2nd opinion?

Hi, I have recently been diagnosed with PsA. My question is, what are the odds of me having this disease when I have never had psoriasis. My father and sister have problems once in a while with psoriasis but never myself. From the reading I have done it seems a very high percentage of people with PsA first get the skin problem. The swelling/pain is in my feet, ankles, and right knee. I am looking into the clinic at Toronto West hospital, and also thinking of seeing a foot doctor to see if I can get any answers there ??



Toronto West is the best. We have several patients who doctor there. Here are tha CASPAR criteria for diagnoses.:


I’m not a big fan of podiatrists for diagnoses. They with varying abilities can treat symptoms. My general opinion is they have crippled as many patients playing around and delaying treatment of actual disease than they have helped. Until the disease is stopped, not much can happen.

I was diagnosed with psoriatic arthritis 7 years ago, and my psoriasis at that point was a tiny spot that has been there since forever on one knee, and occasionally on all knees and elbows, small spots. It hasn't progressed much past there, except that there is now nail involvement as well.

My point is that you may have really minimal psoriasis or nail involvement that you haven't taken note of, but a rheumy or dermatologist might. And for some people, the psoriasis comes later.

I agree with tntlamb. . . . Use the foot doctor to deal with symptoms, but diagnosis and disease control should be done by a rheumy. Regardless, even if the diagnosis is not correct, and it is a different type of inflammatory arthritis, the treatments are very similar, and the sooner that you get the disease under control, the more you can minimize damage.

Welcome to the group! We've got lots of great posts directed at newbies, so definitely make sure you take a look there.


My Dad developed psoriasis in his early forties when my parents divorced (never underestimate the power of stress). Until then he had just had what everyone thought of as bad dandruff. I had flaky skin on my scalp and never really sought treatment for it until my late twenties when I divorced (hello again, stress). My dermatologist at the time said it was bad dandruff although I think she thought it was mild psoriasis given the topical scalp treatments and shampoos she prescribed to keep things in check. When I was the same age as my dad was when he developed psoriasis, I was diagnosed with PsA. My rheumy's first question to me was about my father and his psoriasis.

Like lamb and Stoney said, even with very minimal psoriasis yourself (many people say the same thing as you--but I don't have psoriasis) you can still get PsA. Family history of psoriasis, particularly on the father's side, is an indicator.

I hope you get into the Toronto clinic to figure out a good treatment plan for your aching body soon! Pain and inflammation are surefire markers of unchecked disease. Good luck and welcome!

A percentage of people never exhibit symptoms of psoriasis, or they develop the skin symptoms only after the joint symptoms appear. I believe the number is 10%, according to Chandran and Gladman. (It’s in the book that I recommend in BOOK REVIEWS, above.) Clearly, the genes for psoriatic disease run in your family, and that is the significant thing.

The second opinion at Toronto Western only costs you the time and fare or gas to get there. If I had taken the advice of the good people here (who told me to get a second opinion) a year before I actually did, I might still be walking comfortably today. The foot issues that you have need to be addressed in the context of your disease before you reach out to a foot doctor. JMHO That said, my chiropodist is one of my best allies in dealing with the effects of my PsA.

This disease is stealthy, and is easy to misjudge. If you can get the opinion of a world class expert in this disease, do it sooner rather than later. My experiences have made me somewhat of an evangelist for second opinions, as well as early and aggressive treatment.

OK, I’m off my soapbox. Did you have a good Thanksgiving weekend?


I was diagnosed with the skin disease as a child, around 12 yrs old for psoriasis, so small I didn't even know that I had it. I have since had an itchy scalp a few times over the 30 years, and a spot behind my ear but never anything I would recognize as psoriasis. That said, I definitely have PsA all along as well. I am grateful all the time for not having both in full swing. Heart goes out to those who suffer inside and out.


I have had almost zero skin psoriasis involvement. My rheumy picked up on the PsA due to my fingernails.