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.Not everyone with psoriasis experiences the same symptoms, which can vary from person to person based on the severity and type of psoriasis. However, common symptoms may include:
- Swollen fingers and toes
- Tender, painful, or swollen joints
- Red scaly skin patches known as plaques
- Reduced range of motion of the joints
- Morning stiffness
- Lower back, upper back, and neck pain
- General fatigue
- Changes to nails, such as pitting or separation from the nail bed
People with psoriatic arthritis may have various nail changes (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 the 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. Many people with psoriatic arthritis have nail abnormalities. Some 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 health care provider 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 because this can be an important clue as to the type of arthritis.
Some people with psoriatic arthritis have eye symptoms, including eye inflammation (conjunctivitis), and inflammation of the iris(iritis), the colored part of the eye. Children with juvenile psoriatic arthritis (see below) are examined annually by an eye doctor to check for eye problems.
Pain and inflammation may develop 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.