Can You Have Psoriatic Arthritis Without Having Psoriasis?
Yes, you can have psoriatic arthritis (PsA) without having psoriasis. PsA is an inflammatory form of arthritis, while psoriasis is an immune system disorder that primarily affects the skin. It’s entirely possible to have one condition without the other. While PsA and psoriasis may sound similar, they are distinct health conditions. They do share some genetic traits, but the exact link between them is not fully understood.
In this article, we’ll explore the differences and similarities between these two conditions, as well as how they are diagnosed and treated.
PsA Without Psoriasis
Although it’s uncommon, you can have PsA even if you don’t have psoriasis. Typically, psoriasis will develop before or at the same time as PsA.
A 2017 study found that only 14.8% of participants were diagnosed with PsA before developing psoriasis.
Conversely, you can have psoriasis without developing PsA. According to the National Psoriasis Foundation, about 30% of people with psoriasis also have PsA.
If you have psoriasis and later develop PsA, you will usually receive a PsA diagnosis within approximately 15 years.
The reasons why only some people with psoriasis develop PsA remain unclear.
What Are the Symptoms of PsA and Psoriasis?
Psoriatic arthritis (PsA) causes stiffness, pain, and swelling around the joints. Symptoms of PsA can vary greatly between individuals, but often include:
- Swelling in the fingers or toes
- Throbbing, stiffness, swelling, and soreness in the joints
- Pain
- Inflamed areas of skin
- Fatigue
- Changes to the nails, such as pitting or separation from the nail bed
- Inflammation of the eyes
Psoriasis primarily affects the skin and can also impact the nails. Key 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 note that the appearance of psoriasis patches can vary across different skin tones. On lighter skin tones, psoriasis usually manifests 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 may appear violet with gray scales, or it can also be dark brown and less noticeable.
Risk Factors for Psoriatic Arthritis (PsA)
You are at an increased risk for developing PsA if you have psoriasis. Up to 30% of individuals with psoriasis may eventually develop PsA. Severe psoriasis and obesity are also linked to a higher likelihood of developing PsA. A family history of the condition further increases your risk; around 40% of people with PsA have a family member with either psoriasis or arthritis. Age is another factor, as PsA is most likely to develop in individuals between the ages of 30 and 50.
Diagnosing PsA
Currently, there is no single test that can confirm PsA. Your doctor will likely ask about your family medical history and conduct a physical examination. They may examine your joints and fingernails, as well as look for skin changes associated with psoriasis. Imaging tests such as X-rays and MRI scans may be requested to check for joint changes and to rule out other causes of joint pain.
In addition, healthcare professionals may order laboratory tests, such as the rheumatoid factor test or the cyclic citrullinated peptide test, to help rule out rheumatoid arthritis. Your doctor may also take a sample of fluid from a joint, such as the knee, to exclude conditions like gout.
Treating Psoriatic Arthritis (PsA)
Currently, there is no cure for PsA. Therefore, your doctor will focus on preventing disease progression and managing your symptoms. Treatment plans are tailored to the severity of your condition, and your doctor may prescribe multiple medications to find the most effective one for you.
Common medications used to treat PsA include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): For mild cases, ibuprofen (Advil, Motrin) or naproxen sodium (Aleve) are often recommended.
- Disease-modifying antirheumatic drugs (DMARDs): Medications such as methotrexate (Trexall), sulfasalazine (Azulfidine), and leflunomide (Arava) can reduce inflammation by suppressing the immune system.
- Tumor necrosis factor (TNF)-alpha inhibitors: Etanercept (Enbrel), golimumab (Simponi), adalimumab (Humira), and infliximab (Inflectra, Remicade) block TNF, a substance that causes inflammation.
- IL-17 inhibitors: Secukinumab (Cosentyx) and ixekizumab (Taltz) may be used for severe psoriasis or if TNF inhibitors are ineffective or unsuitable.
- Janus kinase (JAK) inhibitors: Tofacitinib (Xeljanz) and upadacitinib (Rinvoq) can be effective when other medications do not work.
Why Is Early Treatment Important?
Untreated PsA can cause permanent joint damage, leading to significant loss of joint function in severe cases. Early recognition and treatment are crucial for maintaining overall health.
Additionally, having PsA increases the risk of other conditions, including:
- Obesity
- Heart disease
- High blood pressure
- Diabetes
- Depression
Regular checkups with your doctor are essential if you have PsA. Your doctor can monitor your weight and screen for conditions like high blood pressure or diabetes. Early screening and diagnosis can facilitate prompt treatment for any additional health issues that may arise.