Psoriatic Arthritis

Psoriatic arthritis (PsA) is an inflammatory arthritis that can develop in people with psoriasis. It causes joint pain, stiffness, and swelling — sometimes before the skin disease becomes obvious. Like rheumatoid arthritis, early treatment prevents joint damage; unlike it, PsA has distinctive patterns and can affect joints, tendons, and the spine.

Features

• Psoriasis skin patches — scalp, elbows, knees, nails; may be minimal.
• Nail changes — pitting, separation from nail bed — often precede joint involvement.
• Joint pain and swelling — pattern varies: one big joint (knee), small hand/finger joints, a "sausage digit" (dactylitis — whole finger/toe swollen), or inflammatory back pain.
• Enthesitis — inflammation where tendons meet bone (heel, around knee).
• Morning stiffness, fatigue.
• Eye inflammation (uveitis), IBD, metabolic syndrome — associated.

When to see a Health Expert

• Anyone with psoriasis and persistent joint pain — PsA affects up to 30% of people with psoriasis.
• New swollen joint, sausage digit, persistent heel pain, inflammatory back pain (morning stiffness that eases with movement).
• Early rheumatology referral is key — modern treatments work best started early.

Diagnosis

Clinical — a pattern of features. Blood tests show inflammation; rheumatoid factor is typically negative. Imaging (X-ray, MRI, ultrasound) shows characteristic changes. Skin/nail examination is part of the assessment.

Treatment

• NSAIDs — for mild disease, symptom relief.
• DMARDs — several disease-modifying oral tablets under rheumatology supervision.
• Biologics — TNF inhibitors, IL-17, IL-23 inhibitors — transformative for moderate-to-severe disease; treat skin and joints.
• Targeted synthetic drugs (JAK inhibitors, PDE4 inhibitors).
• Physiotherapy, occupational therapy.
• Treat associated conditions — uveitis, IBD, cardiovascular risk, metabolic syndrome.
• Vaccines, weight management, don't smoke — support all treatment.

PsA is under-diagnosed in India — "my psoriasis is just skin" + "this joint pain is unrelated" misses a treatable inflammatory arthritis. Anyone with psoriasis should mention joint symptoms at every visit.