6 Psoriatic Arthritis Symptoms That Might Surprise You

You know that joint swelling and muscle stiffness are symptoms of PsA, but did you know that PsA may affect your nails, eyes, heart, and more?

Common symptoms of psoriatic arthritis (PsA) — joint swelling and muscle stiffness — can be easy to spot. But those aren’t the only issues that crop up with the condition.

Challenges can range from quirky and seemingly unrelated physical difficulties to mental health struggles that affect daily life. Here are six that have all been associated with PsA.

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1. Nail problems

Changes in fingernails and toenails affect up to 80% of people with PsA, according to 2017 research. In some cases, changes can happen even before PsA is diagnosed.

Signs include:

• pitting
• discoloration
• brittleness
• loosening (where one or more nails actually lift up from the nail bed)

You might have just a few nails affected or all of them.

Nails affected by PsA are more likely to develop a secondary fungal infection, so it’s important to get them addressed promptly.

Treatments that address PsA throughout the body can also help with nail issues, says Zhanna Mikulik, MD, a rheumatologist at The Ohio State University Wexner Medical Center who specializes in psoriatic arthritis.

2. Eye diseases

Inflammation with PsA can affect the eyes, and the most common condition is conjunctivitis, or “pink eye,” which is seen in around 20% of people with PsA, according to Mikulik.

“This will present with redness, itching, watery eyes, and general discomfort,” she says. “This is caused by inflammation of the outer membrane of the eyeball and inner eyelid.”

Seen less often, but still a possibility, is uveitis, which affects around 7% of those with PsA.

Uveitis can include:

• eye pain
• light sensitivity
• blurry vision

Like nail concerns, treatments for PsA can help to reduce eye diseases and symptoms, Mikulik says.

3. Hearing loss and dizziness

In a 2014 study, researchers looked at 60 people with PsA who had no history of inner ear infections or other conditions that might affect hearing function. About 60% of participants had abnormal hearing loss, suggesting PsA may contribute to inner ear damage.

A survey in 2019 — which involved over 10,000 participants — found similar results. These researchers suggest that the cause may be chronic inflammation affecting inner ear structures.

Because of that, Mikulik suggests paying attention to the ways your hearing might be affected when your PsA is flaring up. If your joints are swelling, it’s possible that inflammation could be reducing your hearing and vision as well.

Even if your hearing isn’t affected, inflammation in the ears could be leading to another symptom: vertigo or dizziness. Some medications used to treat PsA might make this more likely, so talk with your doctor if you’re experiencing this in case switching your meds can help clear up the problem.

4. High blood pressure

According to the Arthritis Foundation, the risk of heart disease may be nearly doubled in people with PsA.

Like other symptoms, it’s connected to systemic inflammation that may affect your cardiovascular system, says Anca Askanase, MD, a professor of medicine in the division of rheumatology at Columbia University College of Physicians and Surgeons.

“When inflammation is not controlled, it may narrow arteries and that reduces blood flow, not just to the heart but also to other organs as well,” she says. “That’s why staying on top of your PsA is important.”

5. Back pain

Many people with PsA feel muscle stiffness in their backs, especially if they’ve been sitting or sleeping for at least a few hours.

You may also develop a condition called spondylitis, which involves inflammation in the joints of the vertebrae, says Mikulik. This affects the lower back most often but can occur anywhere along the spine, including the neck.

“You can recognize spondylitis by what makes it better,” she says. “Movement and stretching reduces the pain and stiffness, compared to other back problems that get worse with movement.”

6. Low libido

Research presented at a 2022 conference suggests that people living with PsA are more likely than those without to experience sexual dysfunction. And that can come from a number of factors, says Lee Phillips, EdD, psychotherapist, certified sex and couples therapist, and host of the Sex & Chronic Illness podcast.

Chronic conditions like PsA can disrupt the desire and arousal phases of the sexual response cycle, which may increase anxiety. Also, treatments for the condition can affect the libido, exacerbating a lack of desire, he adds.

The bottom line: Track your symptoms

Just because you have PsA, it doesn’t mean you’ll have any of these symptoms. But it’s helpful to keep them in mind and understand that if they do show up, they may be connected to your condition.

Mikulik suggests jotting down symptoms that come up — even if they don’t seem related to your PsA — along with their severity and duration. That way, you and your rheumatologist will be better able to see trends and catch any issues earlier.