Psoriatic arthritis: Symptoms
What are the symptoms of psoriatic arthritis?
Psoriatic arthritis affects the joints of around one in five people with psoriasis.
Psoriatic arthritis often causes inflammation of the knees, ankles and joints in the feet and hands but it may affect any joint in the body. Usually, only a few joints are inflamed at a time. The inflamed joints become painful, swollen, hot and red. Sometimes, joint inflammation in the fingers or toes can cause swelling of the entire digit, giving them the appearance of a sausage.
Joint stiffness is common and is typically worse early in the morning. Less commonly, psoriatic arthritis may involve many joints of the body in a symmetrical fashion, mimicking the pattern seen in rheumatoid arthritis.
Psoriatic arthritis can also cause inflammation of the spine (spondylitis) and the sacrum, causing pain and stiffness in the lower back, buttocks, neck and upper back. In rare instances, psoriatic arthritis involves the small joints at the ends of the fingers. A very destructive form of arthritis, called "mutilans", can cause rapid damage to the joints of the hands and feet and loss of their function. Fortunately, this form of arthritis is rare in patients with psoriatic arthritis.
Patients with psoriatic arthritis can also develop inflammation of the tendons (tendinitis) and around cartilage. Inflammation of the tendon behind the heel causes Achilles tendinitis, leading to pain with walking and climbing stairs. Inflammation of the chest wall and of the cartilage that links the ribs to the breastbone (sternum) can cause chest pain, as seen in costochondritis.
Does psoriatic arthritis cause inflammation of organs?
Yes. Psoriatic arthritis can cause inflammation in other organs, such as the eyes, lungs and aorta. Inflammation in the coloured portion of the eye (iris) causes iritis, a painful condition that can be aggravated by bright light.
Inflammation in and around the lungs ( pleurisy) causes chest pain, especially with deep breathing, as well as shortness of breath. Inflammation of the aorta (aortitis) can cause leakage of the aortic valves, leading to heart failure and shortness of breath.
Nail changes are commonly seen in psoriatic arthritis. Pitting and ridges are seen in the fingernails and toenails of 80% of patients with psoriatic arthritis. Interestingly, these characteristic nail changes are observed in only a minority of psoriasis patients who do not have arthritis.
Acne has been noted to occur in higher frequency in patients with psoriatic arthritis.
When should I seek medical advice about psoriatic arthritis?
If you have psoriasis and are experiencing joint pain or swelling, you should talk to your doctor. You should also seek medical advice if you have these symptoms:
- Stiffness in the joints
- Irritation and redness of the eye
- Chest pain or shortness of breath
In order to identify psoriatic arthritis, your doctor will perform a physical examination. Your doctor may also arrange blood tests, joint fluid tests and X-rays in order to examine the affected areas and rule out other diseases. Of course, the usual symptoms of psoriasis, such as red, scaly patches of skin, may make diagnosis of psoriatic arthritis easier for your doctor.