What Does Psoriatic Arthritis Look Like?

Psoriatic Arthritis in Pictures

Psoriatic arthritis (PsA) is a type of arthritis that often affects people with psoriasis, an autoimmune skin condition that is characterized by red patches of skin topped with silvery scales. Most people who have PsA will develop psoriasis first, but it is possible to have joint problems before skin symptoms appear.

Psoriasis affects up to 3% of people worldwide with up to 40% of this group also having PsA. Both psoriasis and PsA are autoimmune diseases, conditions where the body’s immune system attacks its healthy tissues.

The main symptoms of PsA are joint pain, stiffness, and swelling. These, and other symptoms like chronic fatigue, are often ones that cannot be seen by others. This is why people consider PsA an invisible disease.

Symptoms of PsA can affect any part of the body and will range from mild to severe. PsA often alternates between flare-up periods (periods of high disease activity) and periods of remission (while the disease is mild or inactive).

There is no cure for PsA, so the focus is on controlling disease symptoms and preventing joint damage. Untreated PsA can cause deformed joints, reduced mobility, and even disability. Uncontrolled inflammation also increases the risk of cardiovascular morbidity and mortality.

Psoriatic Arthritis Prognosis and Quality of Life
PredragImages / Getty Images.

How Psoriatic Arthritis Affects the Body

PsA causes a combination of skin and arthritis symptoms. These symptoms are caused by inflammation from an overreactive immune system.

Inflammation is the way the body protects and repairs itself from foreign substances. Characteristics of inflammation include redness, heat, swelling, pain, and loss of function. Inflammation may cause fevers, joint and muscle pain, extreme fatigue, skin symptoms, and organ dysfunction.

PsA inflammation often affects larger joints and the distal joints of the fingers and toes. The distal joints are the first knuckles at the top of the fingers and toes.

PsA Affects People Differently

No people with PsA are affected the same. Some people with the condition might only have peripheral joint disease where only their hands, wrists, knees, and other large joints are affected. The research shows that peripheral joint disease in PsA is quite common and often symmetrical (affecting both sides) and polyarticular (affecting multiple joints).

Others with PsA might have only spine involvement. Still others will be affected by joint and spine inflammation.

Many people with PsA have skin involvement while others don’t have any skin symptoms or psoriasis. It is more common to have skin symptoms with PsA, but there are people with PsA who don’t have skin symptoms. In up to 80% of people with PsA, skin disease usually precedes joint disease.

Other effects of PsA include:

  • Axial disease: Also called psoriatic spondylitis, a subtype of PsA that affects the spine and joints of the pelvis
  • Enthesitis: Inflammation of the entheses, the sites where tendons or ligaments insert into the bone
  • Dactylitis: Diffuse swelling of a finger or toe, described as "sausage-like"
  • Nail psoriasis: Changes to nails, including thickened nails, nail pitting (pinprick holes in the nails), discoloration, nailbed separation, and nail shape changes

Not everyone with PsA will experience all the possible effects of the condition. Each person will experience a different combination of symptoms and severity.

An Invisible Disease

An invisible illness is a condition in which a person does not exhibit external visible signs or symptoms of that condition. PsA is considered an invisible disease because many of its symptoms and effects cannot be seen.

Chronic fatigue is one of the most invisible symptoms of this condition. High levels of inflammation are often to blame for extreme levels of fatigue. Fatigue can also be associated with medications used to treat the condition. Research shows that fatigue is a major problem with PsA, leading to negative effects on quality of life.

Other invisible symptoms of PsA might include joint and muscle pain, blurry vision, anxiety, depression, reduced range of motion, back pain, and anemia.

Joint Distribution 

PsA is often classified into subtypes by the joints it affects. Someone with PsA might only be affected by one subtype of joint involvement, but most people will later go on to develop another subset:

  • Asymmetric oligoarthritis: Also called asymmetric psoriatic arthritis, this type of PsA usually impacts less than five small or large joints on one side of the body.
  • Symmetric polyarthritis: Symmetric PsA affects five or more joints on both sides of the body. This means that if one joint on your right side is affected, the same joint on your left side is also affected. For example, if one knee is affected by inflammation and pain, so is the other knee.
  • Distal arthritis: This subtype of PsA affects the distal interphalangeal (DIP) joints, the end joints of the fingers and toes. It might also cause nail changes.
  • Arthritis mutilans: This is the most severe subtype of PsA. It can deform and destroy the joints of the fingers, hands, wrists, and feet. Fortunately, due to growing treatment advancements in PsA, arthritis mutilans is extremely rare, only affecting 5% of people with PsA.
  • Spondyloarthritis: This subtype of PsA affects the spine, neck, low back, and sacroiliac joints(located on each side of the spine).

Asymmetric vs. Symmetric

Arthritis causes inflammation of the joints. Different types of arthritis, including PsA, affect the body symmetrically or asymmetrically. Symmetric arthritis affects the same joints on both sides of the body, whereas asymmetric affects the joints on one side of the body.

Bone Damage

PsA is a painful and debilitating condition that can cause disabling symptoms and bone and joint damage. Joint and bone damage can be confirmed by your doctor using X-rays and other types of bone and joint imaging. The worse PsA inflammation is, the higher the risk for irreversible damage from PsA.

Sometimes, bone or joint damage might require reconstructive surgery of knees, ankles, or hips. Surgical goals include restoring function so that disability doesn’t affect the ability to work, care for yourself, and your quality of life.

Arthritis mutilans is also known for destroying the small joints of the hands. If not treated, it can lead to permanent disability.

PsA can also cause spinal damage that restricts movement and can cause significant pain. Talk to your doctor if you are experiencing back pain, swelling, or stiffness.

What Psoriatic Arthritis Looks Like 

PsA is characterized by the symptoms it causes. This includes swelling and stiffness of joints, low back pain, foot pain, eye symptoms, skin changes, and nail symptoms. It is important to recognize the signs and symptoms so your doctor can properly diagnose you and start treatment as early as possible.

Stiffness and/or Swelling in the Large Joints

Joint swelling/stiffness
Peter Dazeley / Getty Images.

Joint stiffness and swelling are the main symptoms of PsA. These two symptoms can affect any part of the body, but they often affect the large joints of the knees or hips.

Involvement of the large joints can impair activities of daily living in people with PsA. Activities of daily living include things like grooming, bathing, getting dressed, walking and climbing steps, and safety and emergency responses.

Swollen Fingers and Toes

Swollen fingers
Inna Kozhina / Getty Images.

PsA may also affect the smaller joints of the fingers and toes. These joints can get so swollen they cause the digits to appear sausage-like, a hallmark symptom called dactylitis.

According to the National Psoriasis Foundation, 40% of people living with PsA experience dactylitis. This symptom doesn’t just inflame the joints of the fingers and toes; it causes the entire finger or toe to swell up.

Lower Back Pain

lower back pain
Yuttana Jaowattana / EyeEm / Getty Images.

Because PsA can affect the spine, it can lead to back pain. According to the Arthritis Foundation, PsA spine involvement (axial arthritis) occurs in up to 50% of people with PsA.

Features of axial back pain include:

  • Pain that wakes you up at night
  • Pain that improves with activity and worsens with too much sitting
  • Back stiffness that lasts 30 or more minutes in the morning
  • Inflammation of the sacroiliac joints leading to hip and buttock pain

Foot Pain

Foot Pain
Anchalee Phanmaha / Getty Images.

PsA can affect the feet, from the ankles to the toes. This is because people with PsA often develop enthesitis. This can cause pain, swelling, and tenderness in the heels, midfoot, and toes.

Eye Changes

Eye inflammation
Elizabeth Fernandez / Getty Images.

People with PsA might experience eye symptoms, including inflammation, redness, and photosensitivity. Eye inflammation is often accompanied by irritation, pain, and/or redness in and around the eye. You might also experience vision changes, including blurred vision.

Psoriatic Arthritis Rash/Skin Changes

Skin rash
Natalia SERDYUK / Getty Images.

PsA rashes are psoriasis plaques. Rashes appear as red patches with silvery-white scales on the skin. Skin rashes might burn, itch, hurt, or bleed.

These rashes might come and go. It is very possible to have long periods where a person’s skin is clear.

Nail Changes

Nail symptoms
Elizabeth Fernandez / Getty Images.

A large number of people with PsA will have nail symptoms. According to a study reported in 2017, up to 80% of people with PsA will have nail involvement.

Changes to your nails, including pitting (bumpy or dented nails), onycholysis (when nails separate from the nail bed), and nail discoloration are all nail changes that can affect people with PsA. Psoriasis can also affect the nails, causing them to look like they may be infected.

Less-Visible Symptoms

PsA is known for causing symptoms that are not so easy to see. These might include fatigue, joint pain, reduced range of motion, and anemia.

Fatigue

Fatigue is a common symptom of PsA. It often makes it harder to do even the simplest activities of daily living. This type of fatigue might include a general feeling of tiredness and exhaustion that might make it harder to get through the day without resting or napping.

Joint Pain

PsA usually affects the knees, lower back, hips, ankles, fingers, and toes. Pain might disappear at times or return and worsen at other times. When your symptoms improve, you might be experiencing a period of remission. When symptoms become worse, you might experience a period of flare-up.

Reduced Range of Motion

PsA can affect the range of motion in your joints. Reduced range of motion can make it hard to bend or extend the arms or legs, or even bend forward. You may also have problems using your fingers, which can make it harder to perform certain tasks, including typing and writing.

Anemia

PsA can lead to low red blood cell counts and a condition called anemia. Anemia is a condition where your blood has fewer red blood cells than normal. It can lead to symptoms such as fatigue, dizziness, chest pain, shortness of breath, and pallor.

People with conditions like PsA that cause high levels of inflammation often develop a condition called anemia of chronic disease or anemia of inflammation. With this type of anemia, you may have normal or increased iron in body tissues, but low iron in the blood. This is because inflammation prevents the body from storing iron to make enough healthy red blood cells.

Coping With PsA

The best ways to successfully manage PsA are through medical care from your doctor and with healthy lifestyle habits. The little things you are doing every day will add up and affect how you feel overall. These might include:

  • Keeping your doctor updated: Make sure you are updating your doctor about your symptoms or any problems you might experience as you go about your life with PsA. Take medications as prescribed, and if you think that you are unable to follow your treatment plan, let your doctor know right away so that the two of you can find a plan that best works for your unique situation.
  • Staying active: Exercise is good for everyone, but PsA can make it harder to be as active as you would like. But some activities can be gentle on joints, including walking, swimming, and yoga. Your doctor or a physical therapist can give you some ideas to help you keep moving without pain.
  • Checking your diet: While diet doesn’t cause or cure PsA, healthy eating is good for everyone. A healthy, balanced diet can also help you to manage your weight, which means less pressure on your joints.
  • Connecting with people who get it: You need people in your life who understand what you deal with. Whether that is a good friend or a support group, it is important to open up about your feelings related to PsA and the effect it has on your life.
  • Managing depressed feelings: Living with PsA isn’t easy and it is normal to feel sad or down. But if these feelings last longer than a few weeks or you are struggling to cope, consider talking to a mental health counselor. Depression is a manageable and treatable condition.

A Word From Verywell 

Psoriatic arthritis is a lifelong condition with no cure. The outlook for most people with the condition can be positive. However, that requires early diagnosis and aggressive treatment, and monitoring of both joints and skin. This is the best way to slow down the disease, prevent joint damage and disability, and improve your overall quality of life.

If you develop symptoms of psoriatic arthritis, contact your doctor right away. They can order testing to accurately diagnose you and get you on a treatment plan.

 

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