It is possible to have psoriatic arthritis (PsA) without psoriasis, although this is uncommon. PsA is a chronic inflammatory autoimmune disease affecting the synovial joints and other connective tissues.
Doctors diagnose this condition in around 30% of people with psoriasis. The symptoms of PsA include pain, swelling, and stiffness in joints. People with PsA can feel fatigued and experience depression or anxiety due to their difficulty carrying out daily tasks and work duties, and the inflammation process itself.
There is some overlap between psoriasis and PsA. However, not everyone with psoriasis will develop PsA.
Keep reading to learn more about PsA without psoriasis, symptoms of both conditions, risk factors, treatment, and more.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
PsA and psoriasis are both chronic conditions, meaning they affect people long term, producing persistent symptoms that may come and go over time.
PsA is an inflammatory condition affecting the joints and the sites where tendons and ligaments attach to bone.
Conversely, psoriasis is an immune-mediated skin condition that has no apparent cause. The main component of psoriasis is inflammation due to an immune system irregularity. People with psoriasis may notice visible signs of inflammation, including raised plaques and scales on the skin.
The symptoms appear because the immune system is overactive and speeds up skin cell growth. Instead of natural shedding, the skin cells in people with psoriasis accumulate on the skin.
Plaques and scales characteristic of psoriasis most commonly appear on the elbows, knees, and scalp, but they can develop anywhere on the body.
Although PsA and psoriasis have some genetic similarities, scientists do not fully understand the association between the two conditions.
People can have PsA with no signs of psoriasis, but in most individuals, psoriasis precedes the arthritic symptoms.
People can also have psoriasis without PsA. In fact, only 30% of those with psoriasis have PsA. In the majority of cases, PsA appears 10 years after the development of psoriasis.
While most people with PsA have psoriasis first, some can develop psoriasis after PsA. According to the Arthritis Foundation, while people with PsA are less likely never to develop psoriasis, it is possible.
The names of the two conditions may appear similar, but they have different symptoms.
PsA can develop slowly with mild symptoms or quickly with severe symptoms. It can occur following an injury to a joint, but it can also be genetic.
Some common symptoms of PsA include:
- tenderness, pain, and swelling over tendons
- finger and toe swelling
- pain, stiffness, swelling, throbbing, and tenderness in one or more joints
- morning tiredness and stiffness
- decreased range of motion
- nail changes, including pitting and separation from the nail bed
- eye pain and redness
Symptoms of psoriasis depend on the type of the condition, severity, and location on the body.
- patches of thick, darkened skin, with scales that burn or itch
- thick pitted, ridged nails
- dry, cracked skin that bleeds or itches
People with psoriasis experience flares, during which symptoms worsen, as well as periods of remission, when symptoms go away or ease off.
Factors that can aggravate psoriasis include infections, dry skin, stress, and certain medicines.
The National Psoriasis Foundation (NPF) states that while PsA often manifests between the ages of 30 and 50, it can develop at any age, including in childhood. The NPF also notes that the condition develops in 30% of people with psoriasis, making psoriasis a risk factor.
According to the American College of Rheumatology, the risk of developing PsA is the same for women and men.
Symptoms of psoriasis often begin between the ages of 15 and 25, but they can start occurring at any age.
Gender and skin color do not appear to affect a person’s likelihood of developing psoriasis.
However, prevalence of the condition
Other risk factors for psoriasis
There is no definitive way to diagnose PsA, and it often remains undiagnosed, especially in people with a milder form of the condition.
To rule out other potential health problems, doctors may use the following:
- a physical examination
- a person’s medical history
- MRI scans
- blood tests
They will then use family history and the results of various tests along with a process of elimination, to determine whether a person has PsA.
PsA symptoms can resemble those of gout, rheumatoid arthritis, and reactive arthritis, so a doctor needs to rule out these conditions before diagnosing PsA.
To diagnose psoriasis, doctors look at a person’s skin, nails, and scalp for signs of the condition. They may also examine a small piece of the person’s skin under the microscope to help them establish their diagnosis.
There is no cure for PsA, but a range of treatments can help stop its progression, protect joints, lessen pain, and preserve the range of motion.
Rheumatologists are doctors specializing in how the immune system affects muscles, joints, and bone. These specialists can help an individual find a suitable treatment plan for PsA.
PsA treatment options include:
- nonsteroidal anti-inflammatory drugs
- conventional disease-modifying antirheumatic drugs
The best treatment for an individual takes into account factors such as severity of the condition, and the risks of particular side effects.
Doctors can mistake psoriasis for other skin conditions, such as eczema. Therefore, if a person suspects they have a skin condition, they should contact a dermatologist, as this type of doctor is most proficient at diagnosing psoriasis.
Some treatment options for psoriasis include creams and ointments applied directly to the affected areas. Other options include UV light therapy and medication.
Diagnosing and treating PsA at an early stage can prevent or limit severe joint damage that happens as the condition progresses.
Since there is no cure for PsA, early diagnosis and treatment are the most important thing for those with PsA.
People with the condition may benefit from occupational and physical therapies, which aim at increasing flexibility, strengthening muscles, and protecting joints from further damage.
Psoriasis increases a person’s risk of developing related conditions, such as depression, cardiovascular disease, and type 2 diabetes.
It is advisable for people with PsA or psoriasis to adapt their lifestyle to reduce pain and flare-ups. This can include avoiding psoriasis triggers and diligently taking medication to prevent PsA progression.
Making other lifestyle changes, such as following a balanced diet, reducing stress, and quitting smoking, may also prove effective.
Psoriasis is an immune-mediated disease characterized by inflammation. Around 30% of people with psoriasis develop PsA, a chronic inflammatory condition affecting the joints.
However, not everyone with PsA has psoriasis. Also, in some cases, PsA develops before psoriasis.
One of the most significant PsA risk factors is having psoriasis, and the most significant risk factor for psoriasis is a family history of the condition.
There is no cure for PsA or psoriasis. Available treatment aims to reduce symptoms, lessen pain and inflammation, and prevent disease progression.
The sooner diagnosis of PsA and psoriasis occurs, the better the chance of limiting disease progression and developing related conditions.