in most patients the psoriasis precedes the arthritis by months to years. the arthritis frequently involves the knees ankles and joints in the feet. usually only a few joints are inflamed at a time. the inflamed joints become painful swollen hot and red. sometimes joint inflammation in the fingers or toes can cause swelling of the entire digit giving them the appearance of a "sausage. " joint stiffness is common and is typically worse early in the morning. less commonly psoriatic arthritis may involve many joints of the body in a symmetrical fashion mimicking the pattern seen in rheumatoid arthritis. psoriatic arthritis can also cause inflammation of the spine (spondylitis) and the sacrum causing pain and stiffness in the low back buttocks neck and upper back. in rare instances psoriatic arthritis involves the small joints at the ends of the fingers. a very destructive form of arthritis called "mutilans" can cause rapid damage to the joints. fortunately this form of arthritis is rare in patients with psoriatic arthritis. patients with psoriatic arthritis can also develop inflammation of the tendons (tendinitis) and around cartilage. inflammation of the tendon behind the heel causes achilles tendinitis leading to pain with walking and climbing stairs. inflammation of the chest wall and of the cartilage that links the ribs to the breastbone (sternum) can cause chest pain as seen in costochondritis. aside from arthritis and spondylitis psoriatic arthritis can cause inflammation in other organs such as the eyes lungs and aorta. inflammation in the colored portion of the eye (iris) causes iritis a painful condition that can be aggravated by bright light as the iris opens and closes the opening of the pupil. corticosteroids injected directly into the eyes are sometimes necessary to decrease inflammation and prevent blindness. inflammation in and around the lungs (pleuritis) causes chest pain especially with deep breathing as well as shortness of breath. inflammation of the aorta (aortitis) can cause leakage of the aortic valve valves leading to heart failure and shortness of breath. acne and nail changes are commonly seen in psoriatic arthritis. pitting and ridges are seen in fingernails and toenails of 80% of patients with psoriatic arthritis. interestingly these characteristic nail changes are observed in only a minority of psoriasis patients who do not have arthritis. acne has been noted to occur in higher frequency in patients with psoriatic arthritis. in fact a new syndrome has been described characterized by inflammation of the joint lining (synovitis) acne and pustules on the feet or palms thickened and inflamed bone (hyperostosis) and bone inflammation (osteitis). this syndrome is therefore given the eponym sapho syndrome.
what are psoriatic arthritis symptoms and signs?