Can You Have Psoriatic Arthritis Without Psoriasis?

You have swollen, painful joints. It might be a sign of psoriatic arthritis. But you don’t have the telltale skin rash that signals psoriasis. Could you have one condition without the other?

“Psoriasis and psoriatic arthritis are related conditions, but they don’t always strike at the same time,” says rheumatologist Ivana Parody, MD.

Here’s what to know about psoriasis and psoriatic arthritis and how they fit together.

What is psoriatic arthritis?

Psoriatic arthritis is an autoimmune disease. It occurs when your body’s immune system attacks its own tissues. The disease causes pain and swelling in your joints and the places where tendons and ligaments attach to bones. It can develop at any age, but most people experience their first symptoms between ages 35 and 55.

So, where does the skin come into play? Psoriasis is an autoimmune disease that affects your skin. It causes red, itchy, inflamed patches of skin that can be covered with silvery scales.

Psoriasis is common on the elbows, knees and scalp but can show up just about anywhere on your body. Most people with psoriasis never get psoriatic arthritis. But about 30% of people with psoriasis do develop the disease.

Can you have psoriatic arthritis without the rash?

“It’s possible, but not very common,” says Dr. Parody. Most people develop psoriasis first. Psoriatic arthritis typically emerges about seven to 10 years later.

That’s not always the case, however. A small number of people have joint pain first, and the skin disease appears later. It’s even possible that a person with psoriatic arthritis will never have any skin symptoms. “But that doesn’t happen often. When it does, there is usually a family history of psoriasis,” Dr. Parody says.

Psoriatic arthritis symptoms: Spot the signs

Psoriatic arthritis can cause different symptoms from person to person. But there are several common symptoms:

• Psoriasis (red, itchy scaly patches on your skin) and pitting of your nails.
• Painful, swollen joints, most commonly in your hands, feet, wrists, ankles and knees.
• Reduced range of motion and stiffness in your joints, especially in the morning.
• Fatigue.
• Tenderness in ligaments and tendons, especially at your heel and sole of your foot.
• Painful swelling of an entire finger or toe, giving it a sausage-like appearance.
• Inflammation of your eye, including conjunctivitis and uveitis.
• Digestive disorders like inflammatory bowel disease.

What causes psoriatic arthritis?

Experts aren’t sure what causes psoriatic arthritis. They suspect a combination of genes and environmental factors is to blame.

How is psoriatic arthritis diagnosed?

Unfortunately, no single test can identify psoriatic arthritis. It’s usually easier for a doctor to diagnose you if you have psoriasis, as the two diseases often tag team.

Whether or not your skin is involved, your doctor will consider several factors to make a diagnosis. These include:

• Physical exam.
• Medical history.
• X-rays of affected joints.
• Blood tests (including lab tests to look for the presence of inflammation and to rule out other conditions).

Who can diagnose and treat psoriatic arthritis?

“If you have painful, swollen joints and other symptoms, start with your primary care doctor,” says Dr. Parody. “They may refer you to a rheumatologist, who specializes in diagnosing and treating arthritis and other diseases that affect the joints, muscles and bones.”

Some psoriatic arthritis treatments will also help calm skin symptoms. But if you have bothersome psoriasis symptoms, it can be helpful to see a dermatologist, too (an expert in skin conditions).

Treatment for psoriatic arthritis

Some people with psoriatic arthritis have mild symptoms. They may be able to control pain and swelling with over-the-counter anti-inflammatory drugs.

People with advanced disease usually need prescription medications. These drugs can relieve symptoms and prevent permanent joint damage. They include:

• Nonsteroidal anti-inflammatory medications (NSAIDs) to reduce pain and swelling.
• Cortisone injections and oral steroids to quickly reduce inflammation in the short term.
• Disease-modifying antirheumatic drugs (DMARDs), which protect joints by blocking inflammation.
• Biologics, a special class of DMARDs that target the specific parts of your immune system that drive inflammation.

Besides medications, there are things you can do to help relieve pain and protect your joints:

• Maintain a healthy weight.
• Use splints to stabilize inflamed joints.
• Use hot packs and ice packs to ease pain and swelling.
• Engage in gentle exercises like walking, swimming and tai chi.
• Quit smoking. (Some research suggests smoking can worsen symptoms.)
• Consider surgery. Most people with psoriatic arthritis don’t need surgery. But if you have severely damaged joints, joint replacement surgery can restore function.

“There’s no cure for psoriasis or psoriatic arthritis, but you can manage both with treatment. And new medications come out every year,” says Dr. Parody. “By working with your doctor, you can develop a plan to protect your joints and keep doing the things you love.”