Psoriatic Arthritis: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate psoriatic arthritis:

  • Arthralgia* (joint pain).
  • Joint swelling of the hands and feet (metacarpo or metatarsophalangeal joints, proximal and distal interphalangeal joints) in the sense of dactylitis (Latin: daktyl = fingers or toes and “itis” = inflammation; finger inflammation or also toe inflammation), which from the appearance lead to the so-called “sausage fingers”
  • Back pain (due tosacroiliitis (inflammatory, destructive change in the joints between the sacrum and ilium) and spondylitis (“vertebral inflammation”)).
  • Stiffness of the small joints
  • In the knee joints, usually asymmetric swelling, pain and / or stiffness.
  • The symptoms and complaints pathognomonic (characteristic of a disease) for psoriasis are:
    • Sharply demarcated inflammatory papules (nodular thickening of the skin) with scaling of the skin; the skin lesions may also appear in stripes, rings or arches
    • Constant change in appearance and frequency
  • Predilection sites (body regions where the disease occurs preferentially) of skin lesions are:
    • Knees, elbows and scalp, sacral region (sacral region), anal region.

* Note: Initial nonspecific rheumatic symptoms may present by up to six years before the initial manifestation of PsA. These are, at the time of initial examination, nonspecific arthralgias in female patients, heel pain, marked fatigue (“tiredness“) and high stiffness, especially in the back.

Clinical triad

  • Erythrosquamous plaques (red scaly skin lesions) with silvery white scaling
    • Predilection sites (areas of the body where the disease occurs preferentially)
      • Hairy part of the head
      • Discrete skin changes behind the ears and in the external auditory canal are also possible
      • Palms and soles of the feet
      • Extensor sides of elbows and knees, respectively.
      • Sacral region (sacral region)
      • Anal region
  • Nail changes (about 70% of cases).
    • Spotted nails (pinhead-sized indentations).
    • Oil stain nails (yellowish-brownish discoloration).
    • Onycholysis (yellowish-brownish dirty changes under the surface of the nail).
    • Crumb nails (thickened, dystrophic nails).
    • Cross grooves
    • Subungual keratoses (“below a nail” cornification disorders) on the nail bed.
    • Missing cuticle (psoriatic focus on the nail wall).
  • Arthritis (joint inflammation), in the sense of symmetrical polyarthritis; possibly also axial affection with sacroiliitis (inflammatory, destructive change in the joints between the sacrum and ilium) and spondylitis (“vertebral inflammation”)A special form of arthritis is arthritis mutilans. This is a severe arthritis with rapid destruction of the joint structure.

Note: Rheumatoid nodules are not present in psoriatic arthritis in most cases!

Additional possible extra-articular manifestations (visibility of the disease outside the joints).