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People with psoriasis often develop an inflammatory disease of the joints known as psoriatic arthritis. Psoriasis is a long-term autoimmune skin condition associated with red, itchy flakes usually covered with silver scales, mainly on the skin of the scalp, trunk, elbow, and knees. 30% of people with psoriasis also develop psoriatic arthritis associated with red, swollen joints, particularly of fingers and toes. The involvement of nails may also occur in the form of pitting. In 15% of people, joint disease precedes skin disease. Genetics is thought to play a role in etiology along with obesity and stress as the triggering factors.