What to Know About the Stages of Psoriatic Arthritis

Psoriatic arthritis (PsA) progression isn’t linear and doesn’t look the same for everyone. Learn about early stage, severe disease, and remission, plus how to slow progression.

Being diagnosed with PsA can feel overwhelming. On top of learning about the condition, finding the right healthcare specialists, and understanding your treatment options, you’re likely wondering how things will go from here.

It’s natural to have tons of questions running through your mind. What are the stages of psoriatic arthritis? How quickly does psoriatic arthritis progress? Does the condition get progressively worse over time?

The short answer: PsA isn’t the same for everyone, and not everyone will experience progression the same way. That said, here’s what you need to know about the stages of psoriatic arthritis, including symptoms and some tips for slowing the progression of the condition.

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Early-stage psoriatic arthritis

While some people develop psoriatic arthritis before having any symptoms of skin psoriasis, the majority of people who develop PsA will already have been diagnosed with psoriasis.

About a third of people with psoriasis will develop psoriatic arthritis, typically between 7 and 10 years after the onset of skin symptoms.

Symptoms of early-stage psoriatic arthritis include:

• painful and tender joints, with or without swelling
• morning stiffness
• pain and stiffness in one knee
• fatigue
• back pain

These symptoms can also be a sign of many other health conditions, so PsA can be easily overlooked, sometimes for years.

Be sure to talk with your doctor if you have psoriasis (or a family history of psoriatic arthritis) and you’re experiencing any signs of early-stage psoriatic arthritis.

Long-term psoriatic arthritis

PsA is a chronic condition that, even with treatment, tends to ebb and flow over time. Most people will experience “flares,” or periods of more active disease, followed by periods where symptoms are more under control.

There are six manifestations of the condition, or “domains,” that people with PsA experience. These include:

• Skin psoriasis: People with PsA can have large or small areas of skin psoriasis.
• Peripheral arthritis: With peripheral arthritis, the elbows, wrists, knees, and ankles are most impacted.
• Spondylitis: Also called axial arthritis, spondylitis is arthritis that affects the joints in the spine and sacroiliac joints, causing pain and stiffness.
• Nail lesions: Nail pitting, crumbling, and blood spots under the nails are all common in people with PsA.
• Dactylitis: Also called “sausage fingers,” dactylitis is swelling, redness, and pain in an entire finger or toe.
• Enthesitis: Inflammation of the enthesis, where a ligament or tendon attaches to the bone, is a hallmark of PsA, affecting about half of people with the condition.

You may experience any combination of these domains. The way your condition presents will help determine your course of treatment.

Dactylitis and enthesitis, specifically, point to joint damage and severe disease activity. However, worsening in any of these domains is a sign of PsA progression, which means you may need to explore more aggressive treatment options.

If you’re having more frequent or more intense flares, this is also a sign of PsA progression. Always talk with your rheumatologist if it feels like your treatment isn’t working or you’re experiencing worsening symptoms.

Remission

Frequent communication with your rheumatologist, who will be able to assess what is and isn’t working, is an important step toward managing your symptoms.

While it’s possible that PsA may progress over time, it’s also possible for treatment to result in a state of minimal disease activity or remission.

Even if you aren’t experiencing any symptoms for an extended period of time, your rheumatologist will likely recommend that you continue your medications.

Having low disease activity is generally a sign that your treatment is working, and you may experience a flare quickly if you discontinue your medication.

How to slow PsA progression

Early diagnosis is one of the best ways to slow progression and limit joint damage. While treatment can be complicated, there are several approaches, all with the goal of slowing progression — and possibly leading to remission.

Managing PsA typically involves some combination of:

• medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), biologics, corticosteroids, and topical treatments
• physical therapy
• occupational therapy
• low intensity aerobic exercises, like biking, swimming, walking, and tai chi
• weight loss
• hot and cold therapy
• dietary changes
• stress management
• rest

What works for one person may not work for another, but most people find that a holistic approach including medication and lifestyle changes works best.

The bottom line

Understanding the stages of psoriatic arthritis can help you better understand the condition and get the care you need.

Whether you’re newly diagnosed or have been living with PsA for years, it can be helpful to know you aren’t alone. If you need to talk about your experiences with trying to manage your symptoms — or anything else about life with PsA — your Bezzy PsA community gets it.