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If you have psoriasis, you may eventually develop psoriatic arthritis (PsA), a chronic disease that affects approximately 30 percent of psoriasis sufferers. Although doctors are not sure why this condition occurs, they do know that it affects about one million Americans, and that it stems from a malfunction in the immune system that causes painful swelling in the joints, hands, feet and connective tissues. It can also lead to inflammation in body tissues, such as tendons and cartilage, eyes, heart, lungs and kidneys.

Psoriatic arthritis is not a condition to be ignored. Left untreated, it can progress to the point where debilitating joint damage severely diminishes quality of life. Inflammation can also cause pain in the eyes and in the chest wall, making breathing difficult. If the inflammation reaches the heart, it can eventually lead to heart failure.

Although there is no cure for psoriatic arthritis, it can be treated. After recognizing the initial symptoms and immediately starting effective treatment, people with psoriatic arthritis can learn to relieve the pain and control the damaging inflammation.

Unfortunately, many people with psoriatic arthritis do not know they have it. A survey conducted by the National Psoriasis Foundation found that up to one-third of people with psoriasis said they had suffered from persistent joint stiffness for at least 3 months, but had yet to be diagnosed with psoriatic arthritis.

Psoriatic arthritis may go undiagnosed because it can be hard to identify. The disease varies widely in its initial symptoms and its differing degrees of severity. The symptoms of psoriatic arthritis may develop slowly or appear quickly and relentlessly.

In up to 20 percent of cases, the signs and symptoms of psoriatic arthritis present before the skin lesions common in psoriasis. Other times, the psoriatic arthritis symptoms and psoriasis symptoms arrive simultaneously. In the majority of cases, however, psoriatic arthritis appears after psoriasis has begun to flare. Sometimes patients do not experience the symptoms of psoriatic arthritis until 10 years after the first symptoms of psoriasis.

Symptoms of Psoriatic Arthritis
The joints most often affected by psoriatic arthritis are those of the knee, ankle and feet. Usually, only a few joints are swollen at a time. Like the symptoms of psoriasis, the symptoms of psoriatic arthritis can flare and then subside. Sometimes the same joints are inflamed on both sides of the body; sometimes only one side of the body is affected. In either case, the affected joints become painful, swollen and warm. These symptoms are also typical of rheumatoid arthritis and provide another explanation of how psoriatic arthritis can be misdiagnosed or undiagnosed.

In addition to the symptoms that are similar to those of rheumatoid arthritis, many of the symptoms of psoriatic arthritis are akin to those of other conditions, including gout and reactive arthritis. It is common for patients with these diseases to complain of general fatigue, stiffness, joint pain or swelling, especially in the early morning hours. These symptoms can cause reduced range of motion, another complication common to these diseases. Some people who have psoriatic arthritis may develop a related condition known as psoriatic spondylitis, whereby inflammation can cause pain in the neck, back or buttocks, making movement even more difficult.

Each case of psoriatic arthritis can be unique, so it is vital for patients, especially those with psoriasis or a family history of psoriasis, to be on the lookout for some of the distinct signs that set psoriatic arthritis apart from other diseases. Many of the symptoms of psoriatic arthritis are easily missed, simply because they seem unrelated to arthritis. For example, it is common for people with psoriatic arthritis to complain of tenderness, pain or swelling in their tendons. Typically, this pain takes the form of tendonitis and/or bursitis, separate conditions caused by inflammation around joint areas. If these conditions are present, they may be a result of psoriatic arthritis.

There are a number of other symptoms of psoriatic arthritis that may also be mistakenly attributed to other causes. One of the most distinct is the swelling of the fingers and toes to the point where they look like sausages. This condition, known as dactylitis, is easily ignored by people who believe they have inadvertently injured themselves. Nail lesions are another sign of psoriatic arthritis that may initially seem unrelated. In fact, approximately 80 percent of psoriatic arthritis patients will have lesions on their fingernails or toenails. When these lesions appear, the nail may separate from the nail bed and/or become pitted, ridged or discolored. This condition can be easily mistaken for a fungal infection. Psoriatic arthritis also affects the distal joints, the small joints closest to the tips of the fingers and toes. This condition can be mistaken for osteoarthritis.

An equally noticeable but seemingly unrelated sign of psoriatic arthritis is soreness in the feet caused by enthesitis. In enthesitis, inflammation caused by recurring stress creates tender spots, and often fibrosis and calcification, at the sites where the tendons and ligaments attach to the bone. Enthesitis can also cause pain at the back of the heel, sometimes known as Achilles tendonitis, making it difficult to walk or climb stairs.

Recognizing these symptoms is an important step in preventing the damage that psoriatic arthritis can inflict. If you suffer from psoriasis or have a family history of the condition, and you experience any of these symptoms, talk with your doctor. He or she can recommend an appropriate treatment regimen that can help you relieve the pain, reduce the inflammation and cope with this chronic and potentially disabling disease.