Patient information · Rheumatology
Psoriatic arthritis
if you have psoriasis, know these signs
Up to a third of people with psoriasis develop arthritis, usually years after the skin disease. It causes permanent joint damage if untreated, and the damage happens early — which is why anyone with psoriasis and joint pain should be assessed rather than told to take painkillers and see how it goes.
Seek urgent assessment if you have
- a single hot, red, swollen joint with fever — possible septic arthritis
- a red painful eye with light sensitivity or blurred vision
- severe back pain with leg weakness or numbness, or bladder changes
- rapidly worsening joint swelling over days
- fever while on immunosuppressive treatment
- widespread pustules on red, tender skin with feeling unwell
Uveitis occurs in a proportion of people with psoriatic arthritis and can threaten sight if not treated within days. Anyone on biologics or DMARDs with a fever needs prompt assessment. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
The five patterns
- Asymmetrical oligoarthritis — a few joints, often on one side. The commonest pattern.
- Symmetrical polyarthritis — resembling rheumatoid arthritis.
- Distal interphalangeal — the end finger joints, closest to the nails, often with nail changes in the same digit.
- Spondylitis — inflammatory back and sacroiliac pain, with morning stiffness over 30 minutes.
- Arthritis mutilans — rare, severely destructive, and the reason early treatment matters.
Three signs that point specifically to psoriatic arthritis
Dactylitis — a whole finger or toe swollen along its length like a sausage, rather than swelling at one joint. Enthesitis — pain where tendons attach to bone, classically the back of the heel or the sole. Nail changes — pitting, ridging, thickening or the nail lifting from its bed. Nail involvement is strongly associated with arthritis in the joint of that same digit, and it is one of the best predictors of who will develop it.
If you have psoriasis
- Report any joint pain, swelling or stiffness — particularly morning stiffness lasting over 30 minutes
- Report heel pain, and pain at tendon attachments
- Report back pain that improves with movement and wakes you at night
- Skin severity does not predict joint severity — mild psoriasis can accompany severe arthritis, and scalp, nail and skin-fold psoriasis are particularly associated
- In around 15% of people, the arthritis comes first and the skin follows later
Diagnosis
Clinical, supported by examination of skin, nails, joints and entheses. Rheumatoid factor and anti-CCP are usually negative, which helps distinguish it from rheumatoid arthritis, and inflammatory markers are normal in a substantial minority — so normal blood tests do not exclude it. Ultrasound detects synovitis and enthesitis sensitively; X-rays show established change; MRI is used for spinal involvement.
Treatment
- Anti-inflammatories for mild joint symptoms.
- Steroid injections into individual joints or entheses. Oral steroids are used cautiously, as reducing them can flare the skin badly.
- DMARDs — methotrexate, sulfasalazine or leflunomide — for peripheral joint disease. These do not help spinal disease.
- Biologics and targeted therapies — anti-TNF, IL-17 and IL-23 inhibitors, and JAK inhibitors. These treat skin and joints together and have transformed outcomes.
- Physiotherapy and exercise, which maintain function and are particularly important with spinal involvement.
The rest of the picture
Psoriatic disease carries raised cardiovascular risk, and higher rates of metabolic syndrome, fatty liver, inflammatory bowel disease, depression and uveitis. Annual review of blood pressure, lipids, glucose and weight is part of proper care. Stopping smoking and losing excess weight both improve treatment response measurably.
Why come to us. The gap between joint symptoms starting and rheumatology assessment is where irreversible damage occurs. We can see you within days, examine skin, nails, joints and entheses properly, take inflammatory markers, rheumatoid factor, anti-CCP and full blood count in-house with results the same visit, and perform ultrasound on site to confirm synovitis or enthesitis. We then refer to rheumatology with the workup complete. Dermatology is available here too, so skin and joints are managed together.
Skin and joints assessed together, within days
Ultrasound and bloods on site, results the same visit.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.