First you had to deal with red, flaky scales on your skin… now sore, swollen joints?

Unfortunately, sometimes yes.

If you’re one of the 7.4 million Americans who live with the inflammatory autoimmune disease psoriasis, then you’re at risk of developing psoriatic arthritis.

Up to 30 percent of people with psoriasis develop psoriatic arthritis, though some people experience only mild cases.

“Psoriasis can be present for 10 to 20 years before psoriatic arthritis is diagnosed,” says Dr. Ana-Maria Orbai, director of the Psoriatic Arthritis Program and assistant professor of Medicine at Johns Hopkins. “But for some people, it happens at the same time or slightly later.”

Some people also develop psoriatic arthritis before ever developing skin-related psoriasis.

Psoriatic arthritis is a chronic, inflammatory autoimmune disease of the joints, tendons, and ligaments that connect to the bone. It can affect small or large joints, as well as occasionally the spine.

It’s an autoimmune disease, which means the symptoms are caused by your immune system attacking your body because it can’t tell the difference between something foreign to your body (think: a virus or bacteria) and your own body.

Psoriatic arthritis can start at any age (even children can experience it), but it generally starts between the ages of 30 and 50.

Researchers aren’t really sure why it develops, but they believe there’s likely a genetic cause — 40 percent of people with the disease have one or more family members who also have it — and an environmental trigger, such as an infection, stress, or physical trauma.

There’s no cure, but treatments are available to lessen your pain, protect your joints, and keep you active. The sooner you start treatment, the more likely it is that you can slow the progression of the disease.

Research suggests that more than half of people with psoriatic arthritis have to wait 2 or more years for a diagnosis because initial signs of the disease are missed. So it can be helpful to know the symptoms and keep an eye on any signs you may want to talk about with your doctor.

The symptoms of psoriatic arthritis vary from person to person and can be mild or severe. They also vary depending on what part of the body is affected.

You may go into remission and feel better for a while, or your symptoms may get worse over time.

All this may make you feel like you’re just stuck with what happens, but don’t forget: Treatment can make a big difference in your symptoms and how you feel. So it’s worth making an appointment to talk with a doctor if the following symptoms sound familiar.

Joint pain and stiffness

Joint pain and stiffness is one of the hallmarks of psoriatic arthritis. It can affect one joint or multiple joints, anywhere in your body, from your knees to your fingers, toes, ankles, and lower back.

It’s also one of the symptoms you should never ignore.

“If you ignore signs of psoriatic arthritis, your joints can contract, meaning you can’t move them, and this is permanent,” says dermatologist Dr. Orit Markowitz. “This is why it is very important to get treated if you notice any early signs of joint stiffness.”

Joint swelling or warmth

Psoriatic arthritis is an inflammatory disease, so swelling and inflammation are extremely common. These joints might also feel warm to the touch because inflammation and swelling produce heat.

Pitted nails

Around 60 percent of people with psoriatic arthritis experience changes to their fingernails and toenails.

Some nails get “pits” (or holes) in them, meaning they appear bumpy or dented. Others get lines, thicken, turn colors, or just look slightly deformed.

Nail separation

Another warning sign that involves your nails (sorry) is called onycholysis. It means your nails separate from the nail bed and sometimes even fall off.

The separation usually starts at the tip of the nail and progresses up. The separation point is also susceptible to infection and injury.

Lower back pain

Around 20 percent of people with psoriatic arthritis develop a type called psoriatic spondylitis, which means the condition affects their spine. In this case, the joints of the spine swell.

Now, you may be wondering how to distinguish this from the regular aches and pains you might feel after a late night or a good workout. With this type of swelling, you’re likely to feel stiffness that lasts for an hour or longer, especially first thing in the morning.

In some advanced cases, the points of the pelvis and spine can actually fuse in the lower back or neck.

Swollen fingers or toes

The small joints of your fingers and toes are often the first places inflammation and swelling start with psoriatic arthritis. This is called dactylitis, and it’s extremely common. Somewhere between 32 and 48 percent of people with psoriatic arthritis experience dactylitis.

This swelling can be so bad that your fingers and toes might look a little sausage-like because your entire finger or toe will swell, not just the joint.

Eye inflammation

Around 7 percent of people with psoriatic arthritis get eye inflammation, specifically in the middle layer of the eye that provides most of the blood supply to your retina.

This is known as uveitis, and it feels like a very severe case of conjunctivitis (aka pink eye). It causes redness, inflammation, itchiness, and pain. You’ll also likely have headaches and blurred vision. Sometimes, it may feel like you have sand or grit in your eye.

This eye inflammation is also really serious — without treatment, it can lead to vision loss in the affected eye.

Foot pain

“Psoriatic arthritis does not affect just the joints,” says Orbai. “It can also affect the tendons and ligaments.” And this includes the tendons and ligaments in your feet.

You may have pain (and swelling) in all the areas of your feet where tendons attach to the bone, such as in your heel or at the sole of your foot. This is known as entheitis.

Elbow pain

Psoriatic arthritis can also impact your elbow, since it’s another joint with ligaments and tendons.

The pain generally concentrates on the outside of the elbow but can stretch all the way into your forearm and wrist. It feels a little bit like tennis elbow.

Reduced range of motion

All this swelling in your joints can make it hard to move — literally. You might find yourself struggling to do simple everyday tasks like opening jars, typing, and walking.


It’s not uncommon to feel exhausted physically and mentally if you have psoriatic arthritis. It can make you feel weak, slow, unmotivated, or just too tired to move around.

Research suggests that about half of all people with psoriatic arthritis have mild to moderate fatigue and 29 percent have severe fatigue.

Psoriatic arthritis is painful and, in severe cases, can be debilitating — especially if symptoms go untreated for a long time. But you can manage the condition with the help of rheumatologists and dermatologists. “There’s going to be better days and bad days,” says Orbai, “but management is possible.”

So if you’re experiencing any of these early warning signs, contact a doctor. The sooner you seek treatment, the sooner your doctor can help you find ways to relieve some of your symptoms.