If I Have Psoriasis, Am I Going To Get Psoriatic Arthritis?

Although people can be diagnosed with PsA without skin involvement, they will most likely have a family member with skin psoriasis. For example, my mother has psoriasis, my two siblings and I have psoriasis, and one out of three of my daughters has shown signs of psoriasis—all on our scalp, and I sometimes get it on my face in small patches.

Psoriasis is an inflammatory skin condition, while psoriatic arthritis is an inflammation of the joints and entheses (enthesitis).

Symptoms Of These Two Autoimmune Diseases

Symptoms of Psoriasis

Symptoms of psoriasis depend on what kind you have and how bad it is. Psoriasis makes knees, elbows, and fingernails red, itchy, flaky, and pitted. Most people’s psoriasis symptoms get worse for a few weeks or months, and then they get better. This could get better during remission too.

• Scaly silver patches (mainly on the elbows, knees, and scalp)
• Strep throat may cause red spots or sores.
• Redness (often found in folds of the body, such as in the elbows, knees, armpits, or groin)
• Red or silvery scalp patches (that may lead to hair loss)
• Body blisters (most often on the hands and feet)
• Itchy, scorching skin
• Skin cracking
• False nails

Symptoms of Psoriatic Arthritis

Unlike Psoriasis, PsA has symptoms in the joints, spine, and enthesea. The symptoms are like psoriasis in that they vary by type and severity.

• Skin Plaques. Red spots with silvery scales can cover large parts of the body or show up on the scalp, elbows, knees, and ears.
• Swollen Fingers & Toes. Dactylitis makes the toes and fingers look like “sausages”.
• Painful Joints. Joint pain and stiffness (usually in the hands, knees, and ankles on one side) or inflammation in the spine’s joints (axial involvement).
• Enthesitis. Achilles tendonitis or plantar fasciitis are caused by inflammation of the enthesis.
• Nail Changes. Pitting, thickening, ridging (Beau’s line), crumbling, color changes, nail bed separation, subungual (debris under the nail).

If you have Psoriasis and suspect PsA, there are several warning signs for when to contact a rheumatologist:

• Red, heated, swollen joints
• Long-term joint discomfort
• Stiff joints (greater than one hour)
• Joint discomfort and health changes (i.e., joint pain and fatigue or joint pain and low-grade fever)

RELATED: 10 Psoriasis Myths Debunked

How Do Psoriasis & PsA Begin To Intertwine?

“For every ten people who walk in the door with psoriasis, about three or four of them will eventually get PsA,” says Elaine Husni, MD, MPH, vice chair of the department of rheumatic & immunologic diseases at the Cleveland Clinic in Ohio. Skin and joint problems can happen simultaneously, or the joint problems can show up first. Most of the time, joint pain comes seven to ten years after the skin issue.

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Psoriasis can show up in places that are hard to see or are close to the body, like the scalp, intergluteal cleft, belly button, or ear. Small psoriasis spots on the scalp and buttocks could be missed, which would make the diagnosis take longer. 

Psoriasis could be the cause of a bit of dandruff on your head. Studies show that Psoriasis of the scalp, nails, and groin is linked to PsA. Your PsA risk may be higher if you have psoriasis in these hidden places.

What Individuals With Psoriasis Should Know About PsA

What Causes Psoriasis and Psoriatic Arthritis?

Experts think a malfunctioning immune system contributes to psoriasis and PsA. The psoriatic illness causes inflammation, swelling, and discomfort by attacking healthy skin cells and joints.

Risk factors for Psoriasis include:

• Genogram (having one or two parents with the disease)
• Infectious diseases (including recurring strep throat or HIV)
• Stress (high levels can compromise your immune system)
• Obesity (psoriasis lesions/plaques in skin folds).
• Cigarettes (play a role in the risk and severity of the disease)
• Drinking
• Injury (Koebner phenomena) 
• Sunburn
• Drugs (including beta blockers, chloroquine, lithium, ACE inhibitors, indomethacin, terbinafine, and interferon-alfa)

Risk factors for PsA include:

• Having Psoriasis (specifically in the scalp, nail, and groin area)
• Family history
• Age (between 30 and 50)
• Obesity
• Smoking

Diagnosing Psoriasis and PsA

There’s no straightforward test for psoriasis or psoriatic arthritis. Your doctor will need to consider your symptoms, risk factors, bloodwork (for inflammation), and X-rays or other imaging studies (MRI, ultrasound, CT scan) to diagnose joint involvement.

During a physical exam, your doctor may search for psoriasis on your elbows, knees, scalp, belly button, intergluteal cleft, palms, and soles. They’ll also look for nail irregularities like pitting or ridging and swelling fingers or toes (dactylitis).

Here are some common steps used to diagnose Psoriasis and PsA:

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• A family history, risk factors, and symptoms exam
• Blood testing for inflammatory markers (CRP, ESR) and antibodies (rheumatoid factor, anti-CCP) may rule out other kinds of arthritis, including rheumatoid.
• X-rays and ultrasounds identify joint injury, dislocation, disfiguration (arthritis mutilans), new bone growth, and enthesis inflammation.
• If you have undetected Psoriasis, undergo a skin biopsy.

Surprises of Psoriasis & Psoriatic Arthritis

PsA is often misdiagnosed, particularly if the patient does not have psoriasis. Ninety-six percent of participants suffered at least one mistake before being identified with PsA, according to 2018 research. Thirty percent of psoriasis people require more than five years to be diagnosed with PsA. 

As someone who has psoriasis, I had it awfully bad when I was younger. I got bullied and didn’t know how to deal with it. Luckily, as I got older, my psoriasis was less noticeable on my scalp, and it even seemed to decrease and get better as time continued.

RELATED: Which Psoriasis Treatment Is Right For You?

Psoriasis & Psoriatic Arthritis Treatments

Many drugs may treat skin and joints, but some perform better than others. According to the American College of Rheumatology and National Psoriasis Foundation, your treatment strategy should depend on how PsA affects your body and the severity of your symptoms. If your skin worsens, you may start with a better-for-the-skin medicine that still affects the joints.

People with psoriatic arthritis may have skin, joint discomfort, finger and toe swelling (dactylitis), and pain where tendons and ligaments connect to bone (enthesitis). Identifying the most troublesome locations and determining your treatment of choice is vital.

While there are several PsA medications, it’s often a matter of trial and error to find which one works. Sometimes we need to try many medications to find the appropriate one. Medications used to treat both Psoriasis and PsA include:

• NSAIDs cure modest joint pain but not skin psoriasis or nail involvement.
• Glucocorticoids: used sparingly in PsA
• Biologics and biosimilars JAK inhibitors