How psoriatic arthritis presents
PsA causes joint pain, swelling, and stiffness, and can affect any joint in the body, including the fingers, spine, and sites where tendons attach to bone (enthesitis). The pattern of joint involvement is often asymmetric and can include dactylitis (swelling of an entire finger or toe, sausage digit). PsA can cause joint damage and disability if not treated early.
Skin psoriasis may precede, follow or coincide with joint symptoms. Nail changes (pitting, onycholysis, subungual hyperkeratosis) are common in PsA. Diagnosis is based on clinical features, imaging, and exclusion of other causes.
- Asymmetric joint pain and swelling — any joint can be involved
- Dactylitis — sausage digit, entire finger or toe swelling
- Enthesitis — Achilles, plantar fascia, elbow
- Nail changes — pitting, onycholysis, subungual hyperkeratosis
- Spinal involvement — similar to ankylosing spondylitis
Related: Rheumatology → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Treatment approach
Treatment includes NSAIDs, conventional DMARDs (methotrexate, leflunomide), and biologic agents targeting TNF, IL-17, or IL-23 pathways. The choice depends on disease severity, pattern of joint involvement, skin disease severity, and comorbidities.
Coordinated care between rheumatology and dermatology ensures comprehensive management of both skin and joint disease. Regular monitoring includes disease activity assessment, joint imaging, and drug safety blood tests.
- NSAIDs — first-line for mild disease
- Conventional DMARDs — methotrexate, leflunomide
- TNF inhibitors — adalimumab, etanercept, infliximab
- IL-17 inhibitors — secukinumab, ixekizumab
- IL-23 inhibitors — guselkumab, risankizumab