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Psoriatic arthritis (PsA) is less common among Black people compared to other races, but differences in prevalence may also lead to issues with diagnosis. Many doctors do not know how to spot psoriasis in darker skin. This can cause missed or delayed diagnoses. To solve this problem, I teamed up with the American College of Rheumatology. We created a medical picture bank to train rheumatologists to spot signs of skin inflammation. It includes psoriatic disease in people with deeper skin tones.
Difficulties Diagnosing Psoriatic Arthritis in Black Patients
One big challenge in diagnosing PsA in Black patients is that it is often not recognized. The signs of psoriasis on darker skin can be subtle and are often missed. Black patients often have more severe disease and more joint pain. This is usually due to delays in diagnosis and starting effective medications. These delays can cause more health problems, which can include chronic pain, osteoarthritis, and joint damage. These issues can make it harder for treatment plans to work once they start.
Black patients may have active disease, joint damage, and chronic pain related to under-treatment. Black patients, for example, are more likely to report missing work or disability related to their PsA.¹ They are less likely to have many specialist appointments—instead, they often go to emergency rooms or urgent care for treatment. It is important to ensure that Black patients can access high-quality rheumatology care and receive prescription medications earlier in their disease journey. Making these crucial changes can help ensure Black patients receive effective treatment for their PsA, which can help improve health outcomes.
Understanding Symptoms and Options
For most patients with PsA, the psoriasis rash appears first. This rash is often flaky and raised. It has a silverish look and a purple tint on darker skin. In some cases, arthritis symptoms can happen before any visible skin changes. These symptoms include joint pain, swelling, and stiffness. These symptoms are especially noticeable in the morning and may last for over one hour each day.
Psoriatic arthritis can affect the spine and pelvis area as well. It can cause pain and stiffness in the lower back. It can also show up on the fingers or toes, where single digits may become swollen or tender. This swelling, often called “sausage digits” or dactylitis, can be one of the first signs of PsA. Additionally, nail changes, such as pitting, thickening, or color changes, may also occur and are often mistaken for fungal infections.
Patients should look out for pain and swelling where muscles attach to the bones. It often feels like pain in the Achilles tendon or the bottoms of the feet. Feeling very tired, generally unwell, or having unexplained fatigue can be signs of underlying inflammation in the body
Many PsA patients feel dismissed or misunderstood when explaining their symptoms to their healthcare provider. Self-advocacy is important, especially for Black patients with PsA. Look to trusted resources like the Arthritis Foundation or Creaky Joints for help on how to talk to your doctor about your PsA issues.
How to Prepare for PsA Appointments
Having a trusted doctor with whom you share a strong rapport with is essential. To get the most from your appointments, make a list of questions ahead of time, like “What tests are available to determine my condition?” or “What are some minimally invasive treatment options?” It’s easy to forget important questions during your appointment. Bringing a loved one to support you can be helpful. This is especially true if you feel overwhelmed or unsure about certain issues.
Some patients say they are so used to living with pain that it feels normal. They often don’t mention it during appointments. But it’s crucial to report any pain, stiffness, or other symptoms, even if they seem minor. These can be signs of active PsA. This may cause joint damage or raise the risk of long-term health issues. If your symptoms are still there or you’re not getting better on your current treatment, don’t hesitate to speak up. There are many effective treatments for PsA that you may not have previously considered or discussed with your doctor.
Remember, your voice is an important part of your care team. Speaking up for yourself can help you get the best results.
Ashira D Blazer, MD MSCI (she/her) is the Assistant Professor of Medicine in the Division of Rheumatology at the University of Maryland School of Medicine.
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