You can have psoriatic arthritis (PsA) without psoriasis. PsA is an inflammatory form of arthritis, and psoriasis is an immune system disorder that affects your skin. It’s entirely possible to have either one without the other.
PsA and psoriasis may sound similar, but they’re different health conditions. They do share some genetic similarities, but the link between them isn’t fully understood.
In this article, we’ll talk about the differences and similarities between the two conditions and how to diagnose and treat them.
You can have PsA if you don’t have psoriasis, though it’s uncommon. Usually, psoriasis will develop before or at the same time as PsA.
A 2017 study found that only 14.8% of participants received a diagnosis of PsA before psoriasis.
You can also have psoriasis without having PsA. According to the National Psoriasis Foundation, about 30% of people with psoriasis also have PsA.
If you have psoriasis and develop PsA, you’ll usually receive the PsA diagnosis within approximately 15 years.
It’s still unclear why only some people with psoriasis also develop PsA.
PsA causes stiffness, pain, and swelling around the joints. Symptoms of PsA are often different in each person but can include:
- swelling in fingers or toes
- throbbing, stiffness, swelling, and soreness in joints
- pain
- inflamed areas of skin
- fatigue
- changes to the nails, including pitted nails or separation from the nail bed
- inflammation of the eyes
Psoriasis mainly affects the skin. It can also affect your nails. Some of the main symptoms of psoriasis include:
- raised, dry, discolored patches on the torso, elbows, and knees
- silvery, scaly plaques on the skin
- small, discolored, individual spots on the skin
- dry skin that can crack and bleed
- itchy, burning, or sore skin
- nail pitting and separation from the nail bed
It’s important to remember that the appearance of psoriasis patches can vary on different skin tones. On light skin tones, psoriasis usually appears as pink or red patches with silvery-white scales. On medium skin tones, it can appear salmon-colored with silvery-white scales. On darker skin tones, psoriasis appears violet with gray scales, or it can also appear dark brown and difficult to see.
You’re at an increased risk for PsA if you have psoriasis. Up to 30% of people with psoriasis may develop PsA.
Severe psoriasis and obesity may also be linked to a higher chance of PsA.
A family history of the condition also increases your risk. Around 40% of people with PsA have a family member with psoriasis or arthritis.
Age is another factor. PsA is most likely to develop in people between the ages of 30 and 50.
Currently, no single test can confirm PsA. Your doctor will likely ask about your family’s medical history and conduct a physical exam.
They may examine your joints and fingernails and look for skin changes associated with psoriasis. They may request X-rays and MRI scans to check for joint changes and rule out other causes of joint pain.
A healthcare professional may also order laboratory tests, like the rheumatoid factor test or the cyclic citrullinated peptide test, to help rule out the possibility of rheumatoid arthritis.
Your doctor may also take fluid from a joint, like the knee, to rule out gout.
There’s no cure for PsA at this time. Your doctor will instead focus on keeping the disease from progressing while helping you manage your symptoms.
Your treatment is based on the severity of your condition, and your doctor may prescribe several different medications to identify the most effective one for you.
Common medications used to treat PsA include the following:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): If your condition is mild, you’ll likely try ibuprofen (Advil, Motrin) or naproxen sodium (Aleve) first.
- Disease-modifying antirheumatic drugs (DMARDs): Methotrexate (Trexall), sulfasalazine (Azulfidine), and leflunomide (Arava) can reduce inflammation by suppressing your immune system.
- Tumor necrosis factor (TNF)-alpha inhibitors: Etanercept (Enbrel), golimumab (Simponi), adalimumab (Humira), and infliximab (Inflectra, Remicade) block a substance called TNF that causes inflammation.
- IL-17 inhibitors: Secukinumab (Cosentyx) and ixekizumab (Taltz) may be used for severe psoriasis or if you’re unable to take or don’t respond to a TNF inhibitor.
- Janus kinase (JAK) inhibitors: Tofacitinib (Xeljanz) or upadacitinib (Rinvoq) may help if other medications are ineffective.
Why is early treatment important?
PsA can cause permanent joint damage when left untreated. The joints may become so damaged in severe cases that they no longer function. This is why recognizing it early is important for overall health.
Having PsA also
- obesity
- heart disease
- high blood pressure
- diabetes
- depression
If you have PsA, it’s important to see your doctor for regular checkups. They can help monitor your weight and test you for conditions like high blood pressure or diabetes. Screenings can help you start treatment early if you develop any other conditions.
Here, you’ll find some answers to additional questions about PsA and psoriasis.
How common is psoriatic arthritis without psoriasis?
Doctors only diagnose PsA in about 30% of people who also have psoriasis.
What are the five types of PsA?
The five types of PsA are:
- distal interphalangeal predominant
- asymmetric oligoarticular
- symmetric polyarthritis
- spondylitis
- arthritis mutilans
Is scalp psoriasis the same as psoriatic arthritis?
Scalp psoriasis is a type of psoriasis. But having psoriasis on the scalp can actually indicate that a person may also have psoriatic arthritis.
You can have PsA even if you don’t have psoriasis. But people with psoriasis are at an increased risk for this condition.
There’s currently no cure for PsA. With early diagnosis, your doctor can treat your symptoms and slow the progression of the condition.