Arthritis Psoriatic Arthritis Psoriatic Arthritis Guide Psoriatic Arthritis Guide Symptoms Causes Diagnosis Treatment Coping Symptoms of Psoriatic Arthritis Signs and symptoms can vary by the subtype By Carol Eustice facebook Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. Learn about our editorial process Carol Eustice Medically reviewed by Medically reviewed by Grant Hughes, MD on September 01, 2016 linkedin Grant Hughes, MD, is board-certified in rheumatology and is the head of rheumatology at Seattle's Harborview Medical Center. Learn about our Medical Review Board Grant Hughes, MD Updated on October 29, 2019 Print Table of Contents View All Frequent Symptoms By Subtype When to See a Doctor Next in Psoriatic Arthritis Guide Causes and Risk Factors of Psoriatic Arthritis Psoriatic arthritis (PsA) symptoms such as pain and joint stiffness may seem distinct from those related to psoriasis, but they are actually a direct consequence of the disease. The inflammation that results when the immune system suddenly attacks normal cells in the outer layer of skin can "spill over" and eventually impact other cells and tissues. Over time, the same inflammation that gave way to skin changes can lead to the development of psoriatic arthritis. It is even possible to have psoriatic arthritis with no skin involvement at all. It is important to recognize the signs and symptoms of psoriatic arthritis so that a doctor can diagnose the disease and start treatment as soon as possible. According to a 2014 study in the journal Drugs, as many as 40% of people with psoriasis will develop psoriatic arthritis to varying degrees. On the flip side, 85% of people with psoriatic arthritis will also have psoriasis. Frequent Symptoms Psoriatic arthritis symptoms vary from person to person. They tend to develop in episodes, known as flares, in which symptoms suddenly appear and just as suddenly resolve. Unlike psoriasis, in which the immune system directly attack skin cells, psoriatic arthritis is caused almost entirely by inflammation. Common symptoms include: Pain and swelling in one or more joints, typically the wrists, knees, ankles, fingers, toes, and lower backSwelling of the fingers and toes, known as dactylitis, resulting in a thick, sausage-like appearanceMorning stiffness, similar to osteoarthritisSilvery-white skin lesions (plaques) often on the scalp, elbows, knees, and lower spine This photo contains content that some people may find graphic or disturbing. See Photo Plaque psoriasis. DR P. MARAZZI/SCIENCE PHOTO LIBRARY / Getty Images Pitting or lifting of the nails, also referred to as nail dystrophyPersistent fatigue, common with chronic inflammatory diseasesEye problems, including uveitis and conjunctivitis (pink eye) How Psoriatic Arthritis Is Diagnosed By Subtype There are five subtypes of psoriatic arthritis, each of which is characterized by its location and severity. It is not uncommon for a person to switch from one subtype to another. Scientists are unsure why this is but believe that certain environmental triggers can alter the already-abnormal immune response. The changes in subtype also reflect the progressive nature of the disease. As certain joints sustain damage, often irreversible, the inflammatory response may simply broaden and affect other joints in the body. Moreover, it is possible to have multiple subtypes or to develop other forms of arthritis, both autoimmune and non-autoimmune. Asymmetric Psoriatic Arthritis Psoriatic arthritis is asymmetric when a joint is affected on only one side of the body. Asymmetric psoriatic arthritis tends to be milder than other forms of the disease and is often the first type experienced. According to a 2013 review in the Polish Journal of Radiology, asymmetric psoriatic arthritis accounts for roughly 70% of all cases. By definition, asymmetric psoriatic arthritis affects no more than five joints and will usually impact larger joints rather than smaller ones. Symmetric Psoriatic Arthritis Symmetric psoriatic arthritis, as per its name, is characterized by pain and swelling in the same joints on both sides of the body. Fingers and toes are typically affected, as well as larger joints of the hips and knees. Symmetrical psoriatic arthritis accounts for around 15% of all cases. It is often preceded by asymmetric disease but may develop symmetrically from the start. The symmetrical pattern is similar to that of rheumatoid arthritis, an autoimmune disease that directly targets joint tissue. Because of this, it can be difficult to differentiate the diseases without the use of a rheumatoid factor (RF) blood test. Distal Interphalangeal Predominant (DIP) Psoriatic Arthritis Distal interphalangeal predominant (DIP) psoriatic arthritis may sound complicated, but it simply means that the distal (near the nail) joints of the phalanges (fingers or toes) are affected. This type of psoriatic arthritis is characterized by pain and stiffness near the tips of the fingers or toes. When viewed on an X-ray, the ends of the bone will often appear narrowed like a pencil tip, while the adjacent joint will have a compressed, cup-like appearance. Nail changes, including pitting, thickening, and lifting (onycholysis), are also common. Arthritis Mutilans Arthritis mutilans is an uncommon but severe form of psoriatic arthritis. It is characterized by a condition called enthesitis in which the tissues connecting tendons and ligaments to bone become inflamed. Arthritis mutilans is believed to affect around 5% of people with psoriatic arthritis. The aggressive nature of the disease can cause bone resorption (the breakdown of bone tissue), cartilage loss, and joint deformity. Severe cases may require surgery to either relieve joint compression (arthroscopic debridement) or fuse the joints to reduce pain (arthrodesis). Psoriatic Spondylitis Spondylitis refers to inflammation of the spinal column. Only around 5% of people with psoriatic arthritis will have spondylitis as their main symptom. Although the spine is less commonly affected by psoriatic arthritis than other joints, it is not uncommon to have stiffness in the neck, lower back, and pelvis (particularly the sacroiliac joint). Another common denominator is the genetic marker human leukocyte antigen B27 (HLA-B27), which is present in over half of the people with psoriatic spondylitis. Differentiating Psoriatic Arthritis From Other Joint Diseases When to See a Doctor As a general rule, you should suspect psoriatic arthritis if you have symptoms of psoriasis or a family history of autoimmune diseases. At the same time, it is not uncommon to have multiple autoimmune disorders given that the diseases often share the same genetic mutations. Early diagnosis and treatment are key to bringing the disease under control. Doing so can help slow disease progression, prevent joint damage, and improve your overall quality of life. If you develop symptoms of psoriatic arthritis, ask your doctor for a referral to a joint specialist known as a rheumatologist. While many internists are capable of managing mild psoriasis, psoriatic arthritis is a far more complicated disease. It is not only more difficult to diagnose but often requires a combination of drugs, including disease-modifying antirheumatic drugs (DMARDs) like methotrexate and newer-generation biologic drugs like Enbrel (etanercept) and Humira (adalimumab). Causes and Risk Factors of Psoriatic Arthritis Was this page helpful? Thanks for your feedback! Dealing with chronic inflammation? An anti-inflammatory diet can help. Our free recipe guide shows you the best foods to fight inflammation. Get yours today! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Sankowski AJ, Lebkowska UM, Cwikła J, Walecka I, Walecki J. Psoriatic arthritis. Pol J Radiol. 2013;78(1):7-17. doi:10.12659/PJR.883763 Ogdie A, Weiss P. The Epidemiology of Psoriatic Arthritis. Rheum Dis Clin North Am. 2015;41(4):545-68. doi:10.1016/j.rdc.2015.07.001 Bowness P. HLA-B27. Annu Rev Immunol. 2015;33:29-48. doi:10.1146/annurev-immunol-032414-112110 Mease, P. and Armstrong, A. Managing Patients with Psoriatic Disease: The Diagnosis and Pharmacologic Treatment of Psoriatic Arthritis in Patients with Psoriasis. Drugs.2014;74(4):423-41. DOI: 10.1007/s40265-014-0191-y. Additional Reading Firestein, G.; Budd, R.; Gabriel, S. et al. (2012) Kelley's Textbook of Rheumatology (9th Edition). Amsterdam, Netherlands: Elsevier. ISBN: 9781437717389. Liu, J.; Yeh, H.; Liu, S. et al. Psoriatic arthritis: Epidemiology, diagnosis, and treatment. World J Orthop. 2014 Sep 18;5(4):537-43. doi:10.5312/wjo.v5.i4.537 Mease, P. and Armstrong, A. Managing Patients with Psoriatic Disease: The Diagnosis and Pharmacologic Treatment of Psoriatic Arthritis in Patients with Psoriasis. Drugs. 2014;74(4):423-41. doi:10.1007/s40265-014-0191-y Sankowski, A.; Łebkowska, U.; Ćwikła, J. et al. Psoriatic arthritis. Pol J Radiol. 2013 Jan-Mar;78(1):7-17. doi:10.12659/PJR.883763