Psoriatic Arthritis Explained

Released June 23, 2026 

PODCAST OPEN: Thank you for tuning in to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. You may have arthritis, but arthritis doesn’t have you. Here, you’ll get information, insights and tips you can trust — featuring volunteer hosts and guest experts who live with arthritis every day and have experience with the challenges it can bring. Their unique perspectives may help you — wherever you are in your arthritis journey. The Arthritis Foundation is committed to helping you live your best life through our wide-ranging programs, resources and services. Our podcast is made possible in part by the generous financial contributions of people like you. (MUSIC BRIDGE) This episode of the Live Yes! With Arthritis podcast is brought to you in part by Amgen, by Bristol Myers Squibb and by Johnson & Johnson. 

Julie Eller Olsen: Hi everyone and welcome to the Live Yes! With Arthritis podcast. My name is Julie Eller Olson, and I'm your host for this episode. As you may know, I was diagnosed with juvenile idiopathic arthritis when I was a kid, around 7 years old, and I've lived with arthritis for most of my life. Today I'm mostly in remission, still experiencing some symptoms, but loving and enjoying volunteering with the Arthritis Foundation. You may remember me from my time as a staff person at the very beginning of this podcast. Since then, I went to Harvard, I got my master's in public health, and I have really focused my career on access to care. 

In today's episode, we're talking about PsA, or psoriatic arthritis. Psoriatic arthritis is a chronic autoimmune disease that often comes with the skin condition psoriasis, which is also an autoimmune disease. Psoriatic arthritis is just one of more than 100 types of arthritis, which all told affect nearly 60 million people in the U.S. Today, we're going to explore and explain psoriatic arthritis, what causes it, how does it affect joints and other parts of the body, how is it treated, and what you can do to help manage it and more. 

To help us, I'm joined by Dr. Phillip Mease, who is a director of rheumatology and research at the Swedish Medical Center at Providence St. Joseph's Health and Clinical Professor at the University of Washington School of Medicine. His clinical practice is based in Seattle. He is considered an international key opinion leader, researcher, educator and clinician. He is a Master of the American College of Rheumatology. He's also a co-chair of the PsA Task Force of the National Psoriasis Foundation, which in 2019 awarded him a lifetime achievement award for his work in advancing the field of PsA. Dr. Mease, welcome to the podcast. 

Dr. Philip Mease: Thank you very much, Julie, for having me. I'm excited to be with you. 

Julie Eller Olsen: We're so excited to have you here. Your background speaks for itself, but we'd love to hear about your experiences with psoriatic arthritis and treating the condition over the course of your career. 

Dr. Philip Mease: I entered rheumatology practice in 1982. That dates me, unfortunately, but there we go. When I was a fellow at the University of Washington, we were still having weekly clinics for the administration of gold for the treatment of rheumatoid arthritis and psoriatic arthritis. We were just beginning to use the drug methotrexate at that time, which we had borrowed from dermatologists, who were using it to treat psoriasis. As we got into the late '90s, early 2000s, I had the opportunity to test many of the biologics that we now use routinely for rheumatoid arthritis and psoriatic arthritis as well as axial spondyloarthritis.  

We formed an international group of dermatologists and rheumatologists, coming together to educate and do research on psoriasis and psoriatic arthritis. So, it's been a wonderful journey. We've seen many drugs that are quite effective for both skin and musculoskeletal aspects being developed. The other thing I would say is that I've grown old with many patients. I have seen some of my patients for 30 years, 40 years… And it's not only gratifying to be able to bring to them effective treatments. But emotionally, it's been just so enriching to be with someone over the years and watch them evolve and mature as adults and coping with their disease over time. And thankfully for many of them, we can now get them into a state of low disease activity or remission and get back to a more normal life. I can't tell you how rewarding it's been with this career. 

Julie Eller Olsen: That's so special to hear. As someone who's grown up with arthritis and grown up with rheumatologists, it's so special to think about the reciprocal nature of that relationship. And knowing that, as much as we come to your office to look for answers and to hopefully find adjustments that make our lives a little bit easier, you are also there guiding us through that process. And just thinking about those milestones and being a beneficiary of them myself, I am so grateful for rheumatologists like you who are leading the charge in that way. And helping usher in those new eras for patients. 

Dr. Philip Mease: I might add, Julie, that we're entering into another new era. We're ushering in something called cell therapy, where we take patients' own immune cells, do a genetic engineering thing and then reinfuse them. One of these is called CAR T-cell therapy. And one of the things that we're excited about is the idea of resetting the immune system in a way that we can try to get rid of disease, and the person doesn't have to keep taking these medicines all the time. I think that that's the next really cool wave that we're venturing into now. 

Julie Eller Olsen: It really feels like the age and era of cures is truly at our fingertips. We're getting to this point where patients might really see a turning point, where they might have this disease but have a correction in their genetics and their ability to process that really changes their life. So, it's so exciting to think about. And I thank you so much for the work that you're doing. I want to bring us back to the focus of our conversation today, which is a PSA on PsA. (laughs) Tell us about what psoriatic arthritis is exactly. 

Dr. Philip Mease: Psoriatic arthritis is a chronic autoimmune disease which occurs primarily in people that have the skin condition psoriasis. In the great majority of patients with PsA, the psoriasis appearance precedes the development of PsA, sometimes by as long as 10 years, treating it either topically with creams or systemically with biologic medications. And then the person starts to develop manifestations of an inflammatory arthritis. Some unique features besides swollen and tender joints include the possibility that inflammation may occur where tendons or ligaments insert into bone, say at the Achilles tendon and the heel or the plantar fascia or around the knee, and this can be as disabling as the arthritis. The other type manifestations include, of course, psoriasis, disease of the nails, and then sometimes associated conditions like inflammatory bowel disease or uveitis may occur. About a quarter of patients with psoriatic arthritis may develop immunologic inflammatory spine disease. 

Psoriasis occurs in about 3% of the U.S. population, and psoriatic arthritis typically occurs in about 30% of people with psoriasis. So, as long as a person with psoriasis knows the possibility that PsA may be around the corner, they can know to bring to their physician's attention if they start to develop some of these signs and symptoms like swollen and tender joints or back pain or ligament or tendon pain. There are highly effective treatments for it, so we can try to really squinch it down early before it has a chance to create damage in joints. 

Julie Eller Olsen: I think that's such an important point that you hit on. Every episode that we have is a question on social media for folks. And our question for this episode was: What was one thing you really wish you knew about psoriatic arthritis before or at your diagnosis? And one of our commenters, Lindsay Lewis, she said that she wished that she knew that PsA is more than just joints and to watch out for other issues like eye inflammation, like that uveitis you mentioned. She said that she waited too long to see a doctor the first time she got uveitis because she just didn't understand what was happening to her eye. And I think that's such an important factor, right? How much early education do you have, so that you can have an early intervention in your care? 

PROMO: Arthritis Foundation Connect Groups provide a safe space for people to share their experiences with different forms of arthritis. These virtual and in-person support groups foster connections based on shared interests — allowing participants to support one another in the challenges they face while enhancing their sense of community and understanding. Find your group at connectgroups.arthritis.org. 

Julie Eller Olsen: It helps to get a sense of how psoriatic arthritis affects different parts of your body, your joints and your skin and your organs. But can you talk about some of the key symptoms that folks might see at the very onset of their disease and potentially other comorbidities they might experience later on? 

Dr. Philip Mease: If arthritis occurs in a relatively young person, say a man or woman in her 20s, 30s, early 40s, before we expect osteoarthritis or degenerative arthritis to begin to be symptomatic, that's a key feature. Joint pain often in the fingers, wrist, but really anywhere in the body it can occur, including shoulders, hips, knees and so on. It often appears just with a handful of joints initially, so one to five joints, and we call that oligoarticular disease, when that just happens here and there as opposed to rheumatoid, which tends to come on all at once in multiple joints. And the other feature is asymmetry. So, in rheumatoid, if one wrist is involved, it's common for the other wrist to be involved. But PsA is different; it tends to be asymmetric in character. 

Back to the tendon and ligament issue: It's so common to have inflammation right where that gristle connects to bone. The person thinks, "Boy, did I overdo it with yard work or tennis?" But then it persists. And so, these are warning signs. The back is another issue where spine pain, especially spine pain that gets worse with rest and better with activity or may awaken the person in the middle of the night, these are things to go, "Aha, maybe this is what they were talking about when they talked about psoriatic arthritis." 

Julie Eller Olsen: I often think about folks who do rheumatology care as sort of detectives. You're canvassing all different parts of lifestyle and trying to figure out which triggers are here and thinking about the whole person and the whole body. So much of healthcare is really specialized. Let me go and look at one doctor for my Achilles pain and one doctor for my uveitis and one doctor for my psoriasis and so on and so on. How do you always put together that full picture for patients? And what are some of the things people should start to think about when they're considering maybe some of the aches and pains that might bring them to your office? 

Dr. Philip Mease: A metaphor that I often use with people is to say, "Think of your body like an orchestra." I'm a cellist, by the way, so that's one of the reasons this metaphor comes to mind. 

Julie Eller Olsen: Perfect. 

Dr. Philip Mease: It could well be that every single domain that we've been talking about — joints, enthesitis, skin disease, back pain — is all happening at once. So, the full orchestra is playing fortissimo, and you want to calm that down. But it could be that at certain times just the piccolo section is playing, or just the cello section, in which case your joints are under control, your spine is under control, but darn, that heel pain is just really making it hard. By asking the questions of the patient, by examining each of these clinical domains, these are the ways in which our patients come to learn, "I should be looking for signs of whether I'm in good control or not in good control." 

So, less likelihood of destructive joint changes occurring if we have good control of the disease, better overall physical function, better ability to do work, better ability to do things with your family, less likelihood of getting depressed about and really despondent about your situation, meaning better quality of life. Fatigue often comes along with inflammation. And so sometimes when I ask about fatigue, the person goes, "Wow, I never associated being tired and hitting 4:00 and just, that's it. I'm spent." Not thinking that that's related to having an inflammatory condition, but it is. 

Julie Eller Olsen: Right. Thinking about your body like an orchestra is a really helpful visual, and sometimes, maybe treatment options or even doctors and diagnosis options, maybe those are the songs that you're playing. Tell me a little bit about one, how to find the right doctor for your care, and two, how to find the right treatment for your care. Can you give us a little bit more insight there? 

Dr. Philip Mease: One of the things that's key is, of course, getting to a rheumatologist in the first place. One of our efforts has been to educate dermatologists, but also primary care physicians, orthopedists, physiatrists, others that are involved with the care of patients with painful musculoskeletal conditions, and just having the thought trigger in their mind. Most rheumatologists are pretty darn knowledgeable about psoriatic arthritis and its management. That first step of getting into the rheumatologist office is critical. A part of the rich experience of taking care of a person with psoriatic arthritis has to do with not only addressing signs and symptoms, but talking through the emotional impact, the physical impact of having the disease, and just listening and being supportive can be huge for the patient. 

One of the research studies that we did a number of years ago, what we learned was that, of course, pain is a key issue in psoriatic arthritis, physical function is a key issue, the appearance of the skin and embarrassment around that. The patients had a sense of vulnerability, not knowing when a flare was going to occur. Were their medicines going to be able to adequately treat the flare? Were they going to continue to have insurance to cover the treatments that are effective for them? Were there going to be side effects of treatments? And is my physician going to retire, the one that I've come to trust and love? And this underlying sense of uncertainty or vulnerability was right there on the surface. And so, that's something that I find myself exploring more with patients. 

There's certain comorbidities that are genetically imprinted in people with psoriasis and psoriatic arthritis. One of them is being overweight or obese, and despite their efforts with diet and exercise, they just can't get down to what they consider to be a more normal weight. And we've come to learn that obesity is an inflammatory condition unto itself. Another issue is some patients with PsA have fibromyalgia as a comorbidity, a central pain condition, so identifying that and effectively treating it. I'm proud to say that most rheumatologists are really on top of it. A good working relationship with a rheumatologist is really key. 

Julie Eller Olsen: And it's hard sometimes to get into your rheumatologist at first. Sometimes there are long wait times to get an appointment, and it can feel like you're having a symptom today, but you have to wait three, four, five, six months sometimes to see the rheumatologist. Just keep a journal of: I'm calling the rheumatologist today, it's May, I might not see them until September, but I want to make sure that when I go, I talk about this pain that I'm experiencing in my left wrist, which is significant, so that come that appointment, if that pain has changed or has shifted to a different part of my body, I don't forget to share that part of the picture. I think it's a really important thing to think about: how you build that relationship over time when there are intervals of time between your appointments with your provider. 

Dr. Philip Mease: One other thing on the issue of access: nurse practitioners and physician assistants. Huge. I work with three: two nurse practitioners and one PA. They're terrific. I trust them completely with the full spectrum of care. I think one of the ways in which rheumatology will become more accessible to more people will be bringing advanced practice practitioners, as they're called, more into the rheumatology workforce. 

Julie Eller Olsen: To hear how your care team really helps to support patients is such an important lesson, I think, for today's listeners. I appreciate that quite a bit. I think the most kind of telling part of what you had just shared was that total experience of disease, where it's not just the individual joint swelling or the skin issue, but the anxiety of living with a disease like psoriatic arthritis, and whether your care is going to be effective, and will your rheumatologist retire, and all of the unknowns that go with it. Connect Groups can be really helpful for people because they can share in that experience and hear from others coping mechanisms that they might have and so on. How have you worked with the Arthritis Foundation in the past, or how have you seen programs from the Arthritis Foundation benefit your patients? 

Dr. Philip Mease: I have had wonderful working relationships with, especially the local chapter of the Arthritis Foundation, and then participating in a variety of programs at a national level. Being able to speak with a fellow patient is really important. Having a person to share that with is really valuable. 

Julie Eller Olsen: I think so often about my big sisters in arthritis and how they have made it so much easier for me to go through different chapters of my condition and my care. So many of the folks who reached out and shared some comments with us on social media had shared things like, "I didn't realize that my chronic physical pain could affect nearly every part of my mental and emotional health and that it was OK to need to reprioritize different things and change what feels realistic to you." And others said that they didn't know how disruptive that this condition could be and that you never know when a flare is going to hit you and when your plans for the day are shot. And I think all those folks who are talking to us at the Foundation, when they talk to each other, they can have so much power in the shared experience they have, and the understanding of someone who not only listens to them and can hear about their condition, but really deeply empathize and understand and give them tips for how they're navigating all of the different circumstances that they are dealt. Sometimes it's just as important as the actual treatments that you have are the people who are in your corner. 

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(MUSIC SEGUE) Special recognition in this episode goes to Johnson & Johnson and their Psoriasiblings campaign. To learn more, please visit psoriasiblings.com. 

Julie Eller Olsen: I do want to segue a little bit and talk about two different things. One, I want to hear about how psoriatic arthritis is treated and if it's treated differently than other rheumatology conditions. And also, are there particular populations that are experiencing psoriatic arthritis differently, and what treatments might exist for them as well? 

Dr. Philip Mease: We're now blessed with a number of different types of treatments, the majority of which are what we call biologic medications. For example, there's this so-called TNF inhibitor class, which includes five different medications. And all of these medications have to be given as a subcutaneous injection or an infusion, because they are large proteins that would be broken down in the stomach by stomach enzymes if they were given orally. Some people sort of, when they're first getting into treatment, will balk at the idea: "This sounds pretty dramatic to me to inject myself or to get an IV infusion every once in a while." But once they start doing it, and they start feeling some of the benefits, oftentimes this anxiety will quiet down. Another key treatment is what are called interleukin-17 inhibitors, which come in two forms. There's some oral medications. 

With most of these, we are able to, at least for a period of time, get a patient into a state of what we call low disease activity or remission, low disease being just barely any disease activity going on. And as long as this can be the case, that's really great. With time, most of them will eventually wear off in being effective, unfortunately. So, we have to either change within the class, or we have to switch to a different mechanism, and that's one of the reasons why it's very helpful to have multiple medications that can be effective. Most of the time we use these singly or maybe in combination with methotrexate to boost their efficacy a bit. And looking into the future, we have more of these agents coming along. And then in the further future, we may see cell therapy being developed. That's just a quick overview of some of the treatment approaches. 

Julie Eller Olsen: I think it's incredible. And to think about the medicine cabinet that you've filled over the course of your career, with so many different options, it's really helpful to patients to have so many different treatments available to them. And even more exciting to think about things like that CAR-T study that you mentioned. Potentially, some of these cell therapies might be a lifetime cure. I do want to ask about psoriatic arthritis and how it affects the skin and how it affects different skin tones for different populations. 

Dr. Philip Mease: Sure. In patients with darker skin tones, it is sometimes difficult to A) diagnose psoriasis, and B) really see how effectively treatments are occurring for it. One of the things that is interesting is that we don't see quite as much psoriasis or psoriatic arthritis in an African population, which presumably is related to differences in genetic backgrounds of the patients. But in a majority of the rest of the world, we tend to see similar proportions of the population having psoriasis. One exception to that is the Caucasian population in Japan, which has a little bit less psoriasis. Again, these are genetic factors that can determine that. But it is a worldwide disease, and we're hopefully, as biologics become biosimilar or some of the newer oral medications have generics, we're going to see some of the cost coming down and being more accessible to people in many parts of the world. 

Julie Eller Olsen: It's incredible to think about how you can really take a global view of a disease like this and think about and see different patterns in different communities. For folks of any skin tone, are there certain precautions that should be taken to protect the skin while psoriasis is present with PsA? 

Dr. Philip Mease: One interesting biologic feature of psoriasis is something called the Koebner phenomenon, and that is, if you have a physical injury to some part of the skin, then a psoriasis lesion may develop in that area. So, just protecting from blunt trauma would be an example of that. You know how with lupus patients we advise them to stay out of sunlight? Actually, it's the opposite with psoriasis. Sunlight can actually help the disease of psoriasis. I'm not claiming that it can help psoriatic arthritis, which is more interior. In the old days, before we had methotrexate and other treatments, the biologics, people would come into these centers where they would be in these light booths and get light treatment for their psoriasis. Some of the new treatments that we have are so safe and so effective that it's not necessary to travel in and have light therapy. 

Julie Eller Olsen: Well, I do think that sunlight for anybody is really good for your mental health. Let's dive in a little bit more deeply on just what someone with PsA or psoriasis can do to manage their care, manage their condition, lifestyle interventions and so on. 

Dr. Philip Mease: One thing we strongly recommend is being able to get exercise, physical exercise, whether it's jogging, if you don't have significant lower extremity enthesitis or arthritis, or swimming. Swimming is ideal because you use all of your muscles and not in a weight-bearing form, and Pilates or yoga. These are all things that I think are important to move your body, to keep muscle tone strong. Getting good quality sleep is very important. Of course, diet and weight reduction are important, having a balanced diet. And then stress reduction. These are all things that I think can contribute to overall bettering of the underlying condition. 

Julie Eller Olsen: I think that that covers so much of what is most important for our patients to hear. The experience of finding an incredible rheumatologist and really developing a relationship with someone over time, identifying some of those lifestyle factors, finding community, finding a treatment that works for you, titrating it over time. 

PROMO: A gift to the Arthritis Foundation helps fund vital research aimed at finding new treatments and conquering arthritis. Your contribution also supports education, resources and community events for those affected by this complex condition. Every donation plays a crucial role in improving the quality of life for millions of adults and children in the U.S. Donate today at arthritis.org/donate. 

Julie Eller Olsen: You've really done an incredible job, Dr. Mease, of creating and telling us the narrative around PsA and how we can live our best lives with arthritis. Are there any top takeaways you want to really hit home on before we wrap up today? 

Dr. Philip Mease: Well, just, it takes a village to be part of the care structure for a person with psoriatic arthritis. The patient is at the center, but they're all, you know… supportive family, supportive friends, rheumatologist, dermatologist, having the dermatologist and rheumatologist be able to speak to each other readily as treatment decisions are being made, physical therapist, psychologist, someone who may help with dietary counseling. Another key takeaway is for people with psoriasis to remember that PsA is present in about 30% of people with psoriasis. And so, be on the lookout for musculoskeletal manifestations that may represent the disease waking up and starting to be active, and then tailoring treatment with your dermatology and rheumatology team. 

Another key takeaway is there's a lot of times when people are very afraid about use of immune-moderating medications. Try to balance the overall benefits of being on a medicine to control inflammation and all the good outcomes that can come from that, not only in physical function and current quality of life, but down-the-road issues like early cardiovascular morbidity in people with chronic inflammation. The benefits, I think, really outweigh the potential safety issues. And then, of course, to be sure that your practitioners are taking care of all of you, the way in which the disease is impacting you emotionally. How are you handling it? What are you feeling afraid about or uncertain about? Is there any way that I can help you by addressing some of those uncertainties and concerns and feelings of vulnerability? Those are the key takeaways I would leave you with. 

Julie Eller Olsen: Oh, Dr. Mease, thank you so much. They're incredible takeaways, and we appreciate your time so much. Thank you for joining us. And for our listeners, thanks for tuning in. For more arthritis resources, including information about psoriatic arthritis and psoriasis, please visit the Arthritis Foundation website at arthritis.org. And send any questions, comments and thoughts to [email protected]. We'll see you next time. Thanks again. 

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