What Are Non-Joint Symptoms of PsA?
Psoriatic arthritis (PsA) is a progressive autoimmune disorder that can lead to permanent and debilitating joint damage. Like psoriasis, it is characterized by chronic inflammation. In PsA, immune cells are activated and produce too much of certain proteins which lead to the chronic inflammation that is a hallmark of the disease. While joint involvement and long-term damage to the joints are the primary symptoms of PsA, there are a number of other symptoms of PsA that are non-joint symptoms and/or are not specific to areas of the body where there are joints, including:
- Tendons and ligaments
- Nail changes
- Eye problems
- Hearing loss
- Skin lesions (psoriasis)
Tendon and ligament pain and inflammation
In addition to the joints, psoriatic arthritis can also inflame the attachment points of tendons and ligaments, the entheses, causing enthesitis. This often appears at the heel as Achilles tendonitis or at the bottom of the foot as plantar fasciitis. Other tendons and ligaments may also be affected.
In addition to the joints, psoriatic arthritis can also inflame the attachment points of tendons and ligaments, called the entheses, causing enthesitis. This can often appear at the heel as Achilles tendonitis or at the bottom of the foot as plantar fasciitis. Other tendons and ligaments may also be affected.2,4 When these problems occur frequently without healing in a person with psoriasis, the diagnosis of psoriatic arthritis should be considered.
Nail lesions are frequently seen in patients with psoriatic arthritis and may appear as pitting, crumbling, white or red spots, or lifting of the nail. Nail psoriasis can also cause pain and create an inability to grasp small objects or perform daily tasks like tying shoelaces or buttoning clothes. 5 Pitting and ridges on the nails can occur in both fingernails and toenails. Having these changes to your nails can be an early warning sign that you may have PsA.
People with psoriatic arthritis often experience generalized fatigue. Fatigue may appear as extreme tiredness, difficulty keeping eyes open, or flu-like symptoms. Patients also reported symptoms such as lack of motivation and loss of appetite in conjunction with fatigue.3 While research has not identified the exact cause of fatigue in people with PsA, most agree that it is in part due to the inflammatory process of the disease.
People with PsA are significantly more likely than the “average” person to develop eye problems.2 Of the eye problems that people with psoriasis develop, the most common of which is Uveitis, which is an inflammatory disease process also called intraocular inflammation. Uveitis refers to a group of inflammatory diseases of the eye from various causes that produce swelling and destroy eye tissue. Symptoms of uveitis include vision loss which can range from slight to severe loss of vision.
Research has shown that nearly a third of people with PsA may experience hearing loss. Experts are not entirely sure about the cause or progression of damage to the inner ear but believe that it results from the chronic inflammation that is a hallmark of PsA. This damage to the inner ear may also cause balance problems or feelings of vertigo.
Skin lesions (psoriasis)
Psoriasis is an autoimmune condition that causes symptoms to develop on the skin. There are several different types of psoriasis, but the most common form is called plaque psoriasis, which affects between 80% and 90% of people with the condition. Plaques are patches of skin that are raised, red, dry, and often covered with a layer of silvery scales.
Psoriasis is a chronic, life-long condition. It cannot be cured, but most people will cycle through periods of flare-ups and remissions. Flare-ups are periods of time when symptoms get worse. Remissions are periods of time when the symptoms get better or even go away completely for a time. People who have psoriasis can learn to identify and avoid their own psoriasis triggers, which are things in the environment 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, with stress being a common trigger.