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Joint Pain, Stiffness, and Swelling With Psoriatic Arthritis

Reviewed by: HU Medical Review Board | Last reviewed: July 2022

Some of the classic features of psoriatic arthritis (PsA) are joint pain, stiffness, and swelling. However, these symptoms can look different for each person. They can also change over time.1

In addition to joint pain, people with PsA often experience inflammation where tendons and ligaments attach to bones. This can cause foot pain as well as pain around the ribs, spine, or pelvis (enthesitis). People living with PsA may also have fatigue and changes to their nails.1,2

How does PsA affect the joints?

PsA causes inflammation in the joints. This leads to swelling, stiffness, and chronic pain.1

With PsA, joint inflammation shows up in different ways. You might have inflammation on only one side of your body (asymmetrical PsA). For example, one knee might be inflamed while the other knee is unaffected. Or you may have joint issues on both sides of your body (symmetrical PsA).1

PsA often begins in the joints farthest away from the core of the body (distal joints), such as the joints in the fingers and toes. The disease can cause major swelling in the fingers and toes, creating a sausage-like appearance called dactylitis.1,2

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Other ways PsA affects the joints include:1,2

  • Joint stiffness – With the inflammation of PsA, joints become stiff, especially first thing in the morning or after a period of rest.
  • Redness at the joint – Many people with PsA have redness around the affected joints.
  • Heat at the joint – Joint inflammation can be warm to the touch.
  • Loss of normal function – PsA can cause a noticeable loss of normal functions, including daily tasks of bathing, dressing, shopping, and other activities.

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Why does joint inflammation lead to pain?

Inside your joints is synovial tissue, which releases a lubricating fluid called synovial fluid. This fluid allows your joints to move freely. As PsA affects the synovial tissue, an overload of immune system cells is released, particularly white blood cells. This leads to inflammation.3

In autoimmune diseases like PsA, this inflammation in the joints leads to irritation of the nerves in the area. These nerves send pain signals to the brain.3

Complications of joint issues with PsA

Joint issues with PsA can change and evolve over time. They also can cause complications if left undiagnosed or untreated.1,4

Untreated PsA can lead to the destruction of a person's joints. Approximately 5 percent of people with PsA will develop arthritis mutilans, the most severe form of PsA. Arthritis mutilans causes deformity of the hands, fingers, or toes.1,4

How is PsA in the joints diagnosed?

A PsA diagnosis requires a physical exam by your doctor. They may use what is called a PsARC exam. This measures joint swelling and joint tenderness all over the body using the 66/68 Joint Count. The exam assesses 66 joints for swelling and 68 joints for tenderness and pain with movement.5

Your doctor may also use advanced imaging such as X-ray, MRI, or ultrasound to get a clearer picture. Ultrasound and MRI have been shown to be more sensitive than X-rays in finding changes in the joints. Your doctor also may perform blood and other lab tests to rule out other conditions like rheumatoid arthritis and gout.6

How is joint pain treated?

For minor joint pain and stiffness, non-steroidal anti-inflammatory drugs (NSAIDs) can help. Injections of steroid medicines that reduce inflammation may be used as well.6

For moderate to severe joint pain caused by PsA, recommended drug treatments are:6

  • Disease-modifying anti-rheumatic drugs (DMARDs) – These are drugs that help calm your symptoms, slow down the disease, and prevent or slow joint damage.
  • Biologics – These are drugs that fight inflammation by targeting specific parts of the immune system. They are often prescribed for PsA.
  • Anti-tumor necrosis factor (TNF) agents – TNFs cause inflammation in the body. Anti-TNF agents help stop inflammation. Your doctor may consider this treatment option if DMARDs or biologics are not working.

For severe diseases, surgery may be an option. Arthroscopic surgery on the synovial capsule, as well as joint replacement or reconstructive surgery, may be necessary for extreme cases.6

As a complement to drug treatments, physical and occupational therapy may help ease pain and maintain joint function. Massage therapy may also help with joint discomfort.6

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