Rheumatology TT

Psoriatic Arthritis: What You Need To Know…

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What is Psoriatic Arthritis?

Psoriatic Arthritis (PsA) is a chronic, inflammatory arthritis that affects an estimated 0.1% to 1% of the population. PsA affects more than 20% of patients with psoriasis – a chronic skin condition that involves flaky patches of skin forming into scales [1] [2]. The nature of psoriatic arthritis is one in which the immune system attacks both the skin and the joints. Symptoms, which often occur cyclically, can include sausage like swelling of fingers and toes, pain at sites where tendons or ligaments attach to bone and nail pitting [3]. Psoriatic arthritis can affect anyone, at any age, however, it typically develops after age 30, and affects both men and women equally [4].

Signs and Symptoms of Psoriatic Arthritis

Psoriatic arthritis can present in many different ways, in which the recognition of signs and symptoms are essential for diagnosing and effective management. These features can occur cyclically, whereby a sudden onset is known as a “flare up”. Some common signs and symptoms of PsA include, but are not limited to:

  1. Psoriasis, a chronic skin condition that comprises of  areas of discolored skin covered with scales. These thick, scaly areas are called plaques. These areas can range in color from purple with gray scales on darker colored skin, and pink or red with silver scales on lighter colored skin [5].
  2. Dactilytis, also referred to as, “sausage digit”, is swelling of the whole fingers or toes. This is as a result of joint, tendon, and soft tissue inflammation. When experiencing this, swelling of the joints and nearby soft tissues blends together, hence causing the affected finger(s)/toe(s) to take on a sausauge-like appearance [6].
  3. Enthesitis takes place when entheses – the site at which tendons and ligaments connect to bones become inflamed. On average, enthesitis is developed in one in three patients with PsA [7].
  4. Nail involvement is also common, affecting up to 80% of patients with PsA. Nail changes develop because the nail bed and matrix are physically linked to the nearby joints and tendon-bone attachments. Some common features include [3]:
    • Pitting – whereby tiny dents, called pits, develop on the fingernail(s) and/or toenail(s)
    • Crumbling – takes place when the nail(s) become brittle and begin to crumble
    • Onycholysis – occurs when the nail(s) starts to lift, and separates from the nail bed(s)
    • Hyperkeratosis – in which a buildup of keratin results in thickening of the nail(s) or skin bed(s)
  5. Lower back pain or stiffness due to spinal inflammation, which can lead to fusion over time, called spondylitis.
  6. Uveitis refers to the inflammation of the uvea. Though less frequent, this is an extra-musculoskeletal manifestation in PsA. This can result in red, painful eyes, as well as blurry vision [3].

Types of Psoriatic Arthritis

There are five main types of psoriatic arthritis, each uniquely affecting the joints. These include [8]:

  1. Distal Psoriatic Arthritis which primarily affects the small joints closest to the ends of the fingers and toes. It is in this type of PsA that nail changes are most often observed.
  2. Symmetric Psoriatic Arthritis in which the same joints on both sides of the body are impacted. For example, both knees or both wrists.
  3. Asymmetric Psoriatic Arthritis presents only in a few joints and occurs in asymmetrical sides of the body. For instance, only one knee or one wrist may be affected, while their opposite side is unaffected.
  4. Spondylitis involves the vertebrae and the joints between them. Over time, this can lead to new bone formation and eventual fusion of the spine, resulting in reduced mobility.
  5. Arthritis Mutilans is the rarest, yet most severe form. With significant inflammation, bone loss and joint deformities occur, particularly in the hands and feet.

Causes and Risk Factors of Psoriatic Arthritis

Psoriatic arthritis stems from the immune system mistakenly attacking healthy tissue in the body. While there are no definitive findings as to why this occurs, there are several risk factors involved, including [9]:

  1. Psoriasis
    • Active psoriasis
    • A personal history of psoriasis
    • A family history of psoriasis
  2. A family history of PsA
  3. Caucasian ethnicity
  4. Previous trauma in the joints
  5. Stress

Diagnosing Psoriatic Arthritis

In the diagnosis of psoriatic arthritis, there is no one single test that can be utilized. Instead, a combination of investigations may be used to draw a diagnosis. Some of these include [10]:

  1. Physical examination whereby joint pain, skin lesions and nail disorders are evaluated by a physician
  2. Blood investigations such as Rheumatoid Factor (RF) and Erythrocyte Sedimentation Rate (ESR), to rule out other inflammatory types of arthritis such as rheumatoid arthritis
  3. Imaging including x-rays, ultrasounds and MRIs, which can reveal joint changes that are in keeping with PsA

Treatment of Psoriatic Arthritis

For a closer look into treatment of psoriatic arthritis, see our companion article, “Treatment of an autoimmune inflammatory arthritis” on Rheumatology TT [11].

Living with Psoriatic Arthritis

As mentioned earlier, psoriatic arthritis is a lifelong condition. However, with proper management and care, one can maintain a good quality of life.

What can I do? To begin, you can adjust your dietary habits by starting an anti-inflammatory diet, as well as the intake of anti-inflammatory supplements such as Omega 3 and turmeric. Additionally, this can be paired with low-impact exercises such as brisk walking and yoga stretches. Furthermore, stress can be controlled to avoid flare ups [12].

What should I avoid? Certain lifestyle habits can increase inflammation and can eventually lead to a flare up. These include smoking, the consumption of alcohol and highly processed, sugary foods. Instead, opt to limit smoking and alcohol usage, whilst maintaining a balanced, whole-food, anti-inflammatory diet [13].

Should I seek medical attention? Absolutely – seeking a rheumatological review can help with symptomatic management such as pain, swelling and stiffness. Early diagnosis and management are key when developing a treatment plan to control PsA. Moreover, a dermatological review can be beneficial for diagnosing and managing associated psoriasis.

Key Takeaways

  • Psoriatic arthritis is a chronic autoimmune inflammatory disease that affects both the joints and the skin.
  • Features that are concordant with PsA include joint pain, swelling, stiffness, psoriasis and nail changes.
  • Physician consultations, dietary changes, and lifestyle changes can be implemented to ensure proper management, and an improved quality of life with PsA patients.

Jadon Soodoo
Incoming Y1 DDS Student, U.W.I., St. Augustine

References

  1. Karmacharya, P., Chakradhar, R., & Ogdie, A. (2021). The epidemiology of psoriatic arthritis: A literature review. Best Practice & Research Clinical Rheumatology, 101692. https://pubmed.ncbi.nlm.nih.gov/34016528/
  2. NHS. (2024, October 10). Psoriasis. (NHS Health A to Z) Retrieved from https://www.nhs.uk/conditions/psoriasis/#:~:text=Psoriasis%20is%20a%20skin%20condition,the%20scales%20may%20look%20grey.
  3. Staff, M. C. (2021, October 2). Psoriatic arthritis – Symptoms & causes. (Mayo Clinic) Retrieved from https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/symptoms-causes/syc-20354076
  4. Foundation, A. (n.d.). Psoriatic Arthritis: Symptoms, Diagnosis, and Treatment. Retrieved from https://www.arthritis.org/diseases/psoriatic-arthritis
  5. Staff, M. C. (n.d.). Psoriasis – Symptoms & causes. (Mayo Clinic) Retrieved from https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840
  6. Girolimetto, N., Giovannini, I., Crepaldi, G., De Marco, G., Tinazzi, I., Possemato, N., . . . Zabotti, A. (2021). Psoriatic Dactylitis: Current Perspectives and New Insights in Ultrasonography and Magnetic Resonance Imaging. Journal of Clinical Medicine, 10(12), 2604. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC8231617/
  7. Gower, T. (2024, August 28). Enthesitis in Psoriatic Arthritis. (Arthritis Foundation) Retrieved from https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/physical-effects/enthesitis-and-psa
  8. Clinic, C. (n.d.). Psoriatic Arthritis. (Cleveland Clinic ) Retrieved from https://my.clevelandclinic.org/health/diseases/13286-psoriatic-arthritis
  9. Staff, U. H. (2023, June 9). Early signs and symptoms of psoriatic arthritis. (UCLA Health) Retrieved from https://www.uclahealth.org/news/article/early-signs-psoriatic-arthritis
  10. Staff, M. C. (2025). Psoriatic arthritis – Diagnosis & treatment. (Mayo Clinic) Retrieved from https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/diagnosis-treatment/drc-20354081
  11. TT, R. (2025, May 15). Treatment of an autoimmune inflammatory arthritis. (Rheumatology TT) Retrieved from https://rheumatologytt.com/2025/05/15/treatment-of-an-autoimmune-inflammatory-arthritis/
  12. Foundation, N. P. (n.d.). Living with Psoriatic Arthritis. (National Psoriasis Foundation) Retrieved from https://www.psoriasis.org/living-with-psoriatic-arthritis/
  13. Service, N. H. (2024, April 8). Psoriatic arthritis. (NHS (UK)) Retrieved from https://www.nhs.uk/conditions/psoriatic-arthritis/

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