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Can You Have Psoriatic Arthritis Without Psoriasis?

Last updated: December 2022

Psoriatic arthritis (PsA) consistently gets compared and linked to other conditions. Of course, it can be painful to have a valid condition compared to something else, like rheumatoid arthritis or osteoarthritis. Let's not overlook the itchy elephant in the room.

I mean, when a person shares about their psoriatic arthritis, the mention of psoriasis isn't too far behind. Many people find this invalidating and become defensive of the standalone and unique condition psoriatic arthritis truly is. It shouldn't be compared to other conditions because PsA alone deserves to be recognized.

Shared risk factors

About 15 to 30 percent of people with psoriasis also have psoriatic arthritis. The two conditions are commonly thought to go hand-in-hand, and many people believe that you cannot have PsA alone. However, this is not the case.1-4

The exact causes of psoriasis and PsA are not known. But there may be several things that increase the risk for both. These include:2-4

  • Genetic factors
  • Infections
  • Other medical issues
  • Immune system changes

Some of these shared causes may be the reason why the two conditions often occur together.2-4

Timing of diagnosis

In addition to shared risk factors, psoriasis and PsA are often diagnosed in people of the same age range. While they can be diagnosed at any time, they are most commonly diagnosed in people between the ages of 30 and 50.4,5

The majority of PsA diagnoses are made after a psoriasis diagnosis. The delay between the two diagnoses is usually 7 to 10 years. However, in some cases, psoriasis and PsA are diagnosed at the same time. This happens in about 15 percent of people with both conditions.1,2

Can I have PsA only?

Although most people with PsA also have psoriasis, there are exceptions. It is possible to have PsA only. PsA without psoriasis is most common among people who have a family history of psoriasis or PsA. This suggests that there might be a genetic aspect of this unique situation.1,3

While there are cases of true PsA without psoriasis, it is also possible that something else is going on.

Delayed psoriasis diagnosis

In some people with PsA, psoriasis has not yet been diagnosed. About 15 percent of people with PsA are diagnosed with psoriasis later in life.2

Missed psoriasis diagnosis

Some cases of psoriasis go completely undiagnosed. For example, small patches of psoriasis in hard-to-notice areas like behind the ears or on the scalp may be missed. As many as 80 percent of those with PsA have psoriasis of the nails. This symptom can be hard to spot, too. Missing psoriasis symptoms can prevent accurate diagnosis.6,7

Further, many treatment options for PsA also treat psoriasis. So, treating PsA can prevent symptoms of psoriasis from showing up.7

Misdiagnosis

Another possibility is that PsA is misdiagnosed. You may actually have one of several other health issues that can look like PsA. These conditions include rheumatoid arthritis and arthritis related to inflammatory bowel disease. Age-related wear and tear (called osteoarthritis) and gout can also be mistaken for PsA.4

If you have any questions about your diagnosis, talk to your doctor. They can walk you through the symptoms that are most likely to be PsA.

PsA without psoriasis: You are not alone

Even though it is not common, there are many people who have PsA without psoriasis. This can affect their symptoms, treatment decisions, and more. If you are in this situation, finding community with others who have PsA can be helpful.7

Keeping open lines of communication with your doctor also makes a difference. Your doctor can regularly monitor you for signs of psoriasis or changes in your PsA. Early detection can lead to earlier and more effective treatment.7

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