a needle. This fluid is then tested for the presence of uric acid crystals, which indicates gout.

Modern diagnostic tests for psoriatic arthritis are;

  • Rheumatoid Factor (RF): This blood test detects RF, an antibody found in the blood of patients with rheumatoid arthritis. In PsA patients, this antibody is absent.

  • Anti-cyclic Citrullinated Peptide (Anti CCP) Antibody Test: This blood test helps differentiate psoriatic arthritis from rheumatoid arthritis because Anti CCP is more commonly positive in rheumatoid arthritis.

  • Inflammatory Markers: Blood tests such as ESR and CRP may be elevated and can indicate ongoing inflammation in the body.

  • HLA B27 Testing: This genetic marker may be present in some patients, especially those with spinal involvement or sacroiliitis.

  • CT Scan: In selected cases, CT imaging may be used to assess complex joint damage or involvement of the spine and sacroiliac joints.

What Are the Treatment Options for Psoriatic Arthritis?

There is no cure for PsA, but treatment is done to control inflammation in the affected joints and to prevent permanent deformity. The treatment options include:

  • NSAIDs (nonsteroidal anti-inflammatory drugs): Painkillers like ibuprofen and Naproxen sodium help to reduce joint pain and inflammation.

  • Disease-modifying antirheumatic drugs (DMARDs): It helps in slowing the progression of psoriatic arthritis and prevent the tissue from permanent damage. Examples include Methotrexate, Leflunomide, and Sulfasalazine.

  • Immunosuppressants: As psoriatic arthritis is an immune disease, drugs that lower your immune response are helpful. Medicines like Cyclosporine and Azathioprine can control your immune response.

  • Biologic response modifiers: These DMARD drugs target the immune system responsible for inflammation in psoriatic arthritis. As a result, side effects related to your immune response can be avoided. These drugs are,

  1. Tumor Necrosis Factor (TNF) Inhibitors: TNF is related to inflammation. As a result, the drug which lower TNF levels helps to reduce joint problems. Commonly used medicines include Adalimumab, Etanercept, Infliximab, Golimumab, Certolizumab pegol, and Abatacept.

  2. Interleukin 17 (IL-17) Inhibitors: These medicines target IL-17, an important inflammatory pathway involved in psoriasis and joint disease. Examples include Secukinumab, Ixekizumab, and Bimekizumab.

  3. Interleukin 12 and 23 Inhibitors: These drugs block inflammatory proteins IL 12 and IL 23. Ustekinumab is commonly used in this group.

  4. Interleukin 23 Inhibitors: These newer biologics selectively target IL 23 and are highly effective for both skin and joint symptoms. Examples include Guselkumab, Risankizumab, and Tildrakizumab.

    • Apremilast: Your body's inflammation is triggered by different enzymes. This medicine controls those enzymes and reduces inflammation.

    • Joint Replacement Surgery - In severe cases, where the joints have been damaged beyond repair, the diseased joint is replaced with metal and plastic prostheses.

Home Remedies:

  • Avoid heavy and rigorous activities that can damage your joints.

  • Do not lift heavy weights.

  • Regular light exercises, mobility training, and flexibility exercises are helpful for your joints.

  • Do not smoke, and limit the intake of alcohol.

  • Rest and give your body time to heal.

What Are the Possible Complications of Psoriatic Arthritis?

In some cases, psoriatic arthritis can lead to

  1. Arthritis mutilans is very painful. It can cause disability by damaging small bones in the hands. It can lead to permanent deformity.

  2. Eye problems, such as conjunctivitis or uveitis, can happen due to psoriatic arthritis.

  3. It can damage your heart and hamper its natural function.

Conclusion:

Psoriatic arthritis is an immune disease that affects your joints. In most cases, your joint problems will appear after the skin issues. This disease not only causes pain in the joints but also leads to crooked joints and deformity of the toes and fingers. However, with modern medicines such as biologics, we can now treat it. If you have any queries regarding psoriatic arthritis, consult a rheumatologist for further information.

Key Takeaway:

  • Psoriatic arthritis is an immune disease that equally affects males and females.

  • Skin problems develop before the appearance of joint issues.

  • Pain in the joint, swelling, redness, and mobility issues are common symptoms.

  • Psoriatic arthritis can affect your eyes and heart.

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Frequently Asked Questions

Psoriatic arthritis is a chronic inflammatory disorder that causes severe pain in the joints. In severe cases, it can lead to a disability of the patient due to the permanent damage of the joints. It is not a life-threatening disease, yet it increases the risk of comorbidities like cardiovascular diseases, fatty liver disease, and diabetes.
Psoriatic arthritis primarily causes inflammation in the joints, which leads to pain, tenderness, and stiffness of those affected joints. A person affected with psoriatic arthritis might feel pain in just one or several bones. Psoriatic arthritis commonly affects the knee joints, small joints at the fingers, toes, ankles, and lower back. Patients are known to report severe pain only if they have a problem in several joints.
The most common trigger of psoriatic arthritis is stress. Stress is known to make symptoms worse. Medications like Lithium, antimalarials like Hydroxychloroquine, beta-blockers like Propranolol, Quinidine, and Indomethacin, are also some triggers for psoriatic arthritis. Physical stress on the joints, due to obesity, can also make the inflammation worse.
The most commonly affected joints in psoriatic arthritis are:
- Knee joints.
- Metacarpophalangeal joints.
- Proximal and distal interphalangeal joints.
- Metatarsophalangeal joint.
- Ankle joints.
- Joints in the lower back region.
Psoriatic arthritis is not a disease that affects the life expectancy of the patients. It causes chronic inflammation and pain at joints. It leads to difficulty in maintaining a normal routine in those patients. People with psoriatic arthritis, however, may develop comorbidities like diabetes and hypertension, yet they have a good life.
If psoriatic arthritis is left untreated, it can cause permanent damage to the joints and bones. Chronic psoriatic arthritis that is not controlled by treatment may sometimes result in permanent disability. You should consult your doctor to get proper treatment options.
The most common causes of a flare-up episode in psoriatic arthritis are as follows.
- Uncontrolled stress.
- Excessive physical stress.
- Cold weather.
- Smoking.
- Intake of medications like Lithium, Hydroxychloroquine.
The common presentation in the hands of psoriatic arthritis patients is stiff, puffy, sausage-like fingers, which are seen along with joint pain and tenderness. The skin in the palms may look dry and reddish with patches of silvery-white scales.
The following are the factors that aggravate psoriatic arthritis.
- Cold weather.
- Exposure to cigarette smoke.
- Older age.
- Intake of chicken.
- Physical as well as mental stress.
The inflammation seen in psoriatic arthritis patients significantly has short-term effects such as severe pain and swelling in joints of the body. The usual reason for this severe pain is an altered immune response to certain triggers. Also, when there is a combination of inflammation and stress, it can make the patient more sensitive to pain. There is also no complete cure for this condition. These are some reasons why psoriatic arthritis hurts so bad.
The following are the foods that have to be avoided when a person is affected by psoriatic arthritis.
- Processed meats like hot dogs, sausages, bacon, etc.
- Alcoholic beverages.
- Sugary drinks.
- Processed foods such as packaged cakes, cookies, soda, etc.
- White bread.
- White rice.
- Candy.
Yes, when your psoriatic arthritis is not treated well, it can cripple you. However, it is very rare. The variant of psoriatic arthritis is known as arthritis mutilans, which is a severe form of psoriatic arthritis that could destroy the joints of your hands and feet, which leads to permanent disfigurement and disability of those joints.
The skin of a person affected with psoriatic arthritis looks very dry and warm. It has the presence of red patches and silvery-white scales. However, it is unique for some patients.
The feet of psoriatic arthritis patients look very painful, swollen, and warm due to the inflammatory process. The typical appearance of fingers and toes in this condition is described to be sausage-like.
Psoriatic arthritis is a chronic inflammatory disease that has no cure to date. It can get worse over time as the person becomes aged. Age is one of the essential and frequently noted factors for relapse of this condition. If we note these factors, the recurrence of this condition can be identified.
Disease-modifying antirheumatic drugs (DMARDs) are the most common class of drugs that are being used in the treatment of psoriatic arthritis. These drugs have the ability to slow the progression of psoriatic arthritis in complicated stages of the disease and save the joints and other affected tissues from permanent damage. The most commonly used disease-modifying antirheumatic drugs (DMARDs) include Methotrexate, Leflunomide, and Sulfasalazine.
Psoriatic arthritis can never be diagnosed with the help of a simple blood test. Since the symptoms of psoriatic arthritis are often similar to the symptoms of rheumatoid arthritis, the doctor will always need to order a blood test to rule out rheumatoid arthritis. The blood test will determine if the person’s blood is positive for rheumatoid factor or not. Psoriatic arthritis does not have a positive rheumatoid factor.
There are many tests that can help in diagnosing psoriatic arthritis. That includes blood tests, X-ray, magnetic resonance imaging (MRI), and ultrasound of the affected joint. You should get recommendations from your doctor for performing these diagnostic tests.
Usually, rheumatoid arthritis and psoriatic arthritis present with very similar symptoms, and the treatment provided are usually the same. The only visible difference is the typical appearance of joints of the hands and feet in psoriatic arthritis, which has the silvery scales in the skin and fingers, which are sausage-like in nature.
Yes, psoriatic arthritis can go into remission. Certain factors can cause a remission of this condition that includes older age, chronic stress, physical trauma, intake of foods like chicken, winter weather, and smoking.
There is no definitive cure for psoriatic arthritis yet. However, certain day to day changes can help in decreasing the frequency of flare-up episodes and the severity of symptoms. That includes
- Make exercise as a routine activity so that it can strengthen the joints and prevent permanent disability.
- Proper treatment from a rheumatologist and regular follow-ups.
- Cope with stress by mindfulness practices and yoga. It can reduce the main triggers.
- Maintain personal hygiene at all costs since it can prevent superficial infections.
- Quit smoking and alcoholism.
There is no drug that can permanently cure the pain caused by psoriatic arthritis. However, non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen, Naproxen can be used during acute flare-up episodes where severe pain is experienced. It is important to note that these drugs should always be taken with a proper prescription from a doctor in prescribed doses only. Increased intake of these drugs can lead to peptic ulcers as well as liver toxicity.
Yes, with proper medical management and avoidance of triggers, patients affected with psoriatic arthritis can live a very normal life like any other person. Only if psoriatic arthritis is not well-treated, patients might develop permanent joint damage that leads to disability.
A rheumatologist is a specialist who will deal with diseases like psoriatic arthritis and rheumatoid arthritis. It is sometimes necessary to follow a multi-disciplinary approach.
Vitamin D containing topical ointments are being used around the world to treat psoriasis at the initial stage. The reason behind the use of this vitamin is that vitamin D can change the way cells grow.
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