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The Beyond Pain Foundation

Conditions we support

Conditions guide

Psoriatic arthritis

Psoriatic arthritis is a long-term condition that causes painful, stiff and swollen joints. It affects some people who have the skin condition psoriasis. It can also affect tendons, nails, the spine and the eyes, and it often causes deep tiredness. This guide explains the signs, the treatments used in the UK, how long they take, and your rights at work.

Adults in the UK likely to have it
About 200,000
People with psoriasis who develop it
About 1 in 4
Most often starts within
10 years of psoriasis
DMARDs and biologics can take
Up to 3 months to work

This guide is general information, not medical advice. Medicines and treatments must be prescribed or recommended for you by a doctor or pharmacist. We do not give doses here.

What psoriatic arthritis is

Psoriatic arthritis (PsA) is an autoimmune condition. The immune system attacks healthy parts of the body by mistake, causing inflammation in the joints and in the places where tendons and ligaments attach to bone.

It affects about 1 in 4 people with psoriasis. It most often starts in the first 10 years after psoriasis appears, but the skin and joint problems can start at the same time. Sometimes the arthritis comes first, or the psoriasis is so mild, for example only on the scalp or nails, that it hasn't been noticed.

It can run in families. There is no cure, but treatment can control symptoms and prevent joint damage, so getting diagnosed early matters.

Patterns and features

PsA affects people in different ways. You may have more than one of these, and the pattern can change over time.

A few joints

Sometimes called oligoarthritis. Four or fewer joints are affected, often unevenly, such as one knee and a few fingers. This is a common way for PsA to start.

Many joints

Sometimes called polyarthritis. Five or more joints, often small joints of the hands and feet. It can look like rheumatoid arthritis.

End finger and toe joints

The joints nearest the nails are affected. This is often linked with nail changes.

Spine and pelvis

Also called axial PsA. Inflammation in the back, neck or the joints at the base of the spine causes pain and stiffness, often worse in the morning or at night and better with movement.

Enthesitis

Painful inflammation where tendons attach to bone, such as the back of the heel (Achilles), the sole of the foot, knees, hips, elbows or chest.

Dactylitis

A whole finger or toe swells up like a sausage. It usually affects one or two at a time.

Nail changes

Small dents (pitting), discolouration, or the nail lifting away from the skin. Nail psoriasis is a warning sign for PsA.

Arthritis mutilans

Rare and severe. It can quickly damage the small joints of the hands and feet, changing their shape. Early specialist treatment is vital.

Symptoms and flares

The main symptoms are joint pain, swelling and stiffness. Stiffness is often worst first thing in the morning and lasts more than 30 minutes, easing as you move. Many people feel drained of energy. Symptoms can come and go.

  1. Often years after psoriasis

    Onset

    Joint, heel or back pain, or a swollen finger or toe, starts. It may build slowly or come on quickly.

  2. Weeks to months

    Diagnosis and first treatment

    Referral to a rheumatologist, scans and blood tests, then anti-inflammatories, injections or a DMARD.

  3. Days to weeks

    Flares

    Times when joints, tendons or skin get worse. Stress, illness, injury and stopping treatment can trigger them. Skin and joint flares don't always happen together.

  4. Ongoing

    Control

    With treatment, the aim is few or no symptoms and no further joint damage.

The severity of your psoriasis doesn't predict how bad your arthritis will be. Mild skin psoriasis can come with severe arthritis, and the other way round.

When to get urgent help

Call 999 if you have

  • swelling of your lips, mouth, throat or tongue
  • sudden difficulty breathing
  • skin, lips or tongue turning blue, grey or pale
  • sudden confusion, drowsiness or fainting
  • sudden chest pain

Get same-day help (NHS 111, eye casualty or your rheumatology helpline) if

  • you have a red, painful eye, blurred sight or sensitivity to light. This can be uveitis and needs checking that day
  • you have a high temperature or feel very unwell while on DMARDs or biologics
  • one joint is suddenly hot, red and very painful
  • your skin or the whites of your eyes turn yellow

See your GP if

  • you have psoriasis and new joint, heel or back pain, or a swollen finger or toe
  • you are stiff for more than 30 minutes in the morning
  • your nails are changing
  • your treatment isn't controlling your symptoms

Diagnosis and referral

There is no single test for PsA. A rheumatologist makes the diagnosis from your symptoms, your skin and nails, an examination, and tests such as:

  • Blood tests for inflammation. Tests for rheumatoid factor and anti-CCP help tell PsA apart from rheumatoid arthritis. Blood tests can be normal in PsA.
  • X-rays, ultrasound or MRI to look for inflammation and joint damage.
  • Joint fluid tests to rule out gout or infection.

Your GP should refer you to a rheumatologist if PsA is suspected. If you have possible inflammation in several joints or the small joints of the hands and feet, NICE says the referral should be urgent.

If you have psoriasis, ask for a yearly joint check

NICE says people having treatment for psoriasis should be checked for psoriatic arthritis at least once a year, using a short questionnaire called PEST. If you have psoriasis and any joint symptoms, mention them. You can also fill in the PEST questionnaire yourself and take it to your GP.

Treatments and medicines

Treatment aims to control inflammation in your joints, tendons and skin, and prevent damage. Your rheumatologist and dermatologist may work together.

Anti-inflammatory painkillers

Ibuprofen from a pharmacy; others such as naproxen on prescription

NSAIDs, as tablets, creams or gels, can ease pain and stiffness. They don't slow the disease. Your GP may give a stomach-protecting medicine with them.

Steroid injections

From a specialist

An injection into a swollen joint or tendon area can quickly calm a flare. The effect wears off after a few months. Doctors usually limit how many injections one joint has, often to no more than 3 a year. Steroid tablets are used less often in PsA, as stopping them can make psoriasis flare.

  1. Conventional DMARDs

    Several weeks, up to 3 months, to work

    Disease-modifying anti-rheumatic drugs calm the immune system. The usual choices are methotrexate, which can also help the skin, sulfasalazine and leflunomide. They are started by a specialist. You'll need regular blood tests. Many people take them for years.

    Pregnancy warning: methotrexate and leflunomide can harm an unborn baby. Talk to your team before trying for a baby, and use contraception as advised. Limit alcohol on these medicines.

  2. Biologics and targeted medicines

    Usually after at least 2 DMARDs haven't worked. Up to 3 months to work fully

    Biologics are injections or drips that block specific parts of the immune system. They include TNF blockers such as adalimumab, etanercept, infliximab, certolizumab and golimumab, and others such as secukinumab, ixekizumab, ustekinumab, guselkumab and risankizumab. Many also clear psoriasis well. Tablets such as apremilast, tofacitinib and upadacitinib are other options. For TNF blockers, NICE says you should have at least 3 tender and 3 swollen joints, and your response is checked at 12 weeks.

  3. Switching

    If a medicine stops working or causes side effects

    There are now many options. If one biologic or tablet doesn't work, or stops working, your rheumatologist can usually switch you to another.

Don't stop your medicines on your own, and avoid unproven remedies

Stopping DMARDs or biologics suddenly can cause a flare. Contact your rheumatology team first. The NHS advises against herbal remedies, as some can interact with your medicines. Always tell your pharmacist what you take.

Surgery and other support

Most people with PsA don't need surgery. If a joint is badly damaged, options include joint replacement, joint fusion, or tendon repair. Recovery depends on the joint. After a hip or knee replacement, most people go home within a few days and need several weeks to several months to recover.

Your team can refer you to physiotherapy for exercises, occupational therapy for splints and daily living aids, and podiatry for heel and foot pain, insoles and footwear.

Self-help and living well

During a flare

  • Contact your rheumatology helpline. A steroid injection or treatment change may help
  • Rest sore joints, but keep gently moving them
  • Try cold packs on hot, swollen joints, or warmth for stiffness
  • Wear cushioned, supportive shoes if your heels or feet are sore
  • Do less, and ask for help

Day to day

  • Try low-impact exercise such as swimming, walking, cycling or yoga
  • If you are overweight, losing weight can ease symptoms and help treatment work
  • If you smoke, try to stop
  • Keep alcohol low, especially on methotrexate or leflunomide
  • Pace your activity to manage tiredness
  • Look after your sleep and mood. Living with skin and joint symptoms can be hard

PsA is linked to a higher risk of heart disease. Ask your GP to check your blood pressure, cholesterol and blood sugar regularly. NHS talking therapies can help with anxiety and low mood, and in England you can refer yourself.

Getting the best treatment

Keep a joint, skin and flare diary

Note which joints, heels or fingers are painful or swollen, how long you are stiff in the morning, your tiredness and any skin changes. Take photos of swollen fingers, toes or joints and of your skin and nails. Flares often settle before an appointment, so photos are useful evidence.

Questions to ask

  • At your GP: I have psoriasis and joint pain. Could this be psoriatic arthritis, and can you refer me to rheumatology?
  • Can my skin and joints be treated with the same medicine?
  • How long should I give this treatment before we decide if it works?
  • Am I eligible for a biologic or targeted tablet yet?
  • Is there a rheumatology advice line I can call during a flare?
  • Can I see a physiotherapist, occupational therapist or podiatrist?
  • What should I do if I get a red, painful eye?

If you feel your symptoms are being missed, ask to see another GP, and ask for a second opinion if you need one. In many areas you can refer yourself to NHS physiotherapy.

Psoriatic arthritis and work

PsA can count as a disability under the Equality Act 2010 (the Disability Discrimination Act in Northern Ireland) if it has a substantial, more than minor, effect on your daily life and has lasted, or is likely to last, at least 12 months. Conditions that come and go can count, and the law looks at how you would be without treatment.

If it does, and your employer knows or should know about it, they must make reasonable adjustments. These might include:

  • Flexible start times for morning stiffness
  • Working from home when needed
  • Time off for appointments
  • A supportive, adjustable chair
  • A sit-stand desk
  • An ergonomic keyboard and mouse
  • Voice recognition software
  • A footrest or anti-fatigue mat
  • Changes to uniform or footwear rules
  • Regular breaks to manage tiredness

Access to Work is a government grant that can pay for equipment, travel to work and support. For advice on your rights, contact Acas or Citizens Advice.

Benefits

If you can't work for a while, you may get Statutory Sick Pay from your employer. Depending on how PsA affects you, you may also be able to get Personal Independence Payment (PIP), or Adult Disability Payment in Scotland, Universal Credit or Employment and Support Allowance. Turn2us and Citizens Advice can help you check.

How The Beyond Pain Foundation can help

If NHS waits are too long, or the help you need isn't available to you on the NHS, we may be able to fund:

  • A private consultation with a rheumatologist, if you are facing a long wait for diagnosis
  • A course of private physiotherapy, hydrotherapy or podiatry
  • Custom insoles or supportive footwear for heel and foot pain
  • Splints and daily living aids
  • Workplace or home equipment, such as an ergonomic keyboard, voice software, a supportive chair or a sit-stand desk

We don't pay for everyday living costs, and we can't pay for ongoing medicines such as biologics. We fund treatment from registered or qualified practitioners. Prices vary, so always get a written quote to include with your application.

Apply for funding Check the requirements

Support and sources

Psoriasis UK

Charity for people with psoriasis

Information on psoriasis and psoriatic arthritis. Phone 01604 251 620, or email mail@psoriasisuk.org.uk.

psoriasisuk.org.uk

Arthritis UK

Charity, formerly Versus Arthritis

Free helpline 0800 5200 520, Monday to Friday, 9am to 6pm.

arthritis-uk.org
Sources for this guide

Last reviewed: October 2026.