Psoriatic Arthritis Without Psoriasis

There are times when you may have all of the symptoms of psoriatic arthritis (PsA) without having psoriasis. Continue reading to understand why and how that may be possible.

Can you have psoriatic arthritis without psoriasis?

Though it is rare, it is completely possible to have psoriatic arthritis without having skin lesions. According to the American College of Rheumatology, arthritis precedes psoriasis in rare cases, and it tends to appear alongside family history of psoriasis and/or nail psoriasis.1

Unfortunately, these cases can be extremely difficult to diagnose. And once you have a diagnosis, the lack of information can be extremely frustrating.

Receiving a diagnosis

It took many years and a few doctors to finally conclude that I had psoriatic arthritis without psoriasis at age 13. Many doctors observed my distinct symptoms like enthesitis, but could not make the connection.

A pediatric rheumatologist who specialized in rare rheumatic diseases was able to give me a proper diagnosis after noting my symptoms unique to psoriatic disease, psoriatic nails, and family history of psoriasis. It was an incredible relief to have a name for the pain!

Challenges finding resources and information

The relief was short-lived, however, as I quickly became disheartened because there is so little information about these cases. Not many rheumatologists have experience with cases of psoriatic arthritis without psoriasis. Consulting Dr. Google was practically useless, yet I had so many questions!

It was unnerving to know so little – especially not knowing the average length of time between developing arthritis and psoriasis. In a lot of ways, I almost felt excluded from resources about psoriatic arthritis because they had little to no information about having psoriatic arthritis without psoriasis.

The importance of seeing a rheumatologist

In the 8 years since I was diagnosed, I have learned a lot. While I never found a study on the length of time between developing arthritis and psoriasis, it has been almost 20 years since I developed arthritis and I don’t have psoriasis . . . yet (knock on wood).

I have learned to live knowing I could develop psoriasis, but that I should not worry too much. Sometimes doctors still question if my diagnosis is correct, occasionally checking me for lupus, but always conclude (yet again) it is psoriatic arthritis. Though it is maddening to have people constantly question my diagnosis, I realize it’s only because it’s rare in cases like mine.

A diagnosis is not impossible!

For anyone who has psoriatic arthritis without psoriasis, I highly recommend finding a good rheumatologist – someone who is familiar with psoriatic disease and uncommon rheumatic conditions. It can make a world of difference, as they may be good at recognizing the distinct symptoms you have and will know how to treat them more effectively.

I also recommend making it very clear to others, especially doctors, that you do have psoriatic arthritis – do not let them label you as having rheumatoid arthritis (RA). They are two different diseases. Unfortunately, I have encountered many people and a few physicians who are quick to label it as RA.

And finally, feel confident that your diagnosis is correct. Just because something is uncommon does not mean it’s impossible! Be your own advocate and inform the world! So go and be confident; you are a rarity, my friend! Don’t shy away from people who insist it is impossible, and educate others as much as you can. And above all, you are not alone!

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