How to Spot Psoriatic Arthritis Right Away
If psoriatic arthritis looks painful, you’re right. But the real discomfort is more than skin deep. Most people with psoriatic arthritis (PsA) have thick, red, scaly plaques on their skin—the signature symptom of psoriasis—for about 10 years before their joints begin to ache, swell, or stiffen. That said, you can develop PsA without having psoriasis, and sometimes joint swelling appears before the plaques.
Spotting inflammation ASAP is key: Delaying treatment by as little as six months can result in permanent joint damage, according to a study in Annals of the Rheumatic Diseases. But what exactly does psoriatic arthritis look like, particularly during the early stages? Read on.
PsA is a form of arthritis that affects roughly 30 percent of people with the skin condition psoriasis, according to the Arthritis Foundation. Both conditions are autoimmune diseases, meaning the immune system mistakenly attacks parts of the body—in this case, the skin and joints.
When the condition first appears, people with PsA may notice plaques near their joints—e.g., elbows, knees—despite no joint ache. Topical creams, oral and injectable medications, light therapy, and complementary therapies such as yoga can help eliminate or reduce skin lesions.
Even major medical sites refer to these as “sausage fingers,” but let’s agree to agree it’s a bit mean (and a pretty weird visual). Psoriatic arthritis often makes fingers and toes swell, according to the Mayo Clinic, before you feel pain or stiffness in your joints. It often happens in multiple fingers and toes at the same time, but not always.
If you notice swelling, particularly if it affects multiple digits simultaneously, see your doctor. Both over-the-counter NSAIDs (aspirin, ibuprofen) and prescription corticosteroids can reduce the inflammation.
Sometimes, it’s not your whole fingers that puff up. Sometimes, psoriatic arthritis causes inflammation and stiffness just in the joints near the ends of the fingers and toes, which is called distal psoriatic arthritis.
This form of PsA looks kind of like rheumatoid arthritis (a similar condition except people with RA don’t get skin plaques), but there’s one easy way to tell the difference. That brings us to...
Changes in the nails—such as pitting (tiny depressions in the nail) and white spots—are common with psoriatic arthritis but don’t occur in people with rheumatoid arthritis.
In fact, some researchers believe that small, everyday traumas to the fingers could spark an abnormal immune response and trigger PsA, according to the National Psoriasis Foundation. Sounds scary, but don’t go canceling that kickboxing class: A causal relationship is not yet proven—in other words, scientists can’t say for certain whether you’re at a higher risk because you’ve, say, jammed a finger or dislocated a joint.
Psoriatic arthritis is usually symmetric, meaning the same joints on both sides of the body are affected. You might notice swelling in the right and left knees or right and left wrists, for example. That said, symmetry isn’t a conclusive symptom of PsA. Swelling associated with rheumatoid arthritis also typically appears on both sides of the body.
Limited Mobility in Your Back or Hips
Roughly 20 percent of people with psoriatic arthritis will develop psoriatic spondylitis, a form of the condition that causes discomfort in the neck and spine. Early symptoms include pain or stiffness in the lower back or hips, according to the Mayo Clinic. But…back pain could mean a million things, right? The type associated with PsA often occurs after waking up or getting up after periods of inactivity.
If the inflammation from spondylitis isn’t controlled, it can lead to a condition known as ankylosing spondylitis, where the vertebrae completely fuse and cause a hunched posture and pain if you try to straighten up.
Several OTC and prescription medications can treat the condition, including NSAIDs and prescription tumor necrosis factor-alpha (TNF-alpha) inhibitors, which block a protein that provokes inflammation in the body. Research published in the journal Arthritis and Rheumatology in 2019 suggests immunotherapy may also be an option for the 30 to 40 percent of patients who don’t respond to TNF-alpha inhibitors.
Arthritis mutilans—a.k.a. “opera glass hand” or “telescopic finger”—is the most severe and destructive form of PsA. It affects about 5 percent of patients, causing debilitating deformities in the small joints at the end of toes and fingers as the bones begin to disappear. If you develop psoriatic arthritis mutilans, straightening or bending the affected joint may become impossible. However, one study published in the Journal of Drugs in Dermatology suggests that TNF-alpha inhibitors can help prevent permanent joint damage.
Annals of Rheumatic Diseases Study: Fitzgerald O, et al. (2015). Diagnostic delay of 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. https://www.ncbi.nlm.nih.gov/pubmed/24525911
The Arthritis Foundation: What Is Psoriatic Arthritis? https://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/what-is-psoriatic-arthritis.php
Swelling in Fingers (and Toes!): Mayo Clinic. Psoriatic Arthritis Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/symptoms-causes/syc-20354076
Nail Damage: National Psoriasis Foundation. When Psoriatic Disease Strikes the Hands and Feet. https://www.psoriasis.org/advance/when-psoriatic-disease-strikes-the-hands-and-feet
Ankylosing Spondylitis: Mayo Clinic. Ankylosing Spondylitis Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808
Journal of Drugs and Dermatology Study: Qureshi, AA., et al. (2009). Follow-up of psoriatic arthritis mutilans patients treated with anti-TNF-alpha therapy. Journal of Drugs in Dermatology, 8 (4). https://www.ncbi.nlm.nih.gov/pubmed/19363860