9 Psoriatic Arthritis Symptoms You Should Know

From self.com

They're tell-tale signs that something’s wrong

Psoriatic arthritis is basically a double whammy of autoimmune disorders. Not only do psoriatic arthritis symptoms mimic those of psoriasis, like patches of red, scaly skin, but they can also cause the painful swollen joints that are common with rheumatoid arthritis. What’s more, the symptoms can change from day to day and person to person, making psoriatic arthritis a particularly tricky disease to diagnose and manage.

The symptoms of psoriatic arthritis alone will probably be enough of a motivator for you to seek a proper diagnosis and care. But in case you needed another push, untreated psoriatic arthritis can lead to permanent joint damage, the Mayo Clinic notes. If some (or many) of the below symptoms sound familiar to you, it’s essential that you try to work with a doctor to manage this disease. Keep reading to learn about the symptoms of psoriatic arthritis and how to find a doctor who can help you get some relief.

                                                          Nydia Lilian/Adobe Stock

What is psoriatic arthritis?

Psoriatic arthritis is a chronic disease that causes your immune system to kick into overdrive and mistake your body’s own healthy cells for a threat, according to the Mayo Clinic. There are five types of psoriatic arthritis you can have, per NYU Langone Health:

1. Asymmetric oligoarthritis, the most common type of psoriatic arthritis, affects up to five joints, but not necessarily the same joints on both sides of the body.
2. Symmetric arthritis affects joints on both sides of the body.
3. Spondylitic arthritis causes inflammation in the neck, spine, lower back, and pelvis, potentially limiting your ability to move around.
4. Distal interphalangeal predominant psoriatic arthritis primarily affects the joints near your nails on both your fingers and toes.
5. Arthritis mutilans, the rarest form of psoriatic arthritis, typically also affects joints in the fingers and toes but can also affect your entire body. It’s the most severe form of psoriatic arthritis and can cause quicker, more painful destruction to your joints than the other kinds.

According to the Cleveland Clinic, it’s also possible to have overlapping types of psoriatic arthritis, potentially making this disease even more complicated.

What causes psoriatic arthritis?

The exact cause of psoriatic arthritis is still a mystery, but doctors believe that it may come from a combination of environmental factors and genetics, Elliot Rosenstein, M.D., director of the Institute for Rheumatic & Autoimmune Diseases at the Atlantic Health System’s Overlook Medical Centre, tells SELF.

Many people with psoriatic arthritis seem to have a genetic predisposition to the disease, which doesn’t just impact your likelihood of getting this illness—it may also play a role in determining the type you get, which impacts how the disease shows up in your body. Having a genetic predisposition doesn’t mean you’ll automatically develop psoriatic arthritis, though. Often something environmental triggers psoriatic arthritis symptoms to actually manifest in people with a genetic predisposition. This trigger may be something like an infection or trauma to the skin and joints, according to the Mayo Clinic. With that said, most people with psoriatic arthritis never figure out which environmental factor contributed to their disease, says Rosenstein.

While genetic and environmental factors can play a role, the biggest risk factor for developing psoriatic arthritis is already having psoriasis, according to the Mayo Clinic. This skin condition is known for causing patches of thick, red skin with white silvery scales, usually on body parts like the knees, elbows, or scalp. Psoriasis happens when an overzealous immune system attacks skin cells, which in turn speeds up how quickly skin cells rise to the surface of your body. This ultimately causes a build-up of skin cells that results in psoriasis symptoms.

It’s estimated that up to 30% of people with psoriasis will go on to develop psoriatic arthritis, according to the Cleveland Clinic. However, not having psoriasis doesn’t necessarily mean you can’t get psoriatic arthritis—you can have one disease without the other.
So what are the other symptoms of psoriatic arthritis you should watch out for?

1. Your fingers and toes are very swollen.

Dactylitis, a fancy term for when your fingers or toes swell up to an extreme and painful degree, is considered one of the hallmark symptoms of psoriatic arthritis. In addition to the swelling and pain, it can cause the affected parts of your body to redden and feel warm, and it often comes along with enthesitis, which essentially means that the various connective tissues that link to your bones feel tender and sore. Research suggests that dactylitis affects between 16% and 49% of people with psoriatic arthritis.

This symptom is the result of inflammation in small joints and the spots where ligaments and tendons connect to bones. As you’ll see, this inflammation can result in a number of symptoms, but this is one of the most classic that people with psoriatic arthritis experience.

2. Your nails have holes or grooves.

Up to 80% of people with psoriatic arthritis notice changes in their nails, Zhanna Mikulik, M.D., a rheumatologist at the Ohio State University Wexner Medical Centre, tells SELF. You might see shallow or deep holes, known as pitting, in your fingernails and toenails, due to inflammation in the tendons that connect with the roots of your nails. Your nails may also be crumbly or have grooves and ridges on the surface.

“Other nail findings include a change shape or turning a yellow-brown colour. They can also separate from the nail bed,” Mikulik says. That might sound really scary, but the good thing is that doctors can treat these nail-related symptoms with various targeted approaches, according to the American Academy of Dermatology.

3. You have a hard time moving in the morning.

Psoriatic arthritis can make it incredibly hard to get out of bed when your alarm goes off. The disease can cause inflammation, worn joints, and tightness in the muscles and tendons that can all make you feel really stiff and immobile, especially in the morning after you haven’t moved around for many hours, says Mikulik.

This symptom can be incredibly wide-reaching; some research suggests that morning stiffness affects about 70% of people with psoriatic arthritis.

4. It hurts to grip a pen or bend your toes.

Pain and swelling over tendons—a symptom known as tenosynovitis—is a common symptom in people with psoriatic arthritis due to that persistent inflammation, says Mikulik. It tends to affect the tendons of the toes or fingers. Depending on how exactly it affects you, it might hurt when you try to rotate your wrist or grasp anything, according to the Mayo Clinic, or you may feel pain or stiffness when trying to move your feet and toes.

5. You feel pain in your heel every time you take a step.

“Psoriatic arthritis also has a tendency to cause inflammation in sites where tendons insert into bones, such as the Achilles tendon at the back of the heel, and the plantar fascia, causing pain in the sole of the foot and bottom of the heel which often will interfere with walking,” says Rosenstein.

While experts say this isn’t the most common psoriatic arthritis symptom, it can make life with this condition even more difficult. If you have heel pain that you can’t explain with other reasons (say, a new pair of shoes that haven’t been broken in yet), you should get it checked out by a doctor.

6. Your lower back and hips are often sore.

While many of the symptoms of rheumatoid arthritis and psoriatic arthritis overlap, back pain (particularly the location where it occurs) can help differentiate between the two conditions.

“When psoriatic arthritis affects the spine, it is most often the lowest portions of the spine and the sacroiliac joints that are affected, whereas rheumatoid arthritis most often affects the very top of the neck,” says Rosenstein.

Inflammation in the sacroiliac joints (the parts that connect your pelvis to the bottom of your spine) can also extend into your butt, Lynn M. Ludmer, M.D., medical director of rheumatology at Baltimore’s Mercy Medical Centre, tells SELF. This might make it even more confusing to figure out what’s going on.

7. You have pain or burning in your elbow.

A condition called tennis elbow can sometimes show up as a symptom of psoriatic arthritis, even if you’ve never picked up a racquet. Again, this has to do with the inflammation that happens in spots where your tendons connect to bones, says Rosenstein. You might notice pain or burning in the external part of your elbow, along with poor grip strength, per the American Academy of Orthopaedic Surgeons.

8. You’re having problems with your eyes.

The inflammation from psoriatic arthritis can even target your eyes, says Ludmer. In fact, some research says between 7% and 20% of people with psoriatic arthritis appear to develop uveitis, a serious form of inflammation in the tissue of the eye wall that can lead to irreversible vision loss, according to the Mayo Clinic. Early warning signs of this condition include pain and redness in the eyes, light sensitivity, blurred vision, and “floaters” in your field of vision.

9. You’re constantly exhausted.

Psoriatic arthritis pits your immune system and your healthy cells against each other, which can feel as though it’s turned your body into a battleground. Coping with the chronic inflammation is downright exhausting, with about half of people with psoriatic arthritis reporting intense fatigue as a symptom in some studies. Other symptoms related to psoriatic arthritis, such as pain (along with trouble sleeping because of it) and reduced ability to exercise, can worsen the fatigue and make you feel wiped out all the time.

“Sometimes there’s an overall feeling of weakness," says Mikulik.

If you have these symptoms, here’s where to get professional help.

Just because you have one (or even a few) of these symptoms doesn’t necessarily mean you have psoriatic arthritis. Tons of other things can cause fatigue, for example, like stress, anxiety disorders, and sleep apnea, which makes it difficult to use a list of symptoms alone to figure out if you have psoriatic arthritis. The only way to know for sure is to talk to a doctor and get a proper diagnosis as soon as possible if you need one. Remember: Psoriatic arthritis can lead to permanent joint damage without treatment, not to mention make a big impact on your daily life.

“If someone has persistent joint pain or stiffness, especially if accompanied by joint swelling or tenderness, and even more so if it’s affecting more than one joint simultaneously, this should be brought to the attention of a physician. Most internists or family practitioners can do the preliminary evaluation to determine what condition may be responsible,” says Rosenstein.

Your doctor may need to refer you to a rheumatologist, a dermatologist, or potentially both for diagnosis and treatment. If you realize in your search for care that you have access to a combined rheumatology-dermatology clinic, that can be a really excellent way to land on a treatment plan that collaborates between the two types of care, says Mikulik. The National Psoriasis Foundation can help you find specialist providers and prepare for your first appointment.

While there’s no known cure for psoriatic arthritis, treatments have come a long way, says Rosenstein. “Our understanding of the function of the immune system has led to the development of all sorts of new medications that can help reset the overactive immune system and tone down the attack on its own tissues, whether it be skin or joints,” he explains. “We can now, in the vast majority of cases, moderate the inflammation and minimize or arrest the skin lesions and joint damage.”

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