| What We Treat
Psoriatic Arthritis
Joint or tendon pain in someone with psoriasis is psoriatic arthritis until shown otherwise, and it needs early rheumatology input.
Overview
What It Is
Psoriatic arthritis is an inflammatory arthritis affecting a proportion of people with psoriasis. It differs from rheumatoid in being frequently asymmetrical, in affecting the entheses where tendons attach to bone, and in involving the spine in a significant minority. Skin disease usually comes first, but not always.
Asymmetrical, With Entheses
Frequently asymmetrical, affecting the end joints of the fingers, and involving where tendons attach to bone.
Symptoms
How It Tends to Feel
These are the features that point towards this diagnosis rather than another:
Joint Pain and Swelling
Often asymmetrical, and may affect the end joints of the fingers.
Enthesitis
Pain where tendons attach to bone, classically the Achilles or the plantar fascia.
Dactylitis
A whole finger or toe swelling, described as sausage-like. Highly suggestive.
Nail Changes
Pitting or lifting of the nail, present in most people with joint involvement.
Inflammatory Back Pain
Morning stiffness over thirty minutes, better with movement, in a significant minority.
Fatigue
Common and often underestimated.
Causes & Risk Factors
What Drives It
The usual contributors, in rough order of how often they turn out to matter:
Psoriasis
Present in the great majority, though joint symptoms occasionally precede the skin.
Genetic Factors
A clear familial pattern.
Immune Dysregulation
Inflammation targeting entheses and synovium.
Mechanical Stress
Enthesitis often develops at sites under repeated load.
How We Can Help You
Treatment & Management
Treatment is built around what the assessment finds, but generally follows this shape:
When to Seek Help
Red Flags — Don’t Ignore These
Most presentations are straightforward. These features are the exceptions, and warrant prompt assessment:
⚠ Seek Medical Advice If You Notice
- A single hot, swollen joint with fever — exclude infection urgently
- New eye pain, redness or visual change — uveitis needs same-day assessment
- Rapidly progressive joint deformity
- New back pain with neurological symptoms
If any of these apply, contact your GP or seek urgent medical care rather than waiting for a physiotherapy appointment.
Common Questions
Frequently Asked Questions
Can I have it without bad psoriasis?
Yes. The severity of skin disease does not predict joint involvement, and some people have very limited psoriasis, sometimes only in the scalp or nails.
Why does my heel hurt?
Enthesitis at the Achilles insertion is a classic feature. It behaves differently from ordinary tendinopathy and responds more slowly, which is worth knowing before you get discouraged.
Is exercise safe?
Yes, and beneficial. It needs modifying during flares but should not stop.
Not Sure If This Is What You Have?
An assessment will tell you what is actually going on and what to do about it. I see everyone myself, and you will leave with a plan rather than a leaflet.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.