Psoriatic arthritis

Psoriatic arthritis is a type of arthritis that sometimes develops in people with the skin condition psoriasis. It affects the joints and can cause them to become swollen, stiff and painful.

It is estimated that around 1 in 4 patients with psoriasis have psoriatic arthritis.

In most cases, people will experience problems with their skin before they notice any symptoms in their joints. In a small number of cases, skin problems may start at the same time as joint problems or after.

Psoriatic arthritis can be caused by the immune system wrongly attacking healthy tissue. It’s not clear why some people with psoriasis develop psoriatic arthritis and others don’t.

Symptoms of psoriatic arthritis

Psoriatic arthritis can affect any joint in the body. It causes pain, swelling and stiffness in the joints. It often affects particular areas including the:

  • hands
  • feet
  • knees
  • elbows
  • neck and spine

Psoriatic arthritis can also affect the area where tendons and ligaments are connected to the bone. This is called entheses or enthesitis when inflamed.

Sometimes, the whole finger or toe can get inflamed and look sausage-like. This is called dactylitis

Symptoms usually develop slowly. This means that many people don’t know they’re developing psoriatic arthritis. In rare cases, symptoms can develop suddenly without warning.

The severity of psoriatic arthritis varies. Some people may have severe problems affecting many joints. Others may only notice mild symptoms in 1 or 2 joints.

There may be times when your symptoms get better and worse. These are called flare-ups or relapses. Some people may reach a point where they have no symptoms at all (known as remission).

Relapses can be hard to predict. But they can be managed with medication.

When to get medical advice

Speak to your GP practice if you have:

  • constant pain in your joints
  • swelling in your joints
  • stiffness in your joints

You should do this even if you haven’t been diagnosed with psoriasis.

You should have check-ups at least once a year if you have been diagnosed with psoriatic arthritis. Make sure you let your doctor know if you’re experiencing any problems with your joints.

Diagnosing psoriatic arthritis

If your doctor thinks you may have psoriatic arthritis, they should refer you to a rheumatologist for an assessment. A rheumatologist is a specialist in joint conditions.

If you have psoriasis and problems with your joints, a rheumatologist should be able to diagnose psoriatic arthritis. Other types of arthritis, like rheumatoid arthritis and osteoarthritis, would need to be ruled out first.

You may get some tests to help confirm a diagnosis, including:

  • blood tests to check for signs of inflammation and other types of arthritis
  • X-rays of your joints
  • scans of your joints

Treatment for psoriatic arthritis

The main aims of treatment will be to:

  • help your symptoms
  • slow the progression of the condition
  • improve your quality of life

You may be prescribed medication to help treat psoriatic arthritis. For example:

Some people may be prescribed other medications to block chemicals that activate the immune system. These are known as biological medications. But, you will usually be given DMARDs to try first.

For most people, this will mean trying many different medications. Some of these can also treat psoriasis.

Managing related conditions to psoriatic arthritis

As with psoriasis and other types of inflammatory arthritis, you may be more likely to get some other conditions (such as cardiovascular disease (CVD)) if you have psoriatic arthritis.

CVD is the term for conditions of the heart or blood vessels, such as heart disease and stroke.

Your GP should carry out tests each year (such as blood pressure and cholesterol tests) so they can check whether you have CVD. They may offer additional treatment, if necessary.

Psoriatic arthritis can also cause inflammation of the eyes, such as Conjunctivitis and Iritis.

If psoriatic arthritis affects your skin and joints, you may notice changes in your nails such as:

  • dents
  • pits
  • discolouration
  • loosening from the nail bed

This is less common if only your skin is affected.

Your care team

As well as your GP and a rheumatologist, you may also be cared for by:

  • a specialist nurse – often your first point of contact with your specialist care team
  • a dermatologist (skin specialist) – responsible for treating psoriasis symptoms
  • a physiotherapist – can create an exercise plan to keep your joints mobile
  • an occupational therapist – can help you overcome difficulties in your everyday life
  • a psychologist – can offer psychological support if you need it
  • a podiatrist – can offer assessment and advice on foot problems

Living with psoriatic arthritis

Psoriatic arthritis is a long-term condition. When it affects many joints, regular treatment will likely be needed to keep the disease under control.

An early diagnosis and the right treatment can slow down the progression of psoriatic arthritis. Treatment can also help reduce or prevent permanent damage to your joints.

In some patients with severe disease, the joints may become permanently damaged or deformed, requiring surgical treatment.

You can also help yourself by:

Losing weight

Losing weight will help your general health and reduce the strain on your joints. There is evidence that weight loss can also improve the control of psoriatic arthritis and the response to treatment.

Read more about how to lose weight safely

Stopping smoking

Several studies have shown that patients with psoriatic arthritis who don’t smoke tend to have less severe disease and respond much better to treatment compared to those who do smoke.

Read more about stopping smoking

Last updated:
29 May 2024

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