I was told I had PsA when I was 16 and have been taking methotrexate since. I don't really understand how the doctors knew it was Psoriatic Arthritis when I had had no signs of psoriasis. They told me to keep an eye out for certain things like mild pitting and yellow streaks on my nails. I noticed that I had those symptoms last year. They said it was probably psoriasis. The yellow streaks went away shortly after but the mild pitting stayed. That is the only sign of psoriasis I have had. But after having read everyone's posts on here, I feel as though i'm the only one. I very clearly have arthritis but i'm not so sure about the psoriasis. I feel very lucky not to have had to deal with it yet but does that mean I have been misdiagnosed? Or did everyone's start out this way?
It does not mean that you’ve been misdiagnosed. I was diagnosed with one patch of psoriasis. My mom was diagnosed based on damage visible on X-ray and family history (me) of PsA. For some people the psoriasis comes years after the arthritis. I count myself as lucky that a I have such minimal psoriasis, although I have found that my nails are more affected this last year or two.
Hi, Rosie!
Great question. I was diagnosed with inflammatory arthritis first, and only then was it narrowed down to PsA. My psoriasis was so minimal, I didn't know I had it -- like you, only slight pitting of nails and a couple of weird toenails. Later, I went to another rheumatologist who double checked the diagnosis, and it was confirmed by one small piece of evidence on an x-ray. (It was a tiny but distinctive bit of new bone formation.) There's also blood work that will hint at PsA, and eliminate other kinds of arthritis, although there is no blood test which will confirm PsA. The rheumatologist may also take note of where your pain is -- PsA is notorious for making ligaments hurt as well as joints. It's a case of the rheumatologist connecting dots, sometimes very faint dots.
Skin and nail symptoms usually precede joint symptoms, but in a small number of cases, people get the arthritis first and the skin symptoms show up late to the party. There's another complication: the severity of the joint disease has nothing to do with the severity of the skin disease. I have mild skin and nail symptoms, and severe joint disease.
Family history plays a role in the diagnosis too -- if you have parents or siblings with psoriasis or PsA, you are more likely to have it.
So no, you're not the only one at all with arthritis without noticeable skin disease. Sometimes that comes after, sometimes it never gets bad. Only time will tell.
Seems that the thing with psoriasis is that it takes many different forms and can look exactly the same as a whole host of other skin conditions, particularly the milder forms which may show as little more than patches of dry skin which come and go.
I had all manner of 'itchy' skin issues as a young child explained away as perfum allergies/contact dermatitis - they may have been or they may not! Mid teens horrible patches behind my knees, inner elbows and underarms - explained away as eczema but now I suspect were flexural psoriasis. Sore and dry elbows at school - too much leaning on the desk! Sore itchy bottom - parasites/constipation/anal fissures/piles/sweat rash (take your pick) - no peri-anal psoriasis.
Fast forward a couple of decades and I've had spells of good skin and the odd something of nothing and then wham, off we go again, horrible sore and splitting hands, a funny thumb nail etc. Two dermatologists, neither said it was psoriasis. Fast forward another ten years .... oh crikes, sore flaky knees from lots of kneeling. Then the joint pain started. Sitting at my first rheumatologist appointment I could see he was wondering what on earth was the matter with me when his questions came round to skin - mine and my family history - no I say to his psoriasis questions "but I have had eczema on and off all my life". The lightbulb lit up in his eyes, probably along with the £ signs as it was a private appointment! Did I have any at the moment? So I mentioned my knees, he wanted to see them (oh $%&! I haven't shaved my legs!) one glance and it was the turning point "that's not eczema that is plaque psoriasis, I know exactly what is the matter with you, you have psoriatic arthritis".
So the moral of this tale is that it only takes one rheumatologist to turn on the lightbulb. Sorry, bad but irresistable joke.
No, the real moral is that psoriasis can be mild, virtually unnoticeable. And as the others have said I think the number of people with PsA who develop the arthritis before the psoriasis is something like 15 - 20%. I hope for you that your skin disease never develops in to anything more than you have now and certainly your arthritis treatments should help keep it at bay.
Ok, thank you guys, that's really helpful! i'm a bit scared of the psoriasis side of things, because I'm an actress so I feel like it could really get in the way of my career. Obviously there's no way of stopping it from coming but if anyone knows any dietary things etc. which might be able to help reduce chances of it getting too bad, that would be much appreciated. Really happy to be a part of the group. x
I had psoriasis for about 10 years in my late 20s / 30s. It was constant, in my armpits, but really did not bother me - it hardly itched at all and was just redness, not scaly. Then one morning it went and stayed gone for 23 years at which point I was diagnosed with PsA, partly on the basis of one slightly dodgy toenail. I didn't tell the rheumatologist that I'd had psoriasis because I'd simply forgotten it, it was ancient history.
It has come back now, unfortunately, but hopefully your psoriasis will stay minimal. Lots of people with PsA have little or no psoriasis.
You're an actress! That's so exciting. Bet it is actually hard work though, but to me it sounds thrilling. Incidentally, I should imagine that most psoriasis can be disguised with make-up for the stage or screen. You could always research camouflage products that are unlikely to irritate the skin if you're the kind of person who wants to be prepared for all eventualities.
That's really good to hear. Well I'll keep my fingers crossed. And i'll probably look into make-up for it, that's a good idea. It is exciting being an actress, you never know what's coming around the corner. But it also means there's no consistency in your life which can make things quite difficult. Thank you for the advice!