Most people with psoriatic arthritis (PA) develop psoriasis long before arthritic symptoms appear. In addition, there are rare cases in which joint pain may occur – sometimes for as long as decades – before skin symptoms appear. As a result, people are usually diagnosed with either psoriasis or arthritis before they are eventually diagnosed with PA, the combination of these disorders. It can be very difficult to diagnose PA without skin symptoms.

Patients are diagnosed with PA if they display the following symptoms related to each condition:

• Patches of thick, red skin covered with silvery or gray scales. These most often appear on the elbows, knees, scalp or the lower end of the spine. These patches, known as plaques, often itch or burn. Skin at the joints may crack.
  
  
• Pain, redness, swelling and reduced motion in the joints. About 95 percent of patients with PA experience swelling in joints outside the spine, according to the Arthritis Foundation (AF). Joints most often affected include the small joints at the ends of fingers and toes, giving them a “sausage” appearance. Joints in the spine and sacroiliac joints (two large joints connecting the pelvis and the triangular bone at the end of the spine) may also be affected.
  
  
• Morning stiffness (often lasting more than 30 minutes) and fatigue. Physical activity usually helps alleviate stiffness.  
  
  
• Pitted, discolored nails. About 80 percent of patients with PA have nail lesions, according to the AF. Nails in these patients often separate from the nail beds.
  
  
• Pain in the lower back or buttocks.
  
  
• Inflammatory eye conditions and eye pain. These include conjunctivitis or iritis. About 10 percent to 20 percent of children diagnosed with juvenile PA will experience inflammation of the eye, according to the AF.

Symptoms of PA often go through cycles where they improve or worsen. It is not unusual to experience outbreaks of psoriasis when joint pain goes into remission, and vice versa.

Juvenile PA is a condition that affects children (most often girls), who usually develop symptoms of the disease around age 9 or 10. Symptoms are usually mild, although they can be severe and debilitating and last into adulthood. Although children typically display symptoms similar to those of adults, they are more likely to develop skin and joint problems simultaneously. In other cases, arthritis may appear in the child before psoriasis. Because their bones are still growing, children with PA are at risk for abnormal bone development that can affect growth.