Psoriatic Arthritis

Joint pain and swelling with prolonged morning stiffness, often asymmetrical. Swelling of a whole finger or toe — dactylitis — is characteristic. Pain at tendon insertions, particularly the heel. Nail pitting or separation. Inflammatory back pain in some patients.

The skin psoriasis can be minimal, hidden in the scalp or behind the ears, or can appear years after the joints. Absence of obvious psoriasis is a common reason for delay.

Joint damage can start early: in a cohort of 283 people with psoriatic arthritis, those first seen by a rheumatologist more than six months after symptoms began were more likely to have peripheral joint erosions and worse long-term physical function 2.

This is the single most important thing on this page: if the pattern described above fits you, ask for a rheumatology assessment rather than treating it as mechanical pain.

Maintaining range and strength, joint protection technique, managing enthesitis with graded loading rather than rest, and cardiovascular exercise — cardiovascular risk is raised in psoriatic arthritis and exercise addresses it directly.

Where the spine is involved, the exercise programme resembles that used in axial spondyloarthritis and is a core treatment rather than an adjunct.

Disease activity varies, and a programme has to flex with it. During a flare, load is reduced and range work maintained; between flares, strengthening progresses.

Fatigue is a genuine feature of inflammatory disease and is frequently underestimated. Pacing is part of the plan rather than a sign of poor motivation.

Involvement of the joints at the ends of the fingers, swelling of an entire digit, pain where tendons attach to bone, and spinal involvement. Skin and nail changes may be minor or precede the arthritis by years.

These differences matter because treatment choices differ and because a patient with mild psoriasis and joint pain is frequently assessed without anyone asking about the skin.

European recommendations treat physical activity as an integral part of standard care throughout the course of inflammatory arthritis, including the spondyloarthritis group to which psoriatic arthritis belongs 3. The general public-health targets apply: at least 150 minutes of moderate aerobic activity a week, muscle strengthening on at least two days, and flexibility and balance work, adapted to the joints involved 4. Activity below those levels can still help people who cannot reach them 4.

In 49 trials across inflammatory arthritis and osteoarthritis, aerobic and strength training produced moderate gains in fitness and strength, and none found detrimental effects such as increased disease activity, though a few reported transient increases in pain 4. What exercise cannot do is switch off the inflammation that erodes joints. That is the role of disease-modifying medication, which European guidance recommends starting rapidly in peripheral arthritis 5.