Although psoriatic arthritis normally affects only people with psoriasis, skin and joint problems usually don't develop simultaneously. Many people have psoriasis long before they develop arthritic symptoms, and a few have joint pain for decades before skin symptoms appear. But to receive a diagnosis of psoriatic arthritis, you must have signs and symptoms of both conditions:
Patches of thick, red skin covered with silvery scales, especially on your elbows, knees, scalp or the lower end of your spine. These patches (plaques often itch or burn, and the skin at your joints may crack.
Pain, redness, swelling and reduced motion in your joints — especially the small joints at the ends of your fingers and toes. The joints in your spine and your sacroiliac joints — the two large joints that connect your pelvis and the triangular bone at the end of your spine (sacrum) — also may be affected.
Stiffness and fatigue in the morning.
Pitted, discolored nails that may separate from the nail beds.
Eye inflammations such as conjunctivitis or iritis.
In addition to general arthritic symptoms, there are five distinct types of psoriatic arthritis, each with its own characteristics:
Asymmetric arthritis. The mildest form of psoriatic arthritis, asymmetric arthritis usually affects joints on only one side of your body or different joints on each side — including those in your hip, knee, ankle or wrist. One to three joints are generally involved, and they're often tender and red. When asymmetric arthritis occurs in your hands and feet, swelling and inflammation in the tendons can cause your fingers and toes to resemble small sausages (dactylitis).
Symmetric arthritis. Unlike asymmetric arthritis, symmetric arthritis usually affects four or more of the same joints on both sides of your body. It's similar to rheumatoid arthritis, one of the most common and debilitating of the many arthritic conditions. Although symmetric arthritis is generally milder than rheumatoid arthritis, it can cause progressively disabling joint damage. More women than men have symmetric arthritis, and psoriasis associated with this condition tends to be severe.
Distal interphalangeal joint predominant (DIP). A small percentage of people with psoriatic arthritis — most of them men — have DIP, which affects the small joints closest to the nails (distal joints) in the fingers and toes. DIP is sometimes misdiagnosed as osteoarthritis, a type of arthritis that results from the destruction of cartilage on the ends of the bones. But psoriatic arthritis usually causes nail problems that don't occur with osteoarthritis.
Spondylitis. This form of psoriatic arthritis can cause inflammation in your spine as well as stiffness and inflammation in your neck, lower back or sacroiliac joints. Inflammation can also occur where ligaments and tendons attach to your spine. As the disease progresses, movement tends to become increasingly painful and difficult. Psoriatic spondylitis isn't the same as ankylosing spondylitis, another arthritic condition. Ankylosing spondylitis doesn't occur with psoriasis and usually affects the entire spine, whereas psoriatic spondylitis may affect only your neck or low back.
Arthritis mutilans. A small percentage of people with psoriatic arthritis have arthritis mutilans — a severe, painful and crippling form of the disease. Over time, arthritis mutilans destroys the small bones in the hands, especially the fingers, leading to permanent deformity and disability.
The symptoms of psoriatic arthritis are likely to be better at some times and worse at others. But because skin and joint problems frequently flare up and go into remission at different times, you may have severe psoriasis when your joints are relatively pain-free and aching joints when your skin clears.
Juvenile psoriatic arthritisChildren with psoriatic arthritis usually develop signs and symptoms of the disease around age 9 or 10. Symptoms are often mild, although some children may have severe and debilitating problems that last into adulthood.
In general, children have many of the same signs and symptoms that adults do, but they're more likely to develop skin and joint problems simultaneously. And because children's bones are still forming, abnormal bone development can affect growth.
