Psoriatic arthritis

Psoriatic arthritis, also called PsA, is an inflammatory arthritis/spondyloarthritis causing joint pain, stiffness, and swelling. Some people with the skin condition psoriasis also have psoriatic arthritis. General well-being may also be affected.

Symptoms can come and go in flares, and can include: 

• Psoriasis
• Swelling of the fingers and toes 
• Pain and swelling in the feet, knees, ankles, wrists, hands, particularly the joints near the fingertips
• Discolouration and thickening of the nails 
• Pain and redness in the eyes 
• Fatigue  
• Tendon inflammation (enthesitis)
• Some people with psoriatic arthritis also develop spondylitis (arthritis in the spine)

Your doctor will ask about your symptoms and how long you have had them. They will look at your skin and joints. X-rays and MRI scans are used to support a clinical diagnosis. Blood tests are done to rule out other conditions and check inflammatory levels.

Lifestyle choices are an important part of managing symptoms, improving well-being, and reducing flares. 

• Be careful with your joints. Use your whole body to push the door open, not just your hand. Lift heavy things with two hands
• Exercise helps the muscles supporting your joints to stay strong and flexible. Reduced weight reduces the strain on your joints. This helps keep pain under control
• Don’t smoke. Smoking is associated with worsening of psoriasis
• Manage stress and fatigue. Pace yourself. Take rest breaks. Do exercise that relaxes you like yoga or Tai chi
• Limit alcohol use. Alcohol can increase side effects with some medications, such as methotrexate.

Heredity seems to be a factor in psoriatic arthritis, 40% of people with the condition have a family member with it. It usually starts with the skin condition psoriasis. About a third of people with psoriasis develop PsA.  

As well as heredity, there seems to be a ‘trigger’ to set the PsA off. The trigger can be significant emotional or physical stress, trauma or a viral infection. 

PsA affects both men and women, usually between the ages of 30 and 50 years, but can also begin in childhood.

Your treatment will depend on how bad your symptoms are, and which joints are affected. Rest, splints, heat, paracetamol, and nonsteroidal anti-inflammatory drugs (NSAIDs) can help during a flare-up. 

Medications are used to reduce joint pain and to prevent further joint damage. This will help you maintain mobility. 

Your doctor might refer you to a physio or occupational therapist. They will suggest exercises to help ease your pain so you can continue to do your normal daily activities as much as possible.  

Medications used for psoriatic arthritis include NSAIDs, disease-modifying anti-rheumatic drugs (DMARDs), biological therapies (biologics) and steroid injections.

• Nearly half of all people with psoriatic arthritis have a family member who also has it
• If you have psoriasis and you develop joint pain, visit your doctor to check if you now have psoriatic arthritis. It can be in any joint, including the spine
• Exercise and medical treatment will help keep your joint function and reduce pain
• Psoriatic arthritis can damage your joints if you do not get treatment

Clinically reviewed in 2024.