Psoriatic arthritis (PsA) typically hurts most during morning stiffness or after periods of rest, with pain often improving as you start moving, but also flares up due to stress, injury (Koebner phenomenon), and fatigue, commonly affecting fingers, toes, lower back, and Achilles tendons. Intense pain, redness, and swelling (dactylitis, or "sausage digits") are signs of active disease, indicating inflammation that needs management.
Symptoms of Psoriatic Arthritis
Joint stiffness, pain, and swelling of one or more joints. The joints of the spine can be affected as well, leading to stiffness in the neck, lower back, and hips. Joint stiffness is often worse in the morning or after resting.
But symptoms also can come and go. You may have flare-ups where symptoms get worse. And you may have periods of relief when symptoms improve or go away for a while. Psoriatic arthritis can affect joints on one or both sides of your body.
As if that weren't enough, disrupted sleep can worsen joint pain, and some experts think it may increase inflammation, too. Recognizing the issues that are affecting your sleep can help you find relief. Painful joints or itchy skin may make it hard to fall asleep or stay that way.
Psoriatic arthritis (PsA) progresses through four stages: preclinical, subclinical, prodromal, and clinical. Early detection through imaging and blood tests can identify PsA before significant symptoms appear. Proper management, including exercise and avoiding smoking, can help control PsA and improve quality of life.
Psoriatic arthritis can cause pain and swelling along the bones that form the joints. This is caused by inflammation in the connective tissue, known as entheses, which attach tendons and ligaments to the bones. When they become inflamed it's known as enthesitis.
The asymmetric oligoarticular and symmetric polyarthritis types are the most common forms of psoriatic arthritis. The asymmetric oligoarticular type of psoriatic arthritis involves different joints on each side of the body, while the symmetric polyarthritis form affects the same joints on each side.
Anti-inflammatory Medications
Rheumatologists often prescribe nonsteroidal anti-inflammatory drugs, also known as NSAIDs, to people with psoriatic arthritis. These medications can help ease pain and curb the swelling that accompanies this condition. Common NSAIDs include aspirin, ibuprofen, and naproxen.
The joint pain associated with rheumatoid arthritis is usually a throbbing and aching pain. It is often worse in the mornings and after a period of inactivity.
Just as the effects of weather vary, the best climate may not be the same for all people. But based on research, it appears that for most people with arthritis, a warmer, drier climate may be optimal, such as that in parts of Texas, Arizona, Nevada and the Eastern Sierra region of California.
Definitive diagnosis of PsA is further complicated by several arthritic conditions with similar clinical presentations. PsA is often undiagnosed and can be misdiagnosed for rheumatoid arthritis (RA) or osteoarthritis (OA), especially in a non-rheumatologic setting [7–9].
Studies show close to 80% of people with psoriatic arthritis have some degree of fatigue. When you have this disease, your body makes proteins called cytokines that cause inflammation. They make your joints swell and become painful or stiff. These proteins may also cause fatigue, although doctors aren't sure why.
When psoriatic arthritis flares, you need to rest your joints. Using the joints during a flare puts more stress on the joints. This can lead to lasting damage. Medicine and joint protection (braces, splints, and supports) may help ease joint stress.
Not Enough Rest. Some studies show a link between poor sleep and worsening symptoms of psoriatic arthritis. Lack of sleep and fatigue are linked to flare-ups. A lack of sleep also adds to your stress level, which can cause a flare since stress releases chemicals in your body that lead to inflammation.
Some people may also see improvement with dosages as low as 2.5 mg. These low doses are less likely to cause severe side effects. In fact, according to the Arthritis Foundation, methotrexate is one of the safest arthritis drugs available.
There is no cure for psoriatic arthritis, but treatment can help manage symptoms, lessen inflammation, and protect your joints and skin from damage. One of the main treatment options is prescription medicine called disease-modifying antirheumatic drugs, often shortened to DMARDs.
Applying heating pads, taking hot baths or showers, or using warm paraffin wax can temporarily relieve join pain. Be careful not to burn yourself. Limit heating pad use to 20 minutes at a time. Ice packs can help lessen pain and inflammation, especially after physical activity.
If the question “Why do I have trouble walking after sitting?” has crossed your mind, you're not alone. Common culprits include muscle tightness, reduced circulation, hip and knee stiffness, numb feet, and weak glutes, all of which can make standing up feel harder than it should.
In this test, the second through fourth metacarpophalangeal joints (see image, lower left) or the metatarsophalangeal joints (see image, lower right) are squeezed together to test for tenderness. A positive result raises the question of an inflammatory arthritis such as rheumatoid arthritis.
In September 2024, the FDA approved a new member of this class for psoriatic arthritis, bimekizumab, a humanized monoclonal IgG1 antibody that binds to and inhibits both IL-17A and IL-17F. IL-17A and IL-17F share some overlapping inflammatory properties, but IL-17F is more elevated in psoriatic issues.
Kim has spoken about using everything from prescription creams and light therapy to herbal teas and diet changes in her search for relief. She's tried medical-grade treatments under the guidance of dermatologists, but she has also experimented with natural remedies to see what her body responds to best.
Psoriatic Arthritis Triggers That Can Make Flare-Ups Worse
Your skin will be examined for signs of psoriasis, if you have not been diagnosed with this already. There is no specific test for psoriatic arthritis. However your doctor may order blood tests for inflammation, such as the erythrocyte sedimentation rate (ESR) test.
The most common misdiagnoses prior to receiving a diagnosis of PsA were psychosomatic disorder (26.6%), osteoarthritis (21.7%), anxiety or depression (18.2%), and orthopedic problems (18.2%) (Figure 2).
Physiotherapy is an important part of treatment for most people with psoriatic arthritis (PsA). Physiotherapists (or physios) are part of a team of healthcare professionals who help you to resume or maintain an active and independent life both at home and work.