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Psoriatic arthritis symptoms: What are the early warning signs of psoriatic arthritis?

Medically reviewed by Anne Jacobson, MD, MPH
Board-Certified Family Physician
Updated Jun 10, 2024  •  Published Oct 19, 2023
Fact Checked
In this article:

Overview: What does psoriatic arthritis feel/look like?

Nearly 1 in 3 people with psoriasis also experience psoriatic arthritis, or PsA, during psoriasis flares. Psoriasis is a chronic inflammatory condition that primarily affects the skin. It causes skin plaques, rashes, nail changes, mouth sores, and other problems. As an autoimmune disease, psoriasis turns the immune system against healthy tissues in the body. While the skin is primarily affected, a psoriasis flare-up can target other body parts, including the joints. This results in joint swelling, stiffness, pain, and reduced flexibility, similar to rheumatoid arthritis. Unlike rheumatoid arthritis, psoriatic arthritis often involves tendon swelling (enthesitis). Early symptoms of psoriatic arthritis are often limited to a few joints. Eventually, other joints are involved, including the spine. This results in neck and back pain. In most cases, the earliest indicators of psoriatic arthritis are psoriasis symptoms elsewhere in the body. However, some people may experience psoriatic arthritis before having other signs of psoriasis.

RELATED: Learn about these 8 common types of arthritis

Key takeaways:

  • Psoriatic arthritis is a common health condition that can affect anyone regardless of age, sex, race, or ethnicity. Find updated psoriatic arthritis statistics here.

  • Early signs of psoriatic arthritis include joint pain, swelling, stiffness, and reduced range of movement in a few joints.

  • Serious symptoms of psoriatic arthritis, such as high fever, unusual or severe pain, hot joints, bone breaks, or serious side effects of medications, may require immediate medical attention.

  • Psoriatic arthritis is caused by an autoimmune disease, so a combination of genetics and environmental triggers causes individual flare-ups. You may be at risk for developing psoriatic arthritis symptoms if you have psoriasis or an immediate relative with psoriasis.

  • Psoriatic arthritis requires a medical diagnosis.

  • Psoriatic arthritis generally requires treatment. Psoriatic arthritis symptoms typically improve, and the progress of the disease slows down with treatment.

  • Treatment of psoriatic arthritis may include pain relievers, injected corticosteroids, conventional disease-modifying anti-rheumatic drugs (DMARDs), biologic DMARDs, physical therapy, and occupational therapy. Read more about psoriasis treatments here.

  • Untreated psoriatic arthritis could result in complications like permanent joint damage, joint deformity, disability, and weight gain (due to lack of exercise or immobility).

  • Use coupons for psoriatic arthritis treatments like methotrexate, Xeljanz (tofacitinib), and Orencia (abatacept) to save up to 80%.

What are the early signs of psoriatic arthritis?

Most people with psoriatic arthritis (68%) first experience psoriasis as a skin disease. However, about 1 in 6 people have their first psoriatic arthritis symptoms before noticing other symptoms of psoriasis. 

For people who already have psoriasis symptoms, early warning signs that psoriatic arthritis may eventually develop include:

  • Tendon swelling 

  • Swelling of entire fingers or toes (another form of tendon swelling)

  • Nail changes (pitting, crumbling)

  • Nail bed disease (“oil spots,” nail separation)

  • Uveitis (eye redness, swelling, or pain)

When people first experience psoriatic arthritis, it will typically involve joint pain, swelling, stiffness, and reduced range of motion in just a few joints.

RELATED: What are the early signs of psoriasis?

Other psoriatic arthritis symptoms

Psoriatic arthritis is a complex disease with several symptoms involving the joints, the skin, the eyes, and the tendons. These symptoms don’t always occur together. The severity of one set of symptoms during a flare may not be mirrored by the severity of other symptoms.

The joint symptoms of active psoriatic arthritis can affect any joint and include:

  • Joint pain

  • Joint swelling

  • Reduced range of motion in the joint

  • Morning stiffness

  • Neck pain (if the spine is affected)

  • Back pain

The tendons around a joint can also be affected, causing symptoms such as:

  • Tendon swelling, tenderness, and pain

  • Finger and toe swelling (“sausage fingers” or “sausage toes”)

Common skin symptoms include:

  • Raised, discolored, and scaly patches on the skin

  • Red skin patches without scales

  • Skin patches covered in pus-filled bumps

  • Skin discoloration

  • Skin swelling

  • Dry skin

  • Cracked skin

  • Mouth sores

Nail symptoms include:

  • Pitted, cracked, spotted, ridged, or crumbling fingernails or toenails

  • Nail separation

  • Spots

  • Thick skin growth under the nail

  • Streaks of blood under the nail

Other common symptoms of a psoriasis flare-up include:

  • Dry eye

  • Eye redness

  • Eye pain

  • Vision changes

  • Eyelid swelling

  • Drooping eyelids

  • Eyelash loss

Psoriatic arthritis vs. osteoarthritis symptoms 

While psoriatic arthritis is an inflammatory disorder, osteoarthritis is a noninflammatory degenerative condition. Simply put, osteoarthritis results from mechanical stresses and injuries that damage the tissues between joints, including cartilage, bone, ligaments, and other tissues. Osteoarthritis can result from age, overuse, poor joint alignment, weak muscles, injury, or excess body weight. Because psoriatic arthritis is an autoimmune disease, joint symptoms come and go with disease activity, though damage to the joint may be permanent. Osteoarthritis is due to irreversible joint damage, so symptoms are more constant and predictable. 

Psoriatic arthritis Osteoarthritis
Shared symptoms
  • Joint pain
  • Joint swelling
  • Joint stiffness
  • Reduced range of motion and flexibility in the affected joints
  • Morning stiffness
Unique symptoms
  • Joint problems are worse during active flare-ups and may fade between flares
  • Psoriasis skin symptoms such as skin patches, skin rashes, or nail cracking
  • Permanently discolored skin
  • Other symptoms such as mouth sores, eye problems, tendon swelling, and eyelid problems
  • Joint pain usually occurs as the result of an activity, but it could also be persistent
  • Limited range of motion typically improves with activity
  • Clicking, popping, or grating sound when the joint is moved
  • Joint instability
 

RELATED: Osteoarthritis vs. rheumatoid arthritis symptoms

Types of psoriatic arthritis: How can I tell which one I have?

In addition to diagnosing someone with psoriatic arthritis, healthcare professionals typically make distinctions based on what joints are involved and the severity of the joint damage:

Asymmetric oligoarticular arthritis 

  • Involves less than five joints

  • Most common early form of PsA

Symmetric polyarticular arthritis

  • Involves more than five joints

  • Can look similar to rheumatoid arthritis

  • Most people with PsA will eventually develop polyarticular arthritis

Distal arthritis primarily

  • Involves the fingers, toes, wrists, and ankles

  • Affects about 12% of people with PsA p

Spondyloarthritis

  • Swelling in the spinal joints and ligaments 

  • Pain and stiffness in the neck and back

  • About 30% of people with PsA develop spondyloarthritis

Arthritis mutilans

  • Severe and irreversible damage to the joints

  • About 16% of people with PsA eventually develop this most severe and debilitating form

When to see a doctor for psoriatic arthritis symptoms

See a doctor when experiencing any signs of arthritis or psoriasis. Psoriasis and psoriatic arthritis are serious medical conditions that can get worse. Left unchecked, psoriatic arthritis can permanently damage or deform joints.

In some cases, people with psoriatic arthritis may need immediate medical care, either urgent or emergency treatment. The Arthritis Foundation advises people to seek urgent care if they experience high fever, hot and swollen joints, unusual joint swelling, severe abdominal pain, or a severe PsA flare-up. Psoriatic arthritis weakens bones, so bone fractures may require immediate treatment. Psoriasis medications may have serious side effects, particularly blood clots, so any symptoms of a blood clot, heart attack, or stroke also require emergency treatment.

While most people will first report their symptoms to a primary care physician, psoriasis that involves the joints is usually treated by a rheumatologist. The skin symptoms may be treated by a dermatologist. The diagnosis of psoriatic arthritis will be made based on a medical history, a physical examination, a skin examination, a blood test, and X-rays. A clinician may also require an MRI, ultrasound, or CT scan. 

There is no definitive test for psoriatic arthritis. Instead, clinicians make their diagnosis by assigning scores to certain indicators. The overall score gives them a probability that the problem is psoriatic arthritis and not something else. These criteria include: 

  • Presence, past history, or family history of skin psoriasis

  • History or presence of nail symptoms

  • History or presence of swollen fingers or toes (dactylitis)

  • No rheumatoid factor in the blood

  • New bone formation next to the joints or tendons as seen in an X-ray or CT scan

Complications of psoriatic arthritis

Psoriasis has several complications related to skin, eye, and organ problems. Psoriatic arthritis, in particular, can lead to complications such as:

  • Permanent joint damage

  • Joint deformity

  • Disability

  • Obesity due to lack of exercise 

How to treat psoriatic arthritis symptoms

Healthcare professionals have three goals when treating psoriatic arthritis: relieving symptoms, minimizing joint damage, and preserving the quality of life. People with psoriatic arthritis will also be treated for the disease’s effects on the skin, eyes, and other body parts.

To relieve symptoms of an active flare-up, healthcare providers will use:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief and to reduce inflammation

  • Corticosteroid injections as an add-on to NSAID treatment

  • Oral disease-modifying anti-rheumatic drugs (DMARDs) to suppress the immune system

  • In some cases, an injectable biologic DMARD will be used to suppress the immune response

To increase quality of life, treatments may include physical therapy and occupational therapy.

RELATED: Everything you need to know about biologics for psoriasis

Living with psoriatic arthritis

Psoriatic arthritis is both a chronic and progressive condition. Even so, there are many things people can do to slow its progress and control symptoms:

  • Follow all instructions given by healthcare providers.

  • Understand the medications you’re taking and know their side effects.

  • Get medical help at any sign of a flare-up or medication side effects.

  • Keep a diary of symptoms, side effects, and how they affect your life. Share this information with healthcare providers and therapists.

  • Get physical therapy and occupational therapy when needed.

  • Get assistive devices for home or work and accommodations at work if needed.

  • Maintain a healthy weight. Excess weight can increase the severity of symptoms and the joint damage caused by flares.

  • Exercise—physical activity not only improves joint flexibility, it prevents weight gain and any related conditions such as high blood pressure or diabetes.

  • Eat a healthy diet.

  • Quit smoking.

RELATED: What it’s really like living with psoriasis

Most importantly, see a doctor

Psoriasis and psoriatic arthritis are serious medical conditions that will require a lifetime of treatment. To avoid complications, disability, and compromised quality of life, see a doctor when you have symptoms of arthritis or psoriasis. Only an experienced doctor can diagnose and appropriately treat psoriasis. 

What’s next? Additional resources for people with psoriatic arthritis symptoms

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Anne Jacobson, MD, MPH
Board-Certified Family Physician

Anne Jacobson, MD, MPH, is a board-certified family physician, writer, editor, teacher, and consultant. She is a graduate of University of Wisconsin School of Medicine and Public Health, and trained at West Suburban Family Medicine in Oak Park, Illinois. She later completed a fellowship in community medicine at PCC Community Wellness and a master's in Public Health at the University of Illinois-Chicago. She lives with her family near Chicago.

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