Psoriatic arthritis mostly affects the joints in your hands and feet, but you can have symptoms elsewhere. You may notice swollen joints, skin rashes, structural changes, or even symptoms in your eyes.

Psoriatic arthritis (PsA) is a chronic form of arthritis. It can affect the small and large joints of your body. It can also affect your skin, nails, tendons, and gastrointestinal system.

You may experience PsA symptoms consistently. You may also have flare-ups. That’s when symptoms worsen and then get better or disappear.

PsA can affect each person differently, but there tend to be common signs and symptoms of PsA. In addition to knowing how PsA can make you feel, noticing changes in your body’s appearance can help you manage your PsA.

Read on to learn how PsA can affect your body and what this can look like.

PsA can change the shape and look of your fingers and nails.

PsA on your fingers

PsA in the fingers can manifest as swollen “sausage-like” digits. On the other hand, this occurs from the swelling of the metacarpophalangeal joint (MCP) or knuckle and the proximal interphalangeal joint (PIP joint), the first joint in the finger. The swelling of both joints together triggers what is also known as dactylitis.

The end joint of your finger may also appear bent or crooked. This is from a structural change due to bone loss in your finger.

Known as a “pencil-in-cup” deformity, the end of the middle bone is narrow (like the tip of a pencil), and the base of the end bone is curved (like a cup).

PsA on your nails

PsA in the nails can show up as slight indentations or pits on your nails. The nails can also crumble and break off and may separate from the nail bed.

PsA in the feet can cause your heels and toes to appear swollen or inflamed. It can also cause toenail changes.

PsA on your heel

You may have Achilles tendon inflammation, which connects your calf muscle to your heel. The lower part of your leg above the heel may look swollen, and you may feel pain.

PsA on your toes

You may experience dactylitis in your toes. As with dactylitis in the fingers, this causes the digit to have a sausage-like appearance. This occurs similarly due to the swelling of the metatarsophalangeal joint (MTP) joint, which connects your toes to your foot, and the PIP joint, which in the foot is the first joint in your toes.

Toenails may also separate from the nail bed, crumble, or have indentations or pits, in the same way, that PsA affects fingernails.

Swollen joints are often an early symptom of PsA. In addition to the small joints of the hands and feet, PsA can cause swelling in large joints, such as the knee.

Many people with PsA have a psoriatic skin rash before other symptoms of PsA. These are often raised, scaly patches of skin that may be itchy. They can appear anywhere on the body.

This typically looks a lot like a psoriasis rash.

Psoriatic arthritis in the eyes can show up as conjunctivitis or pink eye.

You may also see signs of uveitis, inflammation in the middle of the eye. About 7-20% of people with psoriasis may have uveitis. The rate is higher in people who also have PsA or PsA alone.

Uveitis can make your eyes look red. It may also make your pupils irregularly shaped or small.

Changes in the body from PsA may be visible on an X-ray. These typically involve changes to the joint, loss of bone, and inflammation.

Some signs that might be visible include:

  • narrowing of spaces between joints
  • erosion of the bone around the joint
  • inflammation of the tissue around the bone (periostitis)
  • bone spurs
  • bone fusion (ankylosis)
  • destruction of bone tissue (osteolysis)

PsA can cause symptoms that may depend on your type of PsA.

Learn more about the five types of PsA.

PsA can be caused by both genetic and environmental factors. Certain risk factors can predispose you to develop it. This includes:

  • history of psoriasis or gout
  • being ages 30-50
  • having a close family with PsA
  • having obesity
  • history of physical trauma or stress
  • history of skin infections
  • history of pharyngitis
  • drinking alcohol

Your diagnosis of PsA will likely come from a thorough examination by your doctor, a detailed history of your symptoms, and the results of various blood and imaging tests.

The doctor will likely look at the Classification Criteria for Psoriatic Arthritis (CASPAR) to determine whether the diagnosis of PsA is the right fit. They will also want to know if you’re experiencing flare-ups, common with PsA.

The treatment for PsA involves a combination of lifestyle changes and medications. Sometimes, your doctor may recommend you try light therapy; in other cases, you may require surgery on an affected joint.

Lifestyle changes can include things like eating a balanced diet and quitting smoking. Medications include disease-modifying anti-rheumatic drugs (DMARDs) or biologic medications.

Over time, PsA can become debilitating. In addition, it can also increase your chance of developing other health problems, including:

What does psoriatic arthritis look like when it first starts?

About 85% of people with psoriatic arthritis experience a rash before they experience any joint symptoms. Similarly to a psoriasis rash, you will likely see plaques on your skin that may be silver of what on top of red patches.

What do psoriatic arthritis lesions look like?

PsA does not cause lesions in the sense of an abscess or an ulcer. That said, PsA does cause a rash which is referred to as lesions. This rash is similar to a psoriasis rash.

What can be mistaken for psoriatic arthritis?

PsA can be misdiagnosed as other types of arthritis, including rheumatoid arthritis (RA) and osteoarthritis (OA).

There is no cure for PsA, so if you have the disease, you will live with it for the rest of your life. There are ways to manage the symptoms with medications and lifestyle changes.

Not everyone will experience PsA in the same way. The symptoms may be mild for some people and debilitating for others. Your doctor and resources for support can help you find the best ways of coping with the disease.

Resources for support

If you or someone you care for has PsA, you may wish to seek support. The National Psoriasis Foundation and Arthritis Foundation can connect you with online and in-person support groups. They also have extensive information about PsA from people living with the condition.

If you have a family doctor, they may be able to identify what might be causing your symptoms and help you develop a personalized treatment plan.

If you would like mental health support, call the Substance Abuse and Mental Health Services Administration’s National Helpline at 800-662-HELP (4357), or dial 988 to reach the Suicide and Crisis Lifeline if you are experiencing a crisis.