Can You Have Psoriatic Arthritis Without Psoriasis?

If you have psoriatic arthritis, is it a given that you’ll get psoriasis, too? Not necessarily, says the research.

About 13–18% of people with psoriatic arthritis (PsA) develop it without having psoriasis first.

If you’re in this camp, you might ask yourself whether a psoriasis diagnosis is in your future. The good news is, you might never get psoriasis, even if you already have PsA.

Or, maybe you suspect you may have PsA and want to know whether it’s actually possible because you don’t have psoriasis.

The answer to that is yes. But it might be harder to detect.

People with PsA often receive a misdiagnosis if they don’t have psoriasis symptoms. For example, if you had a PsA flare in just one toe, your doctor might have diagnosed gout instead.

For many people, it can take years to get the correct diagnosis. That’s why it’s important to be your own advocate, get a second opinion if you think you may have received a misdiagnosis, and keep a journal where you record your symptoms so you can share them with your doctor.

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Can you have psoriatic arthritis if you don’t have psoriasis?

Yes. That said, it’s less common.

People typically get psoriasis first, and then as it progresses, they may also develop PsA. About 30% of people with psoriasis develop PsA later. It’s also common for the two conditions to develop around the same time, often within months of each other.

For people who develop PsA even when they’ve never had psoriasis, psoriasis probably affected one or more of their family members.

It’s also possible to have psoriasis and not know because it appears infrequently or in hard-to-detect areas, like:

• on the scalp
• between the buttocks
• in or on the belly button
• between skin folds, particularly if you have obesity
• inside the ear

Are people who haven’t had psoriasis symptoms less likely to develop psoriasis?

If you have not experienced psoriasis symptoms and you do have PsA, you may not ever develop psoriasis, according to the National Psoriasis Foundation.

But your risk of developing psoriasis is higher than in a person who doesn’t have PsA, especially if you have genetically related family members who have psoriasis.

Symptoms of psoriatic arthritis beyond psoriasis

If you already have PsA, psoriasis may appear like red or silvery plaques.

Other symptoms of PsA include:

• a swollen “sausage finger” or toe
• hot, painful, tender swelling in one or more joints, typically in the hands, knees, or ankles
• flares in the spine or sternum, called axial psoriatic arthritis
• enthesitis, which is pain where a tendon or ligament meets the bone close to a joint, which can manifest as plantar fasciitis or Achilles tendinitis
• changes to your nails, including pitting, color changes, ridging, or thickening of the nail, or separation of the nail from the nail bed

How psoriatic arthritis is diagnosed

To help your doctor narrow your diagnosis, they will look at a combination of information. They will likely start by asking about your family history. If someone genetically related to you has psoriasis or PsA, you’re more likely to have it too.

Your doctor will also perform a detailed physical exam. They will check for signs of skin psoriasis and the other symptoms of PsA.

Your doctor may also request a blood test to check for signs of inflammation, including certain antibodies, higher levels of the inflammatory marker C-reactive protein (CRP), and a high erythrocyte sedimentation rate (ESR).

You might also have imaging tests done, such as X-ray or ultrasound, so your doctor can see whether you have joint damage, dislocation, inflammation, and other signs they can observe via imaging.

How to prevent psoriasis when you have psoriatic arthritis

There’s no surefire way to prevent psoriasis when you have PsA, but there are some things you can do to reduce your risk.

Psoriasis is associated with a few factors, and you can do a few things to change some of them.

Risk factors for psoriasis include:

• family history, such as one or both parents having psoriasis
• prior infections, such as strep throat, HIV, and other viral and bacterial infections
• high levels of stress
• overweight and obesity
• tobacco use
• alcohol use
• skin injury, such as sunburn (skin injury can trigger psoriasis in a process called the Koebner phenomenon)
• certain medications, including:
  • ACE inhibitors
  • beta-blockers
  • chloroquine
  • indomethacin
  • interferon-alfa
  • lithium
  • terbinafine

Taking steps to reduce chronic inflammation can help

Having chronic inflammation can increase your risk of psoriasis. Consider taking some key actions to lower your risk:

• Eat anti-inflammatory foods: Whole foods, like fresh fruits and vegetables, are a great anti-inflammatory choice, as well as whole grains and healthy fats, such as salmon and olive oil. Avoid frequently eating added sugar, trans fats, and saturated fats.
• Get physical activity: Every time you exercise, you actively reduce inflammation in your body.
• Manage body weight: The fat inside your belly, called visceral fat, releases chemicals that cause inflammation. You can lower these levels by reducing excess belly fat if you have obesity or overweight. Eating mainly whole foods and exercising regularly is a great place to start.
• Get at least 7 hours of sleep: The Centers for Disease Control and Prevention (CDC) recommends adults ages 18–60 years get 7 hours of sleep or more a night. Getting less sleep can increase inflammation. (We know that’s easier said than done when you have joint pain. Here are a few suggestions.)
• Bring down your stress levels: Chronic stress can cause inflammation, too. Taking action to reduce your stress can help, including getting enough sleep and physical exercise, as well as practicing in-the-moment stress relief techniques, like deep breathing and progressive muscle relaxation.
• Quit or avoid smoking: Smoking (or vaping) increases chronic inflammation. If you smoke or vape, stopping is a major step you can take to lower yours.

Takeaway

If you have PsA but not psoriasis, you might wonder whether a psoriasis diagnosis is imminent. While it’s true that you’re at higher risk of psoriasis than people in the general population, it’s not inevitable.

Taking steps to reduce your risk factors and curb chronic inflammation may help.