Psoriatic Arthritis Slideshow Pictures Gallery of Skin Problems and Images Collection Adult Skin Problems Slideshow Pictures

Medical Author:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:

Catherine Burt Driver, MD

Catherine Burt Driver, MD

Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

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Psoriatic Arthritis Symptoms and Signs

People with psoriatic arthritis might not have obvious skin findings, or they might have minimal scaly red skin on the scalp, in the bellybutton, or between the buttocks. Some people with psoriatic arthritis might just have nail abnormalities and arthritis and no other skin symptoms. In one study, arthritis was noted more frequently in people with severe skin involvement. In another study, pustular psoriasis was associated with more severe psoriatic arthritis.

People with psoriatic arthritis may have various nail changes (see Nail Psoriasis). The nails may loosen (onycholysis) and there may be lines going across the nails (side to side rather than root to tip) or yellow spots in the nails. There may also be little pits in the nails. The more pits in your nails, the more likely psoriasis will be present. Usually, if skin and arthritis symptoms begin at the same time, nail findings begin too. Often, if one has symptoms in the joints at the ends of the fingers or toes, then those nails will be affected. Eighty percent of people with psoriatic arthritis have nail abnormalities. Only 20% of people with uncomplicated psoriasis have nail changes. Nail abnormalities are usually present in people who have severe arthritis with deformity in the hands and feet. The nails can also become infected with fungus. The doctor will assess them and prescribe antifungal medications if so.

Usually, psoriasis occurs before arthritis, sometimes as much as 20 years before arthritis. Tell your doctor if you have a family history of psoriasis.

Thirty percent of people with psoriatic arthritis have eye symptoms. Eye inflammation (conjunctivitis) occurs in 20%, and inflammation of the iris (iritis), the colored part of your eye, occurs in 7%. Children with juvenile psoriatic arthritis (see below) should be examined every year by an eye doctor to check for eye problems.

Inflammation may occur where your muscles and tendons connect to the bones, especially in the heel and the sole of the foot.

Initial symptoms of psoriatic arthritis may be severe. If symptoms are only in the foot or toe, they may be mistaken for those of gout. (People with psoriasis can have gout. Looking at the joint fluid for gout crystals usually can make the diagnosis clear.) Other people with psoriatic arthritis may only have stiffness and pain and few physically obvious problems. People with HIV often have more severe skin symptoms.

If you have psoriatic arthritis, your condition probably falls into one of the patterns below.

• Asymmetrical oligoarticular arthritis (arthritis that involves a few joints but not necessarily the same joints on both sides of the body or other similar joints on the same side of the body):
• Usually, the fingers and toes are affected first. The fingers may have a "sausage" appearance (called dactylitis). This occurs in 35% of people with psoriatic arthritis.
• Usually, fewer than five joints are affected at any particular time.
• Symmetrical polyarthritis (arthritis that involves the same few joints on both sides of the body): This pattern was recently recognized as one of the most common types.
• The hands, wrists, ankles, and feet may be involved.
• This condition is usually milder than rheumatoid arthritis (in which many more joints may be involved). In people with psoriatic arthritis, joints are less tender and deformity is less severe than it is in people with rheumatoid arthritis. Your doctor may notice additional differences that distinguish this from rheumatoid arthritis.
• Distal interphalangeal arthropathy (arthritis in the joints at the ends of the fingers and toes)
• Involvement of the joints at the ends of the fingers and toes only happens in psoriatic arthritis. (Involvement of the joints at the ends of the fingers and in the big toe can occur in osteoarthritis, but osteoarthritis is much less inflammatory than psoriatic arthritis.) However, this form occurs in only 5%-10% of people with psoriatic arthritis, most commonly men.
• The nail may be involved. The skin around the edges of your nail may be inflamed (called paronychia).
• Arthritis mutilans (a long-term psoriatic arthritis in which the joints are severely damaged and deformities can be seen, especially in the hands and feet)
• This may occur in as many as 16% of people with psoriatic arthritis and can be severe.
• The bone may soften and become absorbed by surrounding tissues (called osteolysis), and the joint may dissolve.
• If the fingers and wrists become shortened with skin folds around them, the condition is called "opera glass hand." This occurs more often in men than in women.
• Spondylitis (inflammation of the vertebrae in the spine) with or without sacroiliitis (inflammation of the sacroiliac joint in the pelvis) and inflammation of the hip
• This occurs in about 5% of people with psoriatic arthritis, usually men.
• People who have other psoriatic arthritis patterns may also have this condition.
• The typical symptom is stiffness of the lower back in the morning, but not everyone has this. It can occur without involvement of the pelvis/hip joints, which often occurs on only one side of the body. Sometimes a person's symptoms do not seem to match the findings on X-rays.
• The vertebrae are not affected evenly. A joint in the neck may be affected and not a lower spine joint.
• Your doctor may notice unusual features on X-rays, such as bony growths on ligaments.
• Juvenile psoriatic arthritis (psoriatic arthritis that affects children)
• Juvenile psoriatic arthritis accounts for 8%-20% of cases of arthritis in children.
• This often occurs in 9- to 10-year-old girls. It is usually mild but occasionally it is severe and lasts into adulthood.
• In half of affected children, only one joint is affected. The joints at the ends of the fingers or toes are involved in about half of affected people as well.
• The tendons are inflamed in 30% of affected children. Nails are involved in 71% of affected children, and little pits can often be seen on the nails.
• Bone growth problems and shortening due to inflammation may occur in 47% of affected children.
• Sacroiliitis (inflammation of the sacroiliac joint in the pelvis) or arthritis of the hip occurs in 28% of affected children.
• Onset of psoriasis and arthritis at the same time occurs more often in children than adults. Arthritis occurs before psoriasis in 52% of affected children.