Psoriatic Arthritis Symptoms
According to the National Psoriasis Foundation, nearly one-third of people with psoriasis will eventually develop psoriatic arthritis. If you have psoriasis and develop new joint pain, there’s a good chance psoriatic arthritis is to blame. Here are top psoriatic arthritis symptoms:
Psoriatic arthritis can affect multiple joints, producing significant pain and stiffness.Psoriatic arthritis often strikes the large joints in the lower extremities, such as the knees or ankles, although any joint can be affected.Psoriatic arthritis can impact joints on the fingers and toes, especially those closest to the fingernails, and may cause fingers to swell in a phenomenon known as dactylitis, or “sausage fingers.”Psoriatic arthritis can cause nails on fingers and toes to become pitted or cracked.Psoriatic arthritis in the spine, called psoriatic spondylitis, causes stiffness in the back or neck, and difficulty bending.Psoriatic arthritis can cause tender spots where tendons and ligaments join onto bones (called enthesitis), leading to pain at the back of the heel and sole of the foot.Psoriatic arthritis pain can flare, subside, and even change location in the body.
Studies have found that psoriasis patients are about three times more likely to have high levels of uric acid in their blood, and those who have both psoriasis and psoriatic arthritis have a five-times greater risk of developing gout, according to the Arthritis Foundation. Here are top gout symptoms:
The most common symptom of gout is pain in the affected joint, such as the big toe.Gout can cause joints to feel swollen, red, warm, and stiff, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.Gout flares often start suddenly at night, and the intense pain may wake you up.Gout flares typically subside over a week or two. While some people experience frequent flares, others can go years between attacks.
“We will use all the tools we have to get an accurate diagnosis,” says Zhanna Mikulik, MD, a rheumatologist at the Ohio State Wexner Medical Center in Columbus. “Your rheumatologist will look at what joints are affected, what the pattern is, and how it started.” A comprehensive evaluation includes a physical exam, blood work to measure inflammation, imaging to determine the extent of joint damage, and an assessment of family history. About 40 percent of psoriatic arthritis patients have a family member who has psoriasis or arthritis, according to the American College of Rheumatology. If you experience joint pain, here are a few tips from Dr. Mikulik to help you distinguish between signs of psoriatic arthritis, gout, and other diseases:
If a single joint swells and becomes extremely painful quickly, you probably have gout. “Patients who have gout won’t let you touch the joint,” Mikulik explains. “The pain usually starts around 4 a.m., gets really severe, and then starts to subside. Patients can’t put on their shoe.”Compared with gout, psoriatic arthritis often has what doctors call a broader presentation. “You’ll see one or two larger joints affected in addition to small, distant joints, such as your fingers,” Mikulik says. Joint pain that’s worse in the morning or after inactivity is another sign of psoriatic arthritis, Mikulik says.If you have little or no joint swelling, but the joint hurts the most after you’re active, it’s probably osteoarthritis.If the joints on both sides of your body hurt, you’ve likely developed rheumatoid arthritis. “Rheumatoid arthritis usually starts in the small joints and is symmetrical,” Mikulik notes.
Treatments for Gout and Psoriatic Arthritis Differ
Treatment for joint pain depends on the underlying disease. If it’s gout, the first step in treating a flare is medication: over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, or naproxen sodium; prescription steroids; or a prescription anti-inflammatory called colchicine, which influences the body’s reaction to uric acid crystals. For ongoing management of gout, the American College of Rheumatology’s 2020 guidelines recommend the drug Zyloprim (allopurinol), which reduces the production of uric acid in the body, along with a three- to six-month course of nonsteroidal anti-inflammatory drugs (NSAIDs). Corticosteroids, taken orally or injected directly into the affected joint, may also be used as an initial treatment. For mild cases of psoriatic arthritis, NSAIDs such as aspirin or ibuprofen usually help. If your symptoms are severe, your rheumatologist may recommend disease-modifying anti-rheumatic drugs (DMARDS) or biologics.
Call a Rheumatologist ASAP
If you have joint pain or stiffness, it’s important to see a rheumatologist to ensure you get the right diagnosis, whether it’s psoriatic arthritis, gout, osteoarthritis, rheumatoid arthritis, or something else. “They are all different diseases, and while they may share symptoms and some pathophysiology, they are all separate diagnoses,” explains Jeffrey Weinberg, MD, an associate clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City. “There may be some treatment overlap for psoriatic arthritis and rheumatoid arthritis,” Dr. Weinberg says, “but all musculoskeletal conditions must be evaluated and treated separately.” Additional reporting by Julia Califano.
