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What Are Non-joint Symptoms of PsA?

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By Editorial Team

3 min read

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

A hallmark symptom of psoriatic arthritis (PsA) is joint pain. This is because immune cells produce too much of certain proteins that create long-term inflammation in the joints. But PsA often causes non-joint symptoms, too.1

What are the possible non-joint symptoms?

The inflammation that comes with PsA can affect other areas of the body outside of the joints. Symptoms may include:1-3

  • Skin lesions (psoriasis)
  • Tendon and ligament pain
  • Nail changes
  • Fatigue
  • Eye problems
  • Gastrointestinal (GI) issues
  • Heart problems

Psoriasis

Psoriasis is an autoimmune condition. This means that the body's immune system attacks health tissue that it mistakes for dangerous invaders.1

There are several types of psoriasis, but the most common is called plaque psoriasis. This type affects about 8 out of 10 people with the condition. Plaques are patches of skin that are raised, red, dry, and often covered with a layer of silvery scales. These patches can itch, burn, and cause pain.1,4

Psoriasis is a life-long condition. While there is no cure, most people go through phases of flare-up and remission. Flare-ups are periods when symptoms get worse. Remissions are periods when the symptoms get better or even go away completely for a time.4,5

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People who have psoriasis can learn to identify and avoid their own psoriasis triggers. Triggers are things that can cause psoriasis symptoms to flare up. People who have both psoriasis and PsA often find that their triggers are the same for both conditions. For example, stress is a trigger for many people.4,5

Tendon and ligament pain

In addition to the joints, psoriatic arthritis can affect the attachment points of tendons and ligaments to bone (entheses). When the entheses become inflamed, it is called enthesitis.2

This inflammation often appears at the heel as Achilles tendonitis or at the bottom of the foot as plantar fasciitis. These conditions can make it difficult and painful to walk.2

Nail changes

People with PsA often have changes in their nails and toenails. Nail changes may appear as:2,6

  • Pitting (small dents on the nail’s surface)
  • Crumbling
  • White or red spots
  • Lifting of the nail from the nail bed

Nail psoriasis also can cause pain and make it hard to grasp small objects or perform daily tasks like tying shoelaces or buttoning clothes. Having these changes to your nails can be an early warning sign that you may have PsA.6

Fatigue

Fatigue is another common non-joint symptom of PsA. Fatigue may feel like extreme tiredness or trouble keeping your eyes open. It also can cause flu-like symptoms. Fatigue affects about one-third of people with PsA. While research has not found the exact cause of fatigue in people with PsA, it may be due to the inflammatory process of the disease.2,7

Eye problems

People with PsA are much more likely to develop eye problems. Eye problems caused by PsA can involve:1

  • Conjunctivitis (pink eye)
  • Dry eye syndrome
  • Inflammation of the uvea (uveitis)

The most serious eye condition that occurs with PsA is uveitis. With uveitis, the tissue in the eye starts to break down. This can cause:1

  • Swelling
  • Redness
  • Pain
  • Irritation
  • Possible partial or total vision loss

GI issues

Because inflammation is so widespread with PsA, it can lead to inflammatory bowel disease (IBD). IBD is an umbrella term that includes Crohn’s disease and ulcerative colitis. These 2 conditions cause inflammation in the digestive tract. This leads to diarrhea and other GI issues. If it is not treated, IBD can damage the digestive tract.1

A 2018 study found that people with PsA had nearly 3 times the risk for Crohn’s disease and a 30 percent higher risk for ulcerative colitis than people without PsA.1

Heart problems

This is one of the most serious non-joint symptoms of PsA. When chronic inflammation is combined with high cholesterol levels and unhealthy body weight, the arteries can become clogged and cause problems for the heart. People who live with PsA commonly have both high cholesterol and high body weight.1

Stay alert to non-joint symptoms

These are not all of the non-joint symptoms that PsA can cause. If you have any of the above symptoms, or any others not listed, talk with your doctor so you can manage them safely.1