Psoriatic arthritis: your questions

Psoriatic arthritis (PsA) is an inflammatory arthritis that is linked to psoriasis. Both come from the same underlying tendency to inflammation, which is why the skin and the joints are connected: the same process that causes the skin plaques can also inflame the joints, and the tendons and the spine. It can cause joint pain and swelling, stiffness, swollen fingers or toes, and problems where tendons attach to bone.

Because it is inflammatory, it is treated with medicines that calm the immune system. There is more on the psoriatic arthritis guide.

Yes. The joint disease does not always follow the skin. Most people have skin psoriasis first, but the arthritis can appear years later, at the same time, or occasionally before any skin signs at all. Some people have only very mild or hidden psoriasis, for example on the scalp, behind the ears, in the navel, or in the nails.

If you have psoriasis, or a family history of it, and you develop joint pain, swelling, or stiffness, it is worth mentioning, because that link is an important clue.

PsA is linked with a higher chance of some other conditions, so your team keeps a general eye on more than the joints and skin. These include heart and blood-vessel health and related things like blood pressure, weight, and blood sugar, as well as the eyes, the bowel, and mood. Awareness matters because looking after these alongside the arthritis is part of good care.

Tell your team about eye redness or pain, tummy symptoms, or low mood, and keep up with general health checks. The PsA guide has more.

PsA can be tricky to pin down. Its symptoms overlap with other kinds of arthritis and with everyday aches, blood tests are not always abnormal, and the link with psoriasis is not always obvious, especially when the skin involvement is mild. Many people describe a long path with more than one wrong turn before things become clear.

Once you are under rheumatology care, the aim is to get the picture and the treatment right. Keeping a record of your symptoms helps.

Not entirely. Because the skin and joints share the same underlying inflammation, treatment is planned with both in mind, and some medicines help both at once. You may still see dermatology for your skin and rheumatology for your joints, but it works best when the two are coordinated rather than treated as separate problems.

Tell each team about the whole picture, including how much the skin and the joints are each affecting your life.

Fatigue is common in PsA and is often ranked by patients as one of the most burdensome symptoms, sometimes ahead of the skin. It is a genuine part of the inflammatory disease, not a personal shortcoming, and it can be worse when the disease is more active, or when sleep and mood are affected.

See our guides on sleep and fatigue and energy and pacing, and raise it with your team.

Yes, and it is more common than many people realise. PsA can affect intimacy in several ways at once: joint pain and stiffness, fatigue, and, for those with skin involvement, itch and worries about how the skin looks, along with the low mood that can come with any long-term condition. Research finds that both men and women with PsA are more likely to have difficulties with sex, and many people feel their care team does not raise the subject enough. None of it is your fault, and it is a legitimate thing to bring up.

Sometimes trouble with sexual function is linked to a treatment, such as an antidepressant, and can be helped, so it is worth mentioning to your team. For practical guidance see our intimacy and relationships guide, and Psoriasis Canada has a helpful PsA-specific page on PsA and relationships.