Mainly occurs in the fingers (in the joints closest to the nail), wrists, ankles and knees. Symptoms such as pain, tenderness, warmth and swelling, may affect different sides of the body (right hand and left knee). This may be referred to as peripheral arthritis.
It usually causes dry, red skin lesions (plaques) covered with silvery scales. Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis — a disease that causes red patches of skin topped with silvery scales.
Most people who develop psoriatic arthritis already have psoriasis (a skin disease) when they are diagnosed, but a small fraction have joint pain before the skin rash. Symptoms appear in different patterns in different people, which can make the disease hard to diagnose.
The disease often appears between ages 30 and 50. For many people, it starts about 10 years after psoriasis develops, but some develop PsA first or without ever developing or noticing psoriasis.
Psoriatic arthritis causes inflamed, swollen, and painful joints. It happens most often in the fingers and toes. It can lead to deformed joints. Treatment may include medicines, heat and cold, splints, exercise, physical therapy, and surgery.
PsA is often undiagnosed and can be misdiagnosed for rheumatoid arthritis (RA) or osteoarthritis (OA), especially in a non-rheumatologic setting [7–9]. RA is a chronic inflammatory arthritis typified by pain, swelling, and stiffness of the joints, particularly symmetric small-joint synovitis of the hands and feet [10].
Erythrocyte sedimentation rate, or ESR or sed rate, is a blood test that measures inflammation in the body, which helps determine a psoriatic arthritis diagnosis, explains Elaine Husni, MD, MPH, vice chair of rheumatology and director of the Arthritis and Musculoskeletal Center at the Cleveland Clinic.
The Arthritis Foundation lists joint pain, stiffness, skin rashes, fatigue, nail changes, decreased range of motion, and swelling as some of the symptoms of psoriatic arthritis. When you combine these problems, the results can be debilitating. “It's like feeling your bones shatter and crumble.
Joint involvement is typically, but not always, asymmetric in PsA, while it is predominantly symmetric in RA. Bone erosions, without new bone growth, and cervical spine involvement are distinctive of RA, while axial spine involvement, psoriasis and nail dystrophy are distinctive of PsA.
Psoriatic arthritis causes joint pain, swelling, and stiffness. Psoriatic arthritis pain is described as worse in the morning or after resting, tender, throbbing, warm to the touch, and exhausting. It primarily affects the knees and ankles, but can also occur in the neck, lower back, hips, shoulders, heels, and feet.
So, basically rheumatoid arthritis and psoriatic arthritis are very similar and treatments are generally the same. The biggest difference is the joints involved in the hands and feet and the fact that psoriatic arthritis also involves psoriasis of the skin which is a persistent chronic disease in itself.
“Worsening joint pain and swelling, or new or worsening psoriatic lesions, are the most common red flags that someone is having a PsA flare,” says Yamen Homsi, M.D., the section chief of rheumatology at NYU Langone Hospital in Brooklyn, NY. But there may be other signs that a flare is on the way.
Blood tests can help diagnose psoriatic arthritis (PsA) and rule out other possible causes of joint pain and stiffness, such as rheumatoid arthritis (RA). Examples include tests for c-reactive protein (CRP) and rheumatoid factor. Doctors do not rely solely on blood tests to diagnose PsA.
Just like psoriasis, PsA can range from mild to severe. Mild PsA is sometimes referred to as oligoarticular, meaning it affects four or fewer joints in the body. More severe PsA is often called polyarticular, meaning it affects five or more joints.
Even so, the pain and discomfort associated with psoriatic arthritis can be significant. A study published in 2015 in the journal PLoS One found that the overall pain, joint pain, and fatigue reported by psoriatic arthritis patients was significantly greater than that reported by people with rheumatoid arthritis.
In fact, nearly 50 percent of patients with psoriatic arthritis report high levels of fatigue (five or higher on a 10-point scale) — and consider fatigue a high-ranking problem, after joint pain and before skin issues, according to a 2016 study published in the journal Joint Bone Spine.
“Psoriatic arthritis is a systemic inflammatory condition,” Gupta says. “Left untreated, it can result in fatigue and a general feeling of sickness.
Foods like fatty red meats, dairy, refined sugars, processed foods, and possibly vegetables like potatoes, tomatoes, and eggplants (you might hear them called nightshades) may all cause inflammation. Avoid them and choose fish, like mackerel, tuna, and salmon, which have omega-3 fatty acids.
Generally psoriatic arthritis is a mild condition. With proper treatment and help from others you can relieve joint pain and stiffness and keep skin problems under control. Some people however have a more serious disease and require combinations of medications to control symptoms and prevent joint damage.
You'll probably think of skin issues first, but your eyes, heart, lungs, gastrointestinal (GI) tract (stomach and intestines), liver and kidneys may also be affected.
Color changes. White, yellow, or brown discoloration and/or reddish marks (aka splinter hemorrhages, which are caused by tiny burst blood vessels under the nails) are common among people with psoriatic arthritis.
Swelling around the ankle is common in psoriatic arthritis affecting the foot. Psoriatic arthritis can lead to shortening or clawing of the toes, hyperextension of the big toe and some in-rolling of the ankle with flattening of the metatarsal arch.
X-rays are the current gold standard. However, signs of psoriatic arthritis often do not appear on radiographs until later stages of the disease when bone erosion has occured.