The signs can sneak up on you — maybe hand stiffness is making it hard to open jars. Or your feet seem to have become more tender than usual. For Geri, who has had psoriasis for a decade, the sign was more obvious: “I knew something was wrong when I couldn’t open a cereal box because my hands were in so much pain!” As it turned out, the same miscommunication between cells that caused her skin to form plaques was now attacking her joints.

Affecting almost one in three people with psoriasis, psoriatic arthritis (PsA) can cause joint pain ranging from mild to severe. It’s important to be alert to the signs, since the earlier you get treatment, the better you can protect your joints from permanent damage.

ALERT: If you have been feeling stiff, see your healthcare provider right away. Early treatment can help halt permanent joint damage.

When does it strike?
“Psoriatic arthritis can be more difficult to diagnose than psoriasis,” says M. Elaine Husni, MD, vice chair of rheumatology at the Cleveland Clinic. “It usually occurs years after the diagnosis of psoriasis — up to 10 years — sometimes with subtle findings of only one or two joints affected.” But, in some cases, the joint problems begin before skin lesions appear.

What to watch for
Symptoms of PsA typically include joint pain, as well as:

• Sausage-like swelling of fingers and toes. Only one finger or toe may be swollen. If you have pitted or thickened fingernails, the joints at the fingertips are often affected.
• Foot pain at the points where tendons and ligaments attach to bones—especially at the back of your heel or in the sole.
• Back pain. Some people develop spondylitis, a condition that causes inflammation of the joints between the vertebrae of your spine and in the joints between your spine and pelvis.
• Morning stiffness. Pain that is worse after waking up and lessens after walking and using your joints for a bit.

Know your treatment options
Current medications can treat the pain. Some can also help slow or prevent joint damage.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can lessen pain, swelling and stiffness, but cannot slow joint destruction.
• Systemic (body-wide) medications may help relieve severe symptoms and limit the amount of joint damage. Methotrexate is usually the first systemic treatment prescribed.
• Biologic medications such as TNF-alpha inhibitors block an inflammatory protein called tumor necrosis factor (TNF), helping to control joint and skin symptoms. “These therapies help reset the immune system so it can slow down or halt inflammation,” says Dr. Husni. That means biologics may prevent the progression of joint disease.

Prepare for your visit
If you think you have PsA, explain:

• Your symptoms
• How often your symptoms occur and how long they last
• What makes you feel better
• If you have any nail problems (e.g., pitting, ridges or lifting nails)