Psoriatic arthritis
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- PsA can show up in several ways at once: swollen joints, swollen fingers or toes, painful heels or tendons, back pain, and skin or nail changes. Your treatment is chosen around which of these affect you.
- The skin and the joints are part of the same condition. Working with a skin specialist as well as your rheumatologist often gives the best result for both.
- Treating PsA early gives the best chance of protecting the joints and feeling well. Tell your team if joint pain and swelling last more than a few weeks.
- Reaching and keeping a healthy weight can lower PsA activity and can help the medicines work better. It also helps your heart and your skin.
- PsA comes with some other health risks worth watching, especially heart and metabolic health. Controlling the inflammation and looking after these things protects your general health.
Understanding this condition
What psoriatic arthritis is
In PsA, the immune system, which normally fights infection, causes inflammation in and around the joints. It is part of the same family as psoriasis, and many people with PsA have psoriasis on the skin, though the joint problem can start before, at the same time, or after the skin changes. PsA can affect the joints, the places where tendons and ligaments attach to bone, the fingers and toes, the nails, and sometimes the spine. Because it is driven by the immune system and not by wear and tear, calming the inflammation is what protects the joints.
Signs and symptoms
PsA looks different from person to person. Common signs are painful, swollen joints, which can affect just a few joints and often not in a matching pattern on both sides. Some people get a whole finger or toe that swells up like a sausage, called dactylitis. Others get pain where tendons attach, such as the heel or the sole of the foot, called enthesitis. Nail changes such as pitting or lifting are common, and some people get low back or buttock pain that is worse with rest and better with movement. Tiredness and morning stiffness are also common.
Who gets it, and why
PsA is closely linked to psoriasis, so it is more common in people who have psoriasis, though most people with psoriasis never develop it. It can start at any age but often begins between about 30 and 50, and it affects men and women fairly equally. Part of the risk is in the genes, and a family history of psoriasis or PsA raises the chance. Having PsA is not caused by anything you did wrong.
How it is diagnosed
There is no single test for PsA. Your rheumatologist makes the diagnosis by examining your joints, the places tendons attach, your skin, and your nails, and by asking about your history. Blood tests can check for inflammation and help rule out other kinds of arthritis; in PsA the antibody tests that are usually positive in rheumatoid arthritis are often negative. Scans such as ultrasound, x-ray, or MRI can show inflammation or joint changes. Because the skin is involved, a skin specialist is often part of the picture.
What to expect over time
PsA is a long-term condition, but the outlook today is good. With early treatment and regular follow-up, many people get the disease quiet and stay active, with better skin as well. Some joints can be damaged if inflammation goes unchecked, which is why the aim is to control it early. Finding the right medicine can take a few tries, and that is normal.
Living with and treating it
The goal of treatment
The goal is to get the inflammation as low as possible, ideally to a quiet state, across all the areas PsA affects: joints, tendons, skin, and spine. Your team measures how you are doing at each visit, looking at each of these areas, and adjusts the plan with you until you reach the goal you agreed on. Because the skin matters too, your rheumatologist and skin specialist aim for a plan that helps both.
Treatments that change the disease
The treatment is chosen around which parts of PsA affect you. For mild joint symptoms, anti-inflammatory painkillers or a steroid injection into a joint can help. For ongoing joint disease, disease-modifying medicines such as methotrexate are often used. When these are not enough, or when the skin, tendons, or spine need more, biologic medicines and targeted tablets that block specific immune signals are very effective, and the choice is matched to your pattern of disease and your skin. Your plan is made with you and, often, with a skin specialist.
Monitoring and follow-up
PsA care means regular check-ins, more often at the start and when medicines change. At visits your team checks your joints, tendons, skin, and nails, asks how you are, and orders blood tests. Some tests track how active the disease is; others make sure the medicines are being tolerated, for example checking blood counts and your liver. Tell your team early about new symptoms or side effects.
Flares, and what to do
A flare is when PsA becomes more active again, with more joint pain and swelling, sorer tendons, more skin trouble, and often more tiredness. Flares can happen even when PsA is usually well controlled, and can be set off by infection or stress, or for no clear reason. Have a plan with your team for what to do, which may include a short adjustment to medicine and resting a sore joint. Contact your team if a flare is severe, does not settle, or comes with a fever and a hot, swollen joint.
Living well with PsA
Medicine is the foundation, and daily habits help too. Regular movement keeps joints and tendons working and lifts mood; a physiotherapist can build a program that fits you, and our virtual exercise program can help. Reaching a healthy weight, not smoking, and looking after your skin all support your joints, your skin, and your heart. Pacing busy days, protecting sore joints, and caring for sleep and mental health matter. Ask your team about staying up to date with recommended vaccines.
Quitting smokingWhy it matters for arthritis, what helps, and free Ontario programs→Looking after the rest of you
PsA is linked with some other health conditions worth keeping an eye on. These include heart and blood vessel health, weight and blood sugar, eye inflammation, and bowel inflammation, as well as mood. Your team helps you stay ahead of these by controlling the inflammation and checking the things that protect your general health.
What to expect at your rheumatology visit
At your first appointment your rheumatologist will ask about your symptoms, your skin, and your health, and will examine your joints, tendons, skin, and nails. They will arrange blood tests and sometimes scans, talk through what the diagnosis means and the treatment choices, and decide the next step with you. PsA is often looked after together with a skin specialist. Follow-up visits are usually closer together at first, then spaced out as things settle.
The aim is the lowest possible disease activity across everything PsA affects, the joints, tendons, skin, and spine, ideally a quiet state, and to keep it there. Your team checks each of these areas at visits and adjusts the plan with you.
PsAID: track the impact of your disease12 quick questions on pain, fatigue, skin, and mood, save your result and print it for your visit→How treatment is stepped up
- 1
First step (mild or single-domain disease)
For mild joint symptoms, anti-inflammatory painkillers or a steroid injection into an affected joint can settle things while the picture is assessed.
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For ongoing joint disease
For joint disease that keeps going, a disease-modifying medicine such as methotrexate is often used, which can also help the skin.
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Advanced, targeted treatment
When earlier steps are not enough, or when the tendons, spine, or skin need more, biologic medicines or targeted tablets that block specific immune signals are very effective. The choice is matched to your pattern of disease and your skin.
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When the disease is well controlled
Once PsA has been quiet for a good while, your team may carefully reduce some medicine, watching closely in case symptoms return.
Medication guides
Plain-language guides to the medicines used for this condition. Each has a patient and a clinician view.
Living well, beyond the diagnosis
The whole-person side of living with a rheumatic disease, the parts patients tell us matter most. These guides apply across conditions.
When to get medical help
- A single joint that is very painful, hot, and swollen, especially with a fever. This can be a joint infection and needs same-day care.
- A fever, night sweats, or feeling very unwell while taking medicines that lower the immune system.
- A painful red eye or sudden change in your vision, which can be eye inflammation and needs prompt care.
- New tummy pain with diarrhoea, sometimes with blood, which can point to bowel inflammation.
- Signs of infection such as burning when passing urine, a spreading red patch on the skin, or a cough with coloured phlegm, while on DMARDs or biologic medicines.
- A flare that is severe, or that does not settle with your usual plan.