Early Psoriatic Arthritis (PsA) Signs and Symptoms

Psoriatic arthritis (PsA) is a chronic (long-term) condition that includes symptoms of arthritis and psoriasis. Arthritis is a joint condition that causes pain and inflammation, and psoriasis is a skin condition caused by an overactive immune system. Psoriasis is a skin condition that causes inflammation and rashes of discolored areas.

People with PsA will have psoriasis first. Early warning signs of PsA often include arthritis symptoms like joint pain, stiffness, and swelling. Early symptoms can appear in different orders, and joint symptoms may start before skin symptoms. Symptoms can occur gradually or suddenly, range from mild to severe, or affect a few or many parts of your body.

Early psoriatic arthritis skin symptoms are related to psoriasis, an autoimmune disease. Autoimmune diseases happen when your body’s immune system mistakenly attacks healthy tissues or organs.

If you have psoriasis, your body makes too many skin cells too quickly. This causes skin changes, including scaly, inflamed patches of skin on your body. These patches are called plaques. They usually look like thick, red patches covered in silver or white scales.

Plaques may be itchy or have a burning sensation. They can form anywhere on the skin, but are common on the scalp, elbows, and knees. If you have psoriasis, you may also have dry or cracked skin, which can cause itching and bleeding. 

In the early stages of PsA, you may see changes in the health of your fingernails and toenails. It’s common for nails to become thicker and to crack or crumble. You may notice ridges or pits on your nails; this can look like grooves or small dents. The nails separate or lift away from the nail bed.

About one out of every four people with psoriasis develops PsA, often between 5-12 years after being diagnosed with psoriasis.

PsA joint symptoms can affect any joint in your body, from small hand and foot joints to the larger spine and pelvis joints. Fingers, wrists, ankles, and knees are common places. Because PsA can cause inflamed joints, you may have the following symptoms:

• Pain, tenderness, or warmth in affected joints
• Swelling, especially in single joints such as the hands and feet, which causes an entire finger or toe to swell (sausage digit)
• Stiffness, or an inability to easily move a joint or get up quickly after sitting or lying down for a long time

PsA most often affects limbs, but it can also cause pain in the lower back, neck, hip, or heel.

Joint symptoms are often the first sign of PsA. This is because most people with PsA already have psoriasis and have been experiencing skin and nail symptoms. When they develop joint symptoms, it could be a sign they’ve developed PsA. However, arthritis symptoms may develop before skin symptoms.

You may experience other psoriatic arthritis symptoms in addition to joint inflammation (swelling) and skin and nail changes. Early PsA symptoms may include:

• Fatigue
• Fever
• Swelling at entheses points, which connect tendons and ligaments to bones. Your Achilles’ tendon, running from your calf down to your heel bone, is a common place to have this symptom.
• Swelling in the middle part of your eye, called uveitis, which causes pain, redness, and blurred vision.

Psoriatic arthritis affects men and women in equal numbers. However, you may have certain symptoms depending on your sex, such as:

• Women are more likely to have peripheral arthritis symptoms, which are symptoms in the limbs (like knees, elbows, and ankles).
• Women are more likely to have more joint-related symptoms, which is medically called polyarthritis.
• Women often experience more pain, even after treatment.
• Women are more likely to have PsA affect their ability to function in daily life.
• Men are more likely to have axial arthritis symptoms, which are symptoms in the spine and pelvis.
• Men are more likely to have skin-related symptoms, including plaques.

In general, you may have more intense symptoms of PsA if you’re born female. Getting a timely diagnosis and seeing improvements from your treatments may also be harder.

Psoriatic arthritis doesn’t usually cause urgent or emergency symptoms. However, if you have any of the early symptoms of PsA, like joint pain, skin plaques, tiredness, and back pain, consider making an appointment with a healthcare provider. Only uveitis symptoms require immediate treatment. If left untreated, uveitis can cause permanent damage.

No sign test confirms PsA. A healthcare provider will ask you questions about your symptoms, examine your joints and skin, and recommend a few other tests, like a blood test and x-rays, to see if you have high levels of inflammation.

Psoriatic arthritis (PsA) is a long-lasting disease with symptoms of arthritis and psoriasis. In the early stages, you might have plaques on the skin and joint pain, swelling, and inflammation. You may also have eye pain, back and foot pain, tiredness, and changes to the health of your nails.

Everyone with PsA can experience different early warning signs, so being aware of all the possible symptoms can help you recognize when you may need to visit a healthcare provider for diagnosis.

It’s important to see a healthcare provider as soon as possible if you have any early disease symptoms. PsA can be treated with medications and lifestyle changes that manage pain and prevent damage to your joints and skin.