Inflammation associated with psoriatic arthritis can affect your entire body — not just your joints.
Psoriatic arthritis is a chronic inflammatory autoimmune disease that affects an estimated 30 percent of people who have psoriasis, according to the National Psoriasis Foundation (NPF).
“Typically, psoriatic arthritis symptoms include pain, swelling, and stiffness that affect your joints — from the small joints of the hands and feet to the large joints of the hips and knees,” explains Rochelle Rosian, MD, a rheumatologist with the Cleveland Clinic in Ohio.
These aren’t the only symptoms you may experience if you have psoriatic arthritis. Inflammation associated with the condition can cause a broad range of symptoms that can affect your entire body — from your head down to your toes. Being able to recognize these symptoms early allows you to immediately discuss them with your doctor so you can find the best treatment for you.
Here’s what you need to know about psoriatic arthritis symptoms and related conditions, as well as steps your doctor may recommend to get them under control.
Uveitis Can Cause Eye Pain and Redness
Psoriatic arthritis can cause inflammation, redness, and pain in the eyes, often accompanied by headache and blurred or reduced vision, Dr. Rosian says. About 7 percent of people who have psoriatic arthritis develop uveitis, or inflammation of the inner area of the eye, according to the NPF. “This is much more than pink eye or conjunctivitis,” Rosian explains. Uveitis can lead to long-term consequences, including vision loss, if left untreated.
Your doctor may prescribe steroid eye drops to help reduce inflammation. If those don’t work, you may need steroid pills or injections. On occasion, immunomodulators may be used to treat uveitis. Rosian stresses the importance of working with an ophthalmologist to protect your vision.
Inflammation Can Impact Your Heart Health
According to the Arthritis Foundation, the risk of heart disease is nearly twice as high in people who have psoriatic arthritis than people who don’t have the joint condition. Studies show a 43 percent higher likelihood of having or developing heart disease for those who have psoriatic arthritis and a 22 percent increased risk of cerebrovascular disease.
The underlying inflammation related to psoriatic arthritis can damage blood vessels and eventually lead to atherosclerosis, or the buildup of plaques, contributing to higher blood pressure and reduced blood flow. When combined with other typical risk factors of heart disease like obesity and diabetes — both of which also show strong correlations with psoriatic arthritis — this can lead to higher risk of stroke, heart attack, or other cardiovascular disease. Treating psoriatic arthritis can help decrease whole-body inflammation, which in turn reduces your risk of related heart complications.
Inflammation of the Spine Can Lead to Stiffness
The spine can also be affected by psoriatic arthritis inflammation. This is called psoriatic spondylitis, which affects about 20 percent of those who have psoriatic arthritis, according to the Spondylitis Association of America (SAA). The condition can affect anywhere from the neck to the lower back, but often occurs in the spine. It and may cause affected joints to ankylose, or fuse together, Rosian explains. People who have psoriatic spondylitis may experience complete fusion of the spine, or it may only occur in certain areas such as the lower back or neck, notes the SAA.
Many people who have psoriatic arthritis experience stiffness lasting an hour or longer when they wake up in the morning. The discomfort can often be eased with nonsteroidal anti-inflammatory medications (NSAIDs), Rosian says. When the stiffness persists or severely affects your quality of life, it’s time to talk to your doctor.
Scaly Skin Is a Symptom of Psoriasis
About 85 percent of people who have psoriatic arthritis first develop psoriasis symptoms on their skin, according to the NFP. Typical psoriasis symptoms include silvery-white or red patches of skin that reveal pinpoint bleeding if peeled away, says Linda Wong, MD, a dermatologist at Kaiser Permanente in Southern California. Psoriasis can also appear on the skin of the face, hands, feet, scalp, and even genitals.
The type of treatment can depend on what part of the body is affected, but over-the-counter 1 percent hydrocortisone creams and prescription medications can often improve the skin. A generous slathering of a plain, thick moisturizer, such as petroleum jelly, can also ease symptoms, Dr. Wong says.
Swollen Fingers and Toes, Sometimes Referred to as "Sausage Digits," Can Occur
Another symptom of psoriatic arthritis is known as dactylitis, commonly called “sausage digit.” You may experience inflammation and swelling in just one finger or toe or in all of them on a hand or foot, which can also be swollen and red along the entire length. Studies show that dactylitis occurs in anywhere from 16 to 49 percent of people who have psoriatic arthritis. “This is because not only the joints but all the ligaments and tendons of the digit are affected, up to the most distal joint near the nail,” Rosian says. NSAIDs may help alleviate swelling and pain.
Psoriatic Arthritis May Increase Your Risk of Inflammatory Bowel Disease
Some people who have psoriatic disease also face an increased risk of developing an inflammatory bowel disease like Crohn’s or ulcerative colitis. Studies point to a 1-4 fold increased risk of IBD in patients who have psoriatic arthritis compared to those who don’t have the joint condition.
Don't ignore warning signs such as diarrhea or blood in the stool, Rosian says. Tell your primary care physician, who can work with your rheumatologist to address intestinal issues or side of affects of taking chronic NSAIDs.
Enthesitis Can Cause Pain and Swelling in the Feet
People who have psoriatic arthritis often develop enthesitis — swelling, tenderness, or pain caused by inflammation in areas where tendons or ligaments connect to bones. Common areas enthesitis may occur include the heel (Achilles tendinitis) and the sole of the foot (plantar fasciitis).
Gentle stretching, applying heat or ice, splinting, and taking certain medications can help control inflammation and ease pain, Rosian says.
Toenail and Fingernail Deformities Are Common With Psoriatic Arthritis
At least 80 percent of people who have psoriatic arthritis will have nail problems, according to the NPF. Fingernails and toenails may develop holes or pits; separate from the nail bed; thicken; turn yellow or orange; or look deformed, Wong says.
Nail psoriasis is hard to manage with topical medications, but phototherapy and corticosteroid injections into the nails may improve symptoms.