It’s possible to develop psoriatic arthritis (PsA) without psoriasis, a related chronic (long-lasting) skin condition that usually develops first.
It’s uncommon to experience joint symptoms of psoriatic arthritis before having the skin symptoms of psoriasis. Here’s a breakdown of how the conditions may occur with or without each other:
- PsA without or before psoriasis: The joint symptoms appear without skin symptoms 17% of the time, or in about 1 in 6 cases. This is more common among children with psoriatic arthritis.
- Psoriasis with PsA: About 15% of people develop skin and joint symptoms at the same time.
- Psoriasis before PsA: People have psoriasis symptoms first 68% of the time.
Psoriatic arthritis occurs when your immune system mistakenly attacks healthy tissues in your joints and entheses, the areas where ligaments and tendons (supportive cords) meet bone.
Symptoms of PsA without skin-related symptoms may include:
- Joint pain: PsA may cause pain and swelling in one or more joints, usually worse in the morning or at night. PsA can also affect joints in your spine, leading to back pain and stiffness.
- Fatigue: You may not have the energy or motivation for regular tasks.
- Tenderness: Tenderness or soreness is common where ligaments, tendons, and bones join, such as on the soles or backs of your feet.
- Swollen fingers or toes: Some people develop severe swelling in an entire finger or toe, giving it a sausage-like appearance.
- Nail symptoms: PsA can severely impact finger and toenails, causing pitting (tiny dents on your nails), crumbling, and splitting from the nail bed.
- Eye inflammation: PsA can also cause uveitis, or swelling in the eye. You may experience pain, blurriness, and redness in the whites of your eyes. It may cause permanent vision loss if you don’t treat it.
- Inflammatory bowel disease: If inflammation spreads to your intestines, it can lead to inflammatory bowel disease (IBD). Common signs include diarrhea, stomach pain, nausea, and unexplained weight loss.
Psoriatic arthritis can be challenging to detect when the arthritis swelling and joint pain happen without the skin symptoms of psoriasis. It can look and feel a lot like rheumatoid arthritis, another arthritis that occurs when the immune system attacks joint tissues. Often, diagnosis involves distinguishing between these diseases.
There’s no specific test for PsA, so a healthcare provider may use several kinds of exams, including:
- Medical history: Healthcare providers will talk to you about your symptoms, medications, and medical history. Since genes you inherit raise your chances of developing it, they’ll also ask about any family history of PsA or other types of arthritis.
- Physical exam: Healthcare providers can assess your physical signs of PsA. If you don’t have psoriasis, they may look for joint swelling, tenderness, and pain, as well as nail symptoms.
- Blood tests: Your healthcare provider may run tests that help confirm or exclude other causes of your symptoms. These include tests that look for rheumatoid factor, anti-CCP antibodies, and the HLA-B27 gene.
- Imaging: Your healthcare provider may want an X-ray, magnetic resonance imaging (MRI) scan, or ultrasound of your affected joints. These let them assess the level of damage and inflammation.
PsA is a chronic disease that often gets worse over time, and there’s no cure yet. Management strategies may help reduce pain and other symptoms, slow disease progression, and prevent complications such as joint deformity.
Options for managing psoriatic arthritis may include:
- Ice or heat therapy: Icing or warming your joint may help reduce swelling and ease pain and stiffness.
- Exercise: Your healthcare provider may recommend regular, gentle exercise, such as walking, water aerobics, yoga, or tai chi, when you aren’t having flare-ups.
- Over-the-counter (OTC) medications: Advil (ibuprofen) or Tylenol (acetaminophen) may help temporarily relieve pain and reduce swelling. Topical (applied to the skin) medications such as Voltaren (diclofenac), which comes in gel, cream, and patch forms, may also help.
- Prescription medications: If at-home methods and OTC medications aren’t effective enough, your healthcare provider may prescribe medication such as corticosteroid injections, disease-modifying antirheumatic drugs (DMARDs), or biologics.
- Physical therapy: This involves working with a physical therapist to restore your joint function and range of motion. The therapist may teach you exercises in their clinic or office that you can also do at home.
- Assistive devices: An occupational therapist (a specialist who can help you adapt to or accommodate your condition) may recommend specialized devices to ease strain on your joints and help you perform tasks. Examples include jar openers, tub railings, and canes.
- Manage stress: Stress can worsen PsA symptoms and increase muscle tension, which can trigger flare-ups. Lean into ways to promote relaxation.
- Surgery: In cases that don’t improve with other treatments, healthcare providers may consider surgery to replace or fuse a joint to increase stability.
People with psoriatic arthritis (PsA) usually have psoriasis symptoms, such as patches of scaly, itchy skin, before their joint symptoms appear. Sometimes, though, PsA symptoms start first. These symptoms may resemble other types of arthritis, but a healthcare provider can help make a proper diagnosis.
