Key takeaways
- Psoriatic arthritis (PsA) is divided into five subtypes based on symptoms. The five subtypes are:
- asymmetric
- symmetric
- distal interphalangeal predominant
- spondylitis
- PsA mutilans
- Each subtype presents distinct joint involvement patterns, with symptoms ranging from mild to severe. You may experience symptoms from more than one category. Early diagnosis is crucial for preventing further joint damage.
- Treatment options for PsA vary depending on symptom severity, the joints affected, and previous treatment responses. Medications, surgery, and exercise are potential components of a comprehensive treatment plan.
PsA affects about
Affected joints become painful, stiff, and swollen. Symptoms can range from mild to severe and can affect only a few or several joints.
This article outlines the five subtypes of PsA, their symptoms, and how common they are. It also covers how doctors treat PsA. A person with PsA may have symptoms consistent with more than one type of PsA.
Here are the five main types or categories of PsA:
Asymmetric PsA affects a joint or joints on one side of your body. Typically, fewer than 5 joints are involved.
This type of PsA is
The Arthritis Foundation notes that most of the time, PsA is asymmetric. It’s estimated that
Asymmetric PsA can affect any joint in the body. Some areas it more commonly affects include:
- knees
- feet
- ends of the fingers and toes
- large joints
Symptoms
Symptoms of asymmetric PsA can include:
- joints that are:
- tender or painful
- swollen
- warm to the touch
- morning joint stiffness
- reduced range of motion in the affected joints
- swelling, redness, or discoloration of the fingers or toes (dactylitis)
- swelling and pain where tendons and ligaments connect to bone (enthesitis)
- nail changes, like pitting, cracking, or separation from the nail bed
- itchy, scaly skin patches
- fatigue
- eye problems like discoloration and uveitis
The symptoms can be mild to severe.
The fact the asymmetric PsA only affects one side of the body can help distinguish it from other types of arthritis, like rheumatoid arthritis (RA).
Symmetric PsA affects five or more of the same joints on both sides of the body.
While this type of PsA can occur in any joint, it most commonly affects the small joints in the hands and feet. Symmetric PsA is less common in larger joints.
Estimates suggest the incidence of symmetric PsA ranges from
Symptoms
The symptoms of symmetric PsA are generally the same as those of asymmetric PsA. They can also range from mild to severe.
Because this type of PsA is symmetrical and mainly affects small joints, people often mistake it for RA, but it’s generally milder than RA. Blood tests for rheumatoid factor are almost always negative.
Distal interphalangeal (DIP) predominant PsA mainly affects the DIP joint, which is the one closest to the ends of the fingers and toes.
According to estimates,
Symptoms
In addition to other general symptoms of PsA, nail changes are very common in people with DIP-predominant PsA. These can include nail pitting, nail cracking, and separation of the nail from the nail bed (onycholysis).
Spondylitis PsA mainly affects the joints between your spinal vertebrae. Doctors may also refer to this type of PsA as axial arthritis.
Spondylitis affects 25% to 70% of individuals with PsA, but research suggests that 2% to 5% of individuals with PsA have only spondylitis PsA (axial involvement).
Symptoms
In addition to other general symptoms of PsA, those with spondylitis PsA also experience pain, swelling, and stiffness in the neck and back, which can make movement very difficult.
Even though spondylitis PsA primarily affects the spine, people with this type of PsA can also experience symptoms in other joints. These can include the:
PsA mutilans (PAM) is the most severe type of PsA. Estimates of how many people with PsA have PAM vary widely depending on the study population, ranging from 0.6% to 21%.
This type of PsA most commonly affects the small joints of the hands, feet, and wrists.
Symptoms
In PsA mutilans, inflammation is very severe, leading to significant damage to the affected joints. This can lead to symptoms like:
- deformities of the affected joint, which can be serious
- problems with movement and range of motion
- bone loss in the affected joint, which can lead to shortening of the fingers or toes
PsA mutilans can also affect other areas as well. People with this type of PsA may experience pain in their neck and back.
| Type | Symptoms |
|---|---|
| Asymmetric PsA | mild to severe and may include: tender, painful, or swollen joints joints that are warm to the touch reduced range of motion in the affected joints morning joint stiffness swelling and redness or discoloration of the fingers or toes swelling and pain where tendons and ligaments connect to bone nail changes, like pitting, cracking, or separation from the nail bed itchy, scaly skin patches fatigue eye problems like redness and uveitis |
| Symmetric PsA | mild to severe and may include: tender, painful, or swollen joints joints that are warm to the touch reduced range of motion in the affected joints morning joint stiffness swelling and redness or discoloration of the fingers or toes swelling and pain where tendons and ligaments connect to bone nail changes, like pitting, cracking, or separation from the nail bed itchy, scaly skin patches fatigue eye problems like redness and uveitis |
| Distal interphalangeal predominant PsA | general PsA symptoms nail pitting nail cracking separation of the nail from the nail bed |
| Spondylitis PsA (axial PsA) | mainly affect the joints between your spinal vertebra general symptoms of PsA pain swelling stiffness in the neck and back movement may be very difficult and painful symptoms in multiple joints, such as hips, arms, legs, hands, feet |
| Psoriatic arthritis mutilans (PAM) | very severe inflammation that leads to joint damage deformities of the affected joint limited movement and range of motion bone loss in the affected joint shortening of the fingers or toes |
There are several potential treatment options for PsA. What’s involved in your specific treatment plan can depend on a variety of factors, including:
- the severity of your symptoms
- how many joints PsA affects
- which joints it affects
- the extent of the damage in the affected joints
- responses to previous treatments for PsA
- your overall health and personal preference
Medications
Various medications can treat PsA. Some examples include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are medications that can ease inflammation and pain in mild PsA. They’re available either over the counter or by prescription.
- Disease-modifying antirheumatic drugs (DMARDs): DMARDs are drugs that help prevent mild to moderate PsA from getting worse. Examples of DMARDs include:
- methotrexate
- ixekizumab (Taltz)
- guseikumab (Tremfya)
- sulfasalazine
- apremilast (Otezla)
- tofacitinib (Xeljanz)
- upadacitinib (Rinvoq)
- Biologics: Biologics are a newer type of DMARD. They’re proteins that target specific parts of the inflammatory process. They may help treat more severe PsA or spondylitis PsA. Examples of biologics are adalimumab (Humira) and secukinumab (Cosentyx).
- Immunosuppressants: Immunosuppressants dampen the activity of your immune system. Due to the availability of biologics, doctors use them less often. Examples include cyclosporine and azathioprine.
- Corticosteroids: Corticosteroids work to reduce inflammation. They come as a pill or an injection. Due to side effects, doctors prescribe oral corticosteroids at the lowest dose for the shortest amount of time possible.
Surgery
Doctors sometimes recommend surgery to treat PsA. This typically only happens when PsA has caused joints to become severely damaged.
Exercise
Engaging in regular, low impact forms of exercise like walking and swimming can also help keep joints healthy. Physical therapy may help people improve or maintain their strength, flexibility, and range of motion.
Psoriatic arthritis (PsA) is a condition that can affect some individuals with psoriasis. It causes joint inflammation and pain that can range from mild to severe. The symptoms of PsA can also affect movement and quality of life.
There are five subtypes of PsA, which doctors differentiate based on factors like the affected area and symptom severity. It’s possible for an individual with PsA to experience symptoms of multiple subtypes of PsA.
Various treatments can help ease PsA symptoms and slow the progression of the condition. An early diagnosis is important in preventing further joint damage. It’s best to contact a doctor as soon as possible if you’re experiencing symptoms of PsA.