Last updated 26/02/2024 by The pain clinics - Interdisciplinary Health

9 early signs of psoriatic arthritis

Psoriatic arthritis is a chronic, rheumatic joint disease.

Psoriatic arthritis can cause pain and inflammation in your joints. Here are nine early signs that allow you to recognize this rheumatic diagnosis at an early stage.

Up to 30% of all people with the skin disease psoriasis develop this joint disease

Psoriasis is a well-known skin disease that causes silvery, reddish and flaky skin. The skin disease particularly affects the elbows and knees, but can also affect the scalp, the area around the navel and the seat. Up to 30 percent of those with this skin disease are also affected by psoriatic arthritis.¹ Psoriatic arthritis particularly affects the joints in the back and fingers. Which provides the basis for joint pain, stiffness and inflammation. However, since it is an autoimmune and multisystemic condition, psoriasis can also affect various organs (including the brain, lungs, heart and intestines), as well as the eyes and tendon attachments.

"The main mechanism behind the damage caused by psoriasis is the chronic and extensive inflammation in the body. To reduce the risk of impact on the body, it is important to make anti-inflammatory lifestyle changes, good diet, use of skin creams and follow-up by a doctor or rheumatologist regarding drug treatment (can be biological medicine, immunosuppressive or traditional drugs). "

Knowing the 9 early signs can provide faster investigation and treatment

In this article, we go through 9 early signs of psoriatic arthritis that enable you to recognize the diagnosis in an early phase, and thus receive the correct rheumatological examination and treatment. Psoriatic arthritis is therefore a form of autoimmune arthritis, and is not the same as rheumatic arthritis.

«Tips: Through the article, we provide relevant advice for self-measures and self-help. Examples include sleep mask for relief of the eyes, use of foam roller against joint stiffness associated with psoriatic arthritis, as well as use of compression noise against swollen hands and feet. All links to product recommendations open in a new browser window. The fact that psoriatic arthritis is directly linked to back pain and stiffness also shows chiropractor Alexander Andorff from Pain clinics Interdisciplinary Health presented a training video with recommended back exercises at the end of the article."

1. Inflammation of the eyes

We start with a symptom that often surprises many, namely eye inflammation. People with psoriatic arthritis have a higher incidence of inflammation in the eyelids and eyes. This can include irritation, burning pain, itching, dryness, red eyes, swelling and reddish skin around the eyes. The most common is that it starts with eyelid inflammation (blepharitis), which can then lead to cataracts (conjunctivitis) or iritis (unseen).

Prolonged iritis can lead to complications

If you are affected by psoriasis, you have between 7-20% chance of developing uveitis.² An inflammation that affects the area of ​​the eye we call uvea. This consists of several structures, including the iris, the choroid, and the corpus callosum. Failure to treat the inflammation can lead to visual complications, such as the development of cataracts, glaucoma and fluid accumulation in the eye. The treatment is primarily medicinal to suppress and reduce inflammation. Early diagnosis can ensure that one preserves one's vision in the best possible way, and that the inflammation does not damage the optic nerve.

Recommendation: Relieve your eyes with a specially designed sleep mask

If you are affected by inflammation of the eyes or dry eyes, a sleep mask like this can be worth its weight in gold. The sleep mask is designed for increased comfort for the eyes, in that - unlike most sleep masks - it has a specially designed space inside the mask for the eyes. This means that you do not get direct pressure stress, but at the same time can preserve moisture and protect the eyes in the best possible way. You can read more about our recommended sleep mask here .

2. Swelling and fluid accumulation in joints

A characteristic sign of psoriatic arthritis and other types of rheumatic joint disease is arthritis. Inflammation of the joints will also cause redness of the skin, heat development and local swelling.

Especially the back joints, pelvic joints and fingers are exposed in psoriatic arthritis

Inflammatory reactions occur especially in the back joints (especially the lower back), the pelvic joints and the external finger joints (DIP joints). But it also affects other joints. Pelvic joint pain, lumbago og sacroilitis are characteristic findings in both psoriatic arthritis and ankylosing spondylitis (Ankylosing spondylitis). Over time, these inflammatory reactions can lead to the breakdown of joint surfaces and cartilage.³

The joint may be warm and swollen

Inflammatory tissue produces heat due to the increased inflammatory activity. An inflamed joint will feel warm to the touch. This is precisely why it is so important for patients with psoriatic arthritis to keep the inflammation in check with correct drug treatment via a rheumatologist or doctor. Did you know that there are natural anti-inflammatory measures against such inflammations? Among these seven recommended natural measures are recommended, among other things turmeric. We have previously written a comprehensive guide called 7 amazing health benefits of eating turmeric which you may benefit from reading.

Also read: 7 natural treatments for psoriatic arthritis

3. Low back pain (lumbago)

Psoriatic arthritis is directly linked to an increased incidence of pain in the lower back, better known as the lower back. This is directly related to the fact that this rheumatic condition leads to an impact on the pelvic joints and spinal joints. Among other things, psoriatic arthritis is linked to an increased incidence of joint inflammation, joint breakdown and fluid accumulation (oedema) in these areas. In addition, patients with psoriatic arthritis also have a greater need for regular follow-up by physiotherapists and chiropractors. Physical therapy techniques that can provide relief and functional improvement include:

• Low-dose laser therapy (also known as therapeutic laser)

• Joint Mobilization

• Massage techniques

• Traction treatment (to stimulate increased mobility in the joints)

• Pressure wave treatment (against tendonitis)

• Dry needling (dry needling)

Here it is particularly worth highlighting this meta-analysis, the strongest form of research, which shows the documented positive effect low-dose laser therapy has against joint stiffness and pain in arthritis.⁴ This is an evidence-based form of treatment that we use at all our affiliated clinic departments with good results. If this is a form of treatment you want to learn more about, then we can recommend that you read this the guide to therapeutic laser therapy written by our clinic department at Lambertseter in Oslo.

4. Falling nails and nail symptoms

Psoriasis arthritis can cause nails to break completely or partially from the nails. The medical term for this phenomenon is called onycholysis. Such nail separation can also occur due to trauma, for example by hitting the toe on an edge or if you are stepped on during a football match.

Many people are affected by such symptoms

This can happen on both hands and feet. It is a troublesome problem that affects several of those with psoriasis vulgaris and psoriatic arthritis, and which can also cause difficulties with jogging or walking. Many may also find it embarrassing or that it even prevents one from being social. The nails can also be affected by small indentations (dents) in the nail structure itself. Research has shown that around 50% of patients with psoriasis vulgaris (the most common skin form of psoriasis) and as many as 80% of people with psoriatic arthritis.⁵ Then we also count on other nail symptoms, i.e. not just that they fall off, such as:

• Thickening and changes in the nail structure

• Search the nail (called pitting in English)

• Color changes (yellow or brown)

• Beau's lines (horizontal, raised lines on the nail)

• Secondary fungal infections

If you have been diagnosed with psoriasis, you should regularly examine your nails for such changes. By detecting it early, you can get the right measures taken and prevent deterioration.

5. Swollen fingers and toes

Swelling of the fingers and toes is also known as dactylitis and is one of the most characteristic signs of psoriatic arthritis. In many people, psoriatic arthritis first starts in the smaller joints of the hands or feet.

- Popularly known as sausage fingers

Dactylitis, when it occurs in the fingers, is more popularly called sausage fingers. Many may be surprised by the fact that such swelling is ranked as one of the surest signs of psoriatic arthritis, and argue that this also occurs in other forms of rheumatism. That's not quite right. Psoriatic arthritis is the condition that causes the entire fingers or toes to swell - not just the joints themselves.

Compression garments can help with swollen hands and feet

The vast majority of rheumatologists are well aware that compression gloves og compression socks can help reduce fluid retention. Compression noise works by stimulating blood circulation, while also leading to improved edema drainage. For those who suffer a lot with swollen feet and calves, one can also inflatable leg elevation pillow be a good investment.

Our recommendation: Give relief to worn venous valves with a leg elevation pillow

Worn venous valves (venous insufficiency), combined with rheumatic inflammations can lead to an accumulation of fluid in the calves, ankles and feet. Over time, this can lead to clear varicose veins in the calves. To help your veins with circulation, you can use a inflatable leg elevation pillow when you relax. By getting your legs up into a well-supported position like this, you can help reduce stress on the veins in your calves, which in turn can lead to less swelling in your feet. You can read more about our recommendation here .

Also read: - 8 natural anti-inflammatory measures against rheumatism

6. Psoriatic arthritis and foot pain

Psoriatic arthritis can cause an increased incidence of pain in the feet and ankles. This is because those with psoriatic arthritis are often affected enthesitis, i.e. a condition where you get pain and inflammation in the tendon attachment itself, where the tendon attaches to the bone.

Affects especially the Achilles and plantar fascia

In the feet and ankles this may be known as pain, swelling and pressure behind the heel (Achilles tendon) or under the foot (plantar fascia). This can, among other things, cause pain when stepping down in the morning, similar to plantar fascite, and that it hurts after jogging. Both heel dampers and use of plantar fasciitis compression socks can be beneficial for those who suffer from foot and ankle problems pain in the heel. A research study has also shown that 30% of patients with psoriatic arthritis have clinical signs of Achilles tendonitis.⁶ Our clinic department at Lambertseter in Oslo has written a large guide about just that Achilles inflammation. The link to the guide opens in a new browser window.

Our tip: Relieve the feet and heels by using heel cushions (silicone gel)

The vast majority of us can get pain in our heels and the soles of our feet from time to time. In such situations, it may be a good idea to give your feet much-needed relief and protection by using heel dampers. These are made of a lot of silicone gel which gives you extra shock absorption when you stand and walk. You can read more about our recommendation here .

7. Psoriatic arthritis and elbow pain

Enthusiasm, pain and inflammation of tendon parties may also hit the elbows. This will cause tendon pain similar to tennis elbow, also known as lateral epicondylitis. Classic symptoms may include pain when gripping, reduced grip strength and pain in the elbow when twisting or manual work.

Enthesitis: A characteristic sign of psoriatic arthritis

Enthesopathy means tendon attachment problems. Enthesitis is more specifically related to tendonitis. A research study published in the American Journal of Clinical Dermatology wrote the following:

"Enthesitis and dactylitis, two hallmarks of PsA, are associated with radiographic peripheral/axial joint damage and severe disease. Clinical symptoms of enthesitis include tenderness, soreness, and pain at entheses on palpation, whereas dactylitis is recognized by swelling of an entire digit that is different from adjacent digits."⁷

They thus show how both enthesitis and dactylitis are two characteristics of psoriatic arthritis. Typical clinical signs of enthesitis include tenderness and pain when pressing against the tendon attachment. Pressure wave therapy is a modern form of treatment that can provide symptom relief and functional improvement. The form of treatment has a well-documented effect against tendinitis. Everyone our clinic departments belonging to Vondtklinikkene Tverrfaglig Health offers pressure wave treatment. You can read this guide about, among other things pressure wave treatment for tendinitis written by our clinic department at Eidsvoll Sundet in Akershus. The link opens in a new browser window.

8. Fatigue and fatigue

Like other rheumatic diagnoses, psoriatic arthritis can lead to a chronic, autoimmune response in the body. This means that the body's own immune system is almost constantly attacking the body's own cells. Not surprisingly, this will require large amounts of energy which can lead to extreme exhaustion. We have previously written an article called arthritis and fatigue which is about how another type of autoimmune arthritis, namely rheumatoid arthritis, can lead to fatigue.

Fatigue: A form of extreme exhaustion

Fatigue refers to a form of exhaustion far worse than that to be tired. Many people with psoriatic arthritis can unfortunately experience this.

9. Joint stiffness and pain

As mentioned, psoriatic arthritis causes changes inside the joints, in the form of inflammation, structural damage and fluid accumulation. These changes can cause the joints to feel stiff with movement and to be painful or directly painful in certain positions.

Morning stiffness is common among patients with autoimmune arthritis

Like other rheumatism patients, those with psoriatic arthritis have an increased incidence of joint pain - and it is well documented that both stiffness and pain are often worst in the morning. Many people therefore try to get optimal, ergonomic adaptation when they sleep, for example by using pelvic cushion with fastening strap. These are used to provide relief to areas often involved in psoriatic arthritis, such as the hips, pelvic joints and lower back.

Our recommendation: Try sleeping with a pelvic pillow

En pelvic cushion with fastening strap provides a better and more ergonomic sleeping position. This can promote improved circulation of both synovial fluid and oxygen when you sleep. In addition to this, it puts less pressure on the knees, hips and pelvis. We must remember that these are used by pregnant women to provide an optimal sleeping position, but it is thus the case that the vast majority of us benefit from sleeping with such a pillow. You can read more about our recommendation here .

In the illustration above, it becomes easier to see how the pelvic lying pillow leads to an improved ergonomic sleeping position for the joints.

VIDEO: 6 exercises to counteract back stiffness

In the video below titled 6 Exercises Against Witch Shot (Crick in the back) shows chiropractor Alexander Andorff forward 6 recommended back exercises. These aim to counteract lower back pain, dissolve tense muscles and stimulate increased mobility. They are therefore well suited for people with psoriatic arthritis with associated back pain.

The six exercises in the video are:

1. Back stretch

2. Cat-camel

3. Pelvic rotation

4. Lateral back mobilization

5. Piriformis stretching

6. "Emergency position" (for the least possible compression pressure in the lower back)

Feel free to subscribe for free our Youtube channel for more great videos with exercise programs and health knowledge.

Summary: 9 early signs of psoriatic arthritis

Psoriatic arthritis is a serious, rheumatic diagnosis. The condition is both chronic and autoimmune. Studies emphasize the importance of detecting signs of psoriasis early, among other things one research study wrote the following:

"Delayed treatment of PsA can result in irreversible joint damage and reduced quality of life."⁷

They therefore show that later discovery of psoriatic arthritis can result in irreversible damage to joints - and thus also lead to a permanently impaired quality of life. Knowing the early signs of the condition can lead to seeking help and examination more quickly.

Help us to increase the focus on rheumatic disorders and invisible illness

There is too little focus on measures that can improve the quality of life for people with rheumatism and people with an invisible illness. We urge an increased focus on health knowledge, improved rehabilitation services and active campaigns to, among other things, promote natural measures and lifestyle advice (including advice on anti-inflammatory diet) for these patient groups. Feel free to join our Facebook group «Rheumatism and Chronic Pain - Norway: Research and news» for updates and articles on this topic. Here you can also comment and exchange experiences with others in the same situation as you.

NEXT PAGE: 7 natural treatments for psoriatic arthritis

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Article: 9 Early Signs of Psoriatic Arthritis (Evidence-Based)

Written by: Our publicly authorized chiropractors and physiotherapists at Vondtklinikkene

Fact check: Our articles are always based on serious sources, research studies and research journals, such as PubMed and the Cochrane Library. Please contact us if you spot any errors or have comments.

Research and sources: 9 early signs of psoriatic arthritis (evidence-based)

1. Ocampo et al, 2019. Psoriatic arthritis. F1000 Res. 2019 Sep 20;8:F1000 Faculty Rev-1665.

2. Fotiadou et al, 2019. Psoriasis and uveitis: links and risks. Psoriasis (Auckl). 2019 Aug 28:9:91-96.

3. Sankowski et al, 2013. Psoriatic arthritis. Pol J Radiol. 2013 Jan-Mar; 78(1): 7–17.

4. Brosseau et al, 2000. Low level laser therapy for osteoarthritis and rheumatoid arthritis: a metaanalysis. J Rheumatol. 2000 Aug;27(8):1961-9.

5. Sobolewski et al, 2017. Nail involvement in psoriatic arthritis. Rheumatology. 2017; 55(3): 131–135.

6. De Simone et al, 2023. Achilles tendinitis in psoriasis: clinical and sonographic findings. J Am Acad Dermatol. 2003 Aug;49(2):217-22.

7. Bagel et al, 2018. Enthesitis and Dactylitis in Psoriatic Disease: A Guide for Dermatologists. Am J Clin Dermatol. 2018 Dec;19(6):839-852.

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