The symptoms of psoriatic arthritis can be mild or severe and come and go in the same way that psoriasis does.
Some joints are more likely to be affected than others. For example, psoriatic arthritis affects the fingers of about 35 in 100 people, but affects the back bone of only about five in 100 people.
Psoriatic arthritis can also affect other joints, such as your, wrists, ankles and feet.
The condition can also affect your tendons and ligaments as well as your joints. The symptoms of the condition often develop gradually over a period of time.
The main symptoms of psoriatic arthritis include:
- joint pain
- stiffness, especially when you get up in the morning or after resting
- a stiff back and neck
- swollen fingers or toes (this is called dactylitis)
- reduced range of movement
- pitting, ridging or thickening of your nails (this can often be mistaken for a fungal infection)
- headaches and pain in your jaw
- painful swollen heels
Your GP will ask about your symptoms and examine you. They may also ask you about your medical history. You may be asked whether anyone in your family has had psoriasis.
There’s no specific test for diagnosing psoriatic arthritis. However, your GP may ask you to have a blood test or arrange for you to have X-rays. This can help to rule out other types of arthritis.
If your GP thinks you have psoriatic arthritis, they’ll refer you to a rheumatologist. This is a doctor who specialises in diagnosing and treating arthritis as well as other conditions affecting the muscles, bones and joints.
It’s important to have your condition diagnosed early so the damage to your joints can be reduced. The longer psoriatic arthritis is left untreated, the more likely it is to become severe and affect your quality of life.
Although there isn’t a cure for psoriatic arthritis, there are a number of treatments that can help. These may help to suppress the inflammation in your joints and tendons/ligaments as well as reduce any pain or swelling. It can also slow down damage to your joints caused by the condition.
There are a number of things you can do to help ease your symptoms. The main ones are listed below.
- Exercise can ease stiffness and keep your joints flexible. A physiotherapist can show you what types of exercises to do.
- Psoriatic arthritis can make you feel very tired. It’s important to listen to your body and rest when you need to. This might mean resting during the day.
- Try to stay a healthy weight. Being overweight can increase the strain on your joints and make your symptoms worse.
No specific foods have been found to help psoriatic arthritis. However, it’s a good idea to eat a balanced diet including plenty of fruit and veg to help look after your general health.
There are a number of medicines that can help to relieve your symptoms and some can prevent damage to your joints.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help to control your pain and stiffness. They work by reducing inflammation in your joints. However, they can’t stop your arthritis from getting worse or affecting your joints. NSAIDs are usually prescribed for short periods of time to help control your pain. Using them for long periods has been linked with heart, kidney and stomach problems.
If NSAIDs don’t help to relieve your symptoms, your doctor may suggest you have a corticosteroid injection into your joint. This can help to reduce pain and inflammation while you’re waiting for other treatments to start working.
If your arthritis is more severe, your doctor may prescribe disease-modifying anti-rheumatic drugs (DMARDs). They can help to slow down the development of the condition as well as easing your symptoms. They can take several weeks to have an effect so it's important to keep taking them even if they don't seem to be working. Some common names of DMARDs include methotrexate, sulfasalazine and leflunomide. You may need to take more than one of these medicines. If you’re taking DMARDs, you should have regular blood tests. These check that your bone marrow, kidneys and liver are working well and to check for side-effects.
If DMARDs don’t work for you, your doctor may suggest biologic medicines. These work by blocking a certain molecule called TNF that promotes inflammation. You can take biologic medicines on their own but your doctor may give them with DMARDs. If your condition doesn’t get better after 12 weeks of treatment, your doctor may advise you to stop taking them. Biologic medicines are given by injection and include infliximab, etanercept and adalimumab.
What treatments you’re offered can vary depending on your personal circumstances. If you’d like more information about your treatment options, speak to your doctor.
You may be offered surgery if you’re in a lot of pain and your joint has become badly damaged. Your doctor may suggest an operation to replace the affected joint with an artificial one.
You may wish to try complementary therapies, such as acupuncture to ease pain and discomfort. However, there is no scientific proof to show that these kinds of treatment work. If you’re thinking about using complementary therapies, talk to your doctor first. Also, make sure you go to a therapist who is registered with a relevant professional body.
Although the exact cause of psoriatic arthritis isn’t known, there are a number of factors which may be involved. The main ones are listed below.
- An infection may trigger the development of psoriatic arthritis or make the condition worse.
- Injuries to tendons or joints may be involved in causing psoriatic arthritis.
- Genetics may play a part in psoriatic arthritis. If someone in your immediate family has the condition, you may be more likely to develop the condition yourself.
As with many long-term conditions, having psoriatic arthritis can affect your emotions and the relationships with those around you. It can also have an impact on your work, social and sex life. Talk to your doctor about the impact the condition has on your life. You may also find it helpful to contact support groups and talk to other people living with the condition.
If your condition is making your daily life difficult, your doctor may refer you to an occupational therapist. This is a health professional who can give practical assistance to help you manage with everyday tasks and increase your independence.
Does psoriatic arthritis affect your nails?
Yes, if you have psoriatic arthritis, it’s likely that your nails will be affected by the condition.
Eight out of 10 people with psoriatic arthritis develop nail problems. It can cause changes in your nail colour and small dents in your nails, called pitting. Sometimes your nail can also become detached from your nail bed. These changes are often mistaken for a fungal nail infection.
Treatment may involve using a cream or ointment. This slows down the overproduction of nail cells and allows your nails to start growing normally. Your nails take a long time to grow and you may need to continue your treatment for up to a year for fingernails and up to two years for toenails. If your toenails are affected you may find it helpful to see a podiatrist. This a health professional who specialises in conditions that affect the feet. They can help to reduce the pressure on your nails from your shoes, and help to ease any pain or discomfort.
What kind of exercise is best for psoriatic arthritis?
It's important to exercise regularly if you have psoriatic arthritis. Exercise can help to ease stiffness and keeps your joints and muscles flexible. You may find exercises which strengthen your joints and improve your range of movement helpful.
If you have psoriatic arthritis, exercise is very important. Without regular exercise your muscles will lose their strength and your joints may become more painful.
Your doctor or physiotherapist can help you to create an individual exercise programme that works for you and takes your condition into account. This may involve a combination of different types of exercise. For example, strengthening exercises can be helpful for people with psoriatic arthritis. These can help improve stability in your joints and may include exercises where you use some of your body weight, such as specially designed squats.
Walking is a great way to exercise if you have psoriatic arthritis. Walking aids and specialised inserts for your shoes are available to help support your knees, ankles or feet if you need them. Speak to your doctor or physiotherapist if you’d like more information about them.
You may also find gentle exercise, such as swimming, beneficial. Swimming is a type of endurance exercise, which increases your heart and breathing rate to help improve your fitness.
It’s also important to include stretching exercise in your routine as these can help you relax. If an exercise starts to hurt, or if you have pain in your joints, stop the exercise straight away. Check with your doctor or physiotherapist before you start exercise again.
Will my psoriatic arthritis keep getting worse?
Psoriatic arthritis affects everyone differently. On average, the condition is thought to get gradually worse in about half of those with the condition. However, there are many treatments that may help to slow down damage to your joints. Starting treatment early can also help to prevent joint damage.
Psoriatic arthritis is a progressive condition, which means it may get worse over time.
However, it’s important to remember that the sooner you have a diagnosis confirmed and start treatment, the better. Treatment can prevent the condition damaging your joints, as well as keeping your symptoms under control.
Some people with the condition will have a more severe form that needs long-term treatment. Your day-to-day life may be affected in some way by psoriatic arthritis. However, it’s worth bearing in mind that the condition affects everyone differently. Speak to your doctor if you’d like more information about your condition.
- Psoriatic arthritis. PatientPlus. www.patient.co.uk/patientplus.asp, published 28 November 2012
- Psoriatic arthritis. Psoriasis Association. www.psoriasis-association.org.uk, published July 2011
- Psoriasis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published December 2012
- Psoriasis. BMJ Best Practice. www.bestpractice.bmj.com, published 9 July 2014
- Psoriatic arthritis. BMJ Best Practice. www.bestpractice.bmj.com, published 10 December 2013
- Map of medicine. Psoriasis. Map of Medicine. Psoriasis. International View. London: Map of Medicine; 2013 (Issue 2)
- Psoriasis. Medscape. www.emedicine.medscape.com, published 3 April 2014
- Clinical manifestations and diagnosis of psoriatic arthritis. Uptodate. www.uptodate.com, accessed 5 September 2014
- Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press 2010; 526
- Psoriatic arthritis. American College of Rhuematology. www.rheumatology.org, published September 2012
- Palmoplantar and nail psoriasis. Dermnet NZ. www.dermnetnz.org, accessed 9 January 2015
- Psoriatic arthritis. Arthritis Care. www.arthritiscare.org.uk, published July 2011
- Diagnosis and management of psoriasis and psoriatic arthritis in adults. Scottish Intercollegiate Guidelines Network (SIGN), 2010. www.sign.ac.uk
- Rheumatology is a speciality. National Psoriasis Foundation. www.psoriasis.org, accessed 5 September 2014
- Psoriatic arthritis. Arthritis Foundation. www.arthritis.org, accessed 30 June 2014
- Self help and daily living for psoriatic arthritis. Arthritis Research UK. www.arthritisresearchuk.org, accessed 15 August 2014
- Psoriatic arthritis. Medscape. www.emedicine.medscape.com, published 3 April 2014
- Fruits and vegetables. British Nutrition Foundation. www.nutrition.org.uk, accessed 15 August 2014
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed date
- Gossec L, Smolen JS, Gaujoux-Viala C, et al. European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies. Ann Rheum Dis 2012;71:4–12. doi:10.1136/annrheumdis-2011-200350
- Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis. National Institute for Health and Care Excellence (NICE), 2010. www.nice.org.uk
- Therapy-related issues: musculoskeletal diseases. Oxford handbook of clinical pharmacy (online). Oxford Medicine Online. www.oxfordmedicine.com, published January 2012
- Psoriatic arthritis. Arthritis Research UK. www.arthritisresearchuk.org, accessed 27 June 2014
- Psoriatic nail disease. PatientPlus. www.patient.co.uk/patientplus.asp, published 20 November 2012
- Psoriatic arthritis. DermNet NZ. www.dermnetnz.org, published 12 August 2014
- Topical treatments for psoriasis. National Psoriasis Foundation. www.psoriasis.org, published September 2013
- Psoriatric arthritis. Spondylitis Association of America. www.spondylitis.org, accessed 1 July 2014
- Arthritis and exercise (beyond the basics). Uptodate. www.uptodate.com, published 25 June 2013
- Physical activity and psoriasis. National Psoriasis Foundation. www.psoriasis.org, accessed 1 July 2014
- Personal communication, Dr Sundeept Bhalara, Consultant Rheumatologist, West Hertfordshire Hospitals NHS Trust, 9 January 2015
We’d love to know what you think about what you’ve just been reading and looking at – we’ll use it to improve our information. If you’d like to give us some feedback, our short form below will take just a few minutes to complete. And if there's a question you want to ask that hasn't been answered here, please submit it to us. Although we can't respond to specific questions directly, we’ll aim to include the answer to it when we next review this topic.
Let us know what you think using our short feedback form Ask us a question
Reviewed by Hemali Bedi, Bupa Health Content Team, January 2015.
Let us know what you think using our short feedback form Ask us a question
About our health information
At Bupa we produce a wealth of free health information for you and your family. We believe that trustworthy information is essential in helping you make better decisions about your health and care. Here are just a few of the ways in which our core editorial principles have been recognised.
Information StandardWe are certified by the Information Standard. This quality mark identifies reliable, trustworthy producers and sources of health information.
Plain English CampaignWe hold the Crystal Mark, which is the seal of approval from the Plain English Campaign for clear and concise information.
What our readers say about us
But don't just take our word for it; here's some feedback from our readers.
“Simple and easy to use website - not alarming, just helpful.”
“It’s informative but not too detailed. I like that it’s factual and realistic about the conditions and the procedures involved. It’s also easy to navigate to areas that you specifically want without having to read all the information.”
“Good information, easy to find, trustworthy.”
Our core principles
All our health content is produced in line with our core editorial principles – readable, reliable, relevant – which are represented by our diagram.
In a nutshell, our information is jargon-free, concise and accessible. We know our audience and we meet their health information needs, helping them to take the next step in their health and wellbeing journey.
We use the best quality and most up-to-date evidence to produce our information. Our process is transparent and validated by experts – both our users and medical specialists.
We know that our users want the right information at the right time, in the way that suits them. So we review our content at least every three years to keep it fresh. And we’re embracing new technology and social media so they can get it whenever and wherever they choose.
Here are just a few of the ways in which the quality of our information has been recognised.
The Information Standard certification scheme
You will see the Information Standard quality mark on our content. This is a certification programme, supported by NHS England, that was developed to ensure that public-facing health and care information is created to a set of best practice principles.
It uses only recognised evidence sources and presents the information in a clear and balanced way. The Information Standard quality mark is a quick and easy way for you to identify reliable and trustworthy producers and sources of information.
Certified by the Information Standard as a quality provider of health and social care information. Bupa shall hold responsibility for the accuracy of the information they publish and neither the Scheme Operator nor the Scheme Owner shall have any responsibility whatsoever for costs, losses or direct or indirect damages or costs arising from inaccuracy of information or omissions in information published on the website on behalf of Bupa.
We comply with the HONcode (Health on the Net) for trustworthy health information. Certified by the HONcode for trustworthy health information.
Plain English Campaign
Our website is approved by the Plain English Campaign and carries their Crystal Mark for clear information. In 2010, we won the award for best website.
Website approved by Plain English Campaign.
British Medical Association (BMA) patient information awards
We have received a number of BMA awards for different assets over the years. Most recently, in 2013, we received a 'commended' award for our online shared decision making hub.
If you have any feedback on our health information, we would love to hear from you. Please contact us via email: firstname.lastname@example.org. Or you can write to us:
Health Content Team
15-19 Bloomsbury Way