Psoriatic Arthritis: Causes, Symptoms, and Treatment Options

Many of us think about arthritis as something you only deal with when you’re older, but that’s not the case with psoriatic arthritis. Most people will develop the condition between ages 30 and 40, according to the Johns Hopkins Arthritis Center. 

If you or a loved one are living with psoriatic arthritis—and you’ve been googling “psa arthritis” lately trying to understand it better—then you’ve come to the right place. 

We’ll go over everything you need to know—like the symptoms of psoriatic arthritis, the connection between psoriasis and joint pain, how psoriatic arthritis diagnosis works, and the most powerful psoriatic arthritis treatment options and lifestyle changes for getting your condition under control. 

What Is Psoriatic Arthritis?

“Psoriatic arthritis is when the immune system attacks the healthy cells in your joints, causing inflammation, stiffness, and pain,” says Deanna Moore, NP, a Dermatology Nurse Practitioner at Zest. 

As the name suggests, psoriatic arthritis (PsA) is connected to psoriasis. Most people who are diagnosed with PsA already have the skin condition, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. 

About 30% of people with psoriasis will also develop PsA, Moore says. You’re at higher risk if your psoriasis is severe or involves your scalp or nails. 

Like psoriasis, PsA is an autoimmune disease. Your overactive immune system attacks the joints and skin and causes inflammation throughout your body, Moore explains. Along with your joints, PsA can also cause inflammation in the foot tendons, the points where your tendons meet the bone, and your eyes.. And PsA and psoriasis are often associated with metabolic syndrome and inflammatory bowel disease. “Many people believe psoriatic arthritis only impacts the joints, but it can also affect other parts of your body,” Moore says. 

Causes of Psoriatic Arthritis

The causes of psoriatic arthritis are not fully understood but involve a mix of genetic and environmental factors. 

Genetics

“About 40% of people have a family history,” Moore says. Having a particular gene abnormality (called HLA-B27) raises your risk of PsA. 

Environmental Factors

“Environmental” means all the other factors that can trigger the immune system and kickstart the onset of PsA. 

That includes infections (like strep), joint injuries, and lifestyle habits like smoking, obesity, poor diet, and stress, Moore says. (One fascinating study on over 1.6 million Swedish men found that young adults with low stress resilience—meaning higher chronic stress levels—were 23% more likely to later get PsA.) 

Habits that cause an imbalance of bacteria in your gut (like a poor diet or overusing antibiotics) and increase inflammation might also play a role, Moore says. 

Symptoms and Diagnosis 

The classic symptoms of psoriatic arthritis are early-morning joint stiffness, pain, swelling, and redness. “People may describe a flu-like feeling with achiness or stiffness in their joints,” Moore says. “It's typically worse when they first wake up and after sitting for long periods, and improves as the day progresses.” 

PsA most commonly affects the fingers, toes, knees, hips, spine, and sacroiliac joint (connecting the spine and pelvis), but can involve any joint, Moore says. You could have mild symptoms in just a few joints, or severe symptoms in many joints, according to the National Library of Medicine. 

But the signs of psoriatic arthritis go beyond your joints. You might be struck by “overwhelming fatigue, or feeling like you were hit by a semi-truck,” Moore says. Or you may experience pain in your tendons, like in the sole of your foot or back of your heel, Moore adds. And if PsA affects your eyes, it can cause eye pain, redness, and blurred vision, according to the Mayo Clinic.

Psoriatic arthritis diagnosis is “not very black and white,” Moore says—there’s no definitive test for it. “So we go off of a lot of what the individual says, as well as their symptoms and patterns.” 

If you have psoriasis, your dermatologist should regularly screen you for signs of psoriatic arthritis, Moore says. Otherwise, you can see a primary care provider. Your derm or PCP can send you to a rheumatologist (a specialist in autoimmune diseases) to confirm your psoriatic arthritis diagnosis, Moore says. They might order X-rays or MRIs to check for joint or tendon damage. 

Effective Psoriatic Arthritis Treatment Options 

Your doctor will tailor your treatment based on how widespread and severe your symptoms of psoriatic arthritis are "as well as your personal preferences, Moore says. (Here we’ll focus on treatments that address joint symptoms. But if you also have psoriasis and are curious about psoriatic arthritis and skin care, check out this story.)

• NSAIDs
  • Nonsteroidal anti-inflammatory drugs (like Advil and Aleve) reduce inflammation and provide pain relief for psoriatic arthritis in more mild cases, Moore says.
• Oral Steroids
  • Oral steroids (like prednisone) suppress an overactive immune system and provide rapid pain relief for psoriatic arthritis. But they’re usually not the best for long-term use due to side effects, Moore says, although “you have to take into account the severity of the discomfort and inflammation.” Plus, they can cause a rebound psoriasis flare when you stop taking them.
• Steroid Injections
  •  Injections of corticosteroids (like cortisone) can quickly bring down severe pain and swelling. (The effects can last up to several months.) Systemic steroids are sometimes used “if there is widespread inflammation and several inflamed and stiff joints,” Moore says. 
• DMARDs
  • DMARDs (disease-modifying anti-rheumatic drugs) are often a first-line treatment for managing psoriatic arthritis symptoms in the long term, Moore says. These commonly prescribed oral medications (like methotrexate) tamp down on immune system activation and prevent joint damage, the Mayo Clinic explains.
• Biologics
  • If DMARDs don’t do the trick, you might need an injectable or oral biologic treatment for psoriatic arthritis. They stop inflammation and prevent joint damage by interrupting signals in the immune system.
  • Some of these medications (like TNF inhibitors, IL-23s, and IL-17s) are also prescribed for psoriasis. “They don’t just treat the skin, they actually treat the joints as well,” Moore explains. So this can be a good choice if you have psoriasis and joint pain.
• Otezla
  • This oral medication inhibits a specific pro-inflammatory enzyme to help improve symptoms, Moore says.
• Surgery
  • Rarely, people need surgery to replace or repair damaged joints. 

Managing and Preventing Flare-ups

Psoriatic arthritis can be frustratingly unpredictable. “​​One day, you may feel great, and then the next day, you start having a flare-up,” Moore says.

During a flare, you’ll want to take it extra easy on your joints, rest, and check in with your doctor. They may want to adjust your treatment plan, Moore says, as well as give you something to manage your flare in the short term (like low-dose steroids, steroid shots, or Meloxicam, a prescription NSAID). At-home remedies like cold therapy or Epsom salt baths may also soothe swollen, painful joints during a flare, according to the Cleveland Clinic.

The best way to prevent flares in the first place is leading an overall healthy lifestyle. That starts with managing the biggest trigger for PsA: stress. “A big life change, emotional stress, physical stress, injuries, illnesses—anything that triggers the immune system may cause flares,” Moore says. And it’s a downward spiral: A flare can cause more stress, triggering another flare.

“So anything you can do to lower your stress is going to help,” Moore says. Some ideas: Meditation, therapy, deep breathing, being in nature, massages, yoga, spending time with friends, and getting plenty of sleep.

Lifestyle Changes for Psoriatic Arthritis

While not everything is in your control with PsA, “doing everything you can on your end to live a healthy life,” makes a substantial difference in managing psoriatic arthritis symptoms, Moore says. Certain lifestyle habits can protect your joints or lower the underlying inflammation.

Manage Your Weight

Keeping your BMI in the healthy range can prevent extra stress on the joints and lower overall inflammation, Moore says. A healthy weight can also improve how your body responds to treatment.

Eat Well

A high-fat, low-fiber diet can increase harmful gut bacteria and create inflammation, Moore says. So choose whole foods over processed foods, and get plenty of fiber.

A recent study found that eating a Mediterranean diet (rich in foods like veggies, fruit, and fish) is linked to better PsA control.

You might also consider going gluten-free. Even if you don’t have celiac disease, gluten can “exacerbate inflammation” in some people, Moore explains. Give it a shot for a few weeks to see if you notice any difference.

Exercise

You might be avoiding the gym because of pain and stiffness (understandably). But that can actually make your symptoms worse by weakening your muscles and joint stability, NYU Langone Health explains.

Working out can be “highly beneficial” for managing psoriatic arthritis symptoms, Moore says.

Research has found that exercise reduces symptoms like pain and fatigue. Skip high-impact workouts like HIIT and stick to:

• Low-impact activities like walking, swimming, bicycling, and yoga. These are gentle on your joints, Moore says.
• Strength training, which builds up the muscles and tendons that provide joint support and stability. 

Just don’t overdo it, Moore cautions—that can trigger a flare-up and put extra stress on inflamed joints. Listen to your body and prioritize rest.

Protect Your Joints

Little adjustments can lighten the everyday burden on your joints. Maintain proper posture when sitting and don’t putt too much weight on joints when doing chores and lifting loads. You can also lean on doors to open them without straining your fingers. Your doctor might suggest a fitted brace or splint for added joint support, the American Academy of Dermatology says.

Quit Smoking

Since smoking is pro-inflammatory, it can make your PsA worse. Research also shows that TNF inhibitors don’t work as well in smokers.

Nurture Your Gut

Probiotics (strains of good bacteria) and prebiotics (food for good bacteria) can help correct an inflammatory imbalance in your gut, Moore says. A small 2023 study found that when individuals with psoriasis and PsA took these supplements for three months, their inflammation and symptoms improved.

Impact on Quality of Life

Untreated PsA can lead to early joint damage and disability, as well as a higher risk of cardiovascular problems and metabolic syndrome due to systemic inflammation, Moore says.

The physical symptoms of psoriatic arthritis can impact your mental and emotional well-being, too. Stiff and achy joints make it hard to go about your daily routine, get out to do activities you enjoy, and see friends. Your risk for social isolation, anxiety, and depression are higher, Moore says.

People with PsA also face sleep issues, fatigue, mood changes, poor body image, and lower productivity, according to research.

But getting your PsA under control has a cascade of positive effects, Moore says. “When joint pain and stiffness improves, mental health tends to also improve.” That same research paper found that some common PsA treatments improved quality of life.

The last piece of the psoriatic arthritis treatment puzzle? Working closely with an experienced team of specialists who take a “whole-body approach” to your PsA, Moore says (like the doctors at Zest). With expertise and one-on-one attention, they can guide you toward the treatments and lifestyle changes that will give you the long-lasting pain relief for psoriatic arthritis you’re looking for.