Common Symptoms of Psoriatic Arthritis

Reviewed by: HU Medical Review Board | Last reviewed: May 2023

Psoriatic arthritis (PsA) is a chronic autoimmune disorder in which a person's immune cells mistakenly attack healthy tissue. This leads to chronic inflammation, which can lead to permanent and disabling joint damage.1,2

About one-third of people who have psoriasis – a skin condition that causes red, inflamed skin – will go on to develop psoriatic arthritis. Skin symptoms typically emerge before the joints are involved. Skin symptoms can sometimes occur up to 10 years before any joint symptoms appear.3

PsA affects everyone a little bit differently. But there are certain symptoms that are more common than others. The most common symptoms are:1,2

  • Joint swelling, pain, stiffness, or tenderness
  • Swollen fingers and toes (dactylitis)
  • Tendon and ligament pain (enthesitis)
  • Back and neck pain
  • Changes to the nails, such as pitting
  • Eye problems
  • Fatigue

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Joint swelling, pain, stiffness, or tenderness

PsA causes swelling of the tissues related to the joints, including the tendons, ligaments, and bone. This inflammation causes a range of different symptoms, including:1,2

  • Joint stiffness – Joints become stiff, especially first thing in the morning or after a period of rest.
  • Redness over the joint – Many people with PsA experience redness of the skin in the area of the affected joints.
  • Heat at the joint – The inflammation of PsA can also create a feeling of heat at the joint.
  • Loss of range of motion – PsA can cause a noticeable loss of range of motion of the joints. This can affect daily tasks such as grooming, shopping, and other activities.
  • Pain – Inflammation can cause pain at the joints. Stress can worsen this, making people with PsA more sensitive to pain.

Swollen fingers and toes

Because PsA causes inflammation of the joints, people with PsA often develop swelling of the fingers or toes. This is called dactylitis.1,2

Dactylitis is also called “sausage digits" or “sausage fingers and toes" because sometimes the whole finger or toe can swell in a sausage-like formation. This can be very painful. It can make it hard to do simple tasks with your hands, such as buttoning a shirt or tying your shoes.1,2

Tendon and ligament pain

In addition to the joints, PsA also can cause inflammation at the attachment points of tendons and ligaments. These are called the entheses. When there is inflammation at these attachment points, it is called enthesitis. Pain also often appears at the heel from Achilles tendonitis or at the bottom of the foot from plantar fasciitis.3

Back and neck pain

PsA can also affect the spine, most often the sacroiliac joints located at the lower back. When these spinal joints are affected, it is called axial arthritis or spondylitis.4

Back and spine symptoms usually come later in a person’s PsA journey. It is rare for the back and spine to be the only areas involved with PsA, but it can happen. Neck pain can happen as well.4

Inflammation in the back and spine may wake up people with PsA in the night. Pain worsens with long periods of rest, so it is especially bad in the morning upon waking up. Getting regular physical activity can help back and spine pain feel better.4

Nail changes

Nail changes are a common symptom of psoriatic arthritis. These nail changes most often affect 1 or more fingernails, but they can affect the toenails as well. Symptoms include:5

  • Pitting (small indentations on the surface of the nail)
  • Crumbling or splitting of the nail
  • White or red spots on the nail

Nail psoriasis can be painful and make it hard to grasp small objects or perform tasks like tying shoelaces or buttoning clothes. If you notice changes to your nails, tell your doctor. It can be an early warning sign of PsA.5

Eye problems

People with PsA are more likely to develop eye problems over time. Eye problems associated with PsA include:6

  • Pink eye (conjunctivitis)
  • Dry eye syndrome
  • Uveitis

Uveitis produces swelling and destroys eye tissue. It can cause vision loss, which can range from slight to severe. If you have any eye problems in addition to your PsA, get treatment early.6

Fatigue

Chronic inflammation in the body can make you feel run down and tired. It is no wonder, then, that people with PsA often live with fatigue. Fatigue may feel like extreme tiredness, difficulty keeping your eyes open, or flu-like symptoms.7

In addition to fatigue, people with PsA may have a lack of motivation or loss of appetite. Fatigue can be experienced very differently depending on the person.7

Monitor your symptoms

PsA symptoms, which vary from person to person, can get better or worse over time. It is possible to experience periods of symptom relief (remission) even as the symptoms get progressively worse.1-3

The fact that joint symptoms sometimes unfold over time can make PsA difficult to diagnose and can delay treatment. But with PsA, early treatment is critical. Without treatment, many of its symptoms can lead to progressive, permanent joint damage. Monitor yourself for new symptoms, and share them with your doctor so you can get the treatment you need.1-3

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