Will the skin rash eventually come later?

My daughter has itchy legs, but no signs of the psoriasis rash yet. She was diagnosed as having PsA with several joints that have been affected, including her jaw -which is still locked. She has struggled with fatigue for several years, but the joint issues just came this past year. She is now on prednazone and beginning MTX. Can some people go through their lives and never get the rash, or will it eventually start someday? She is 20.

Karen, I've wondered the same thing. I have no rash either: years ago, I developed toenail "fungus", which was resistant to every OTC and prescription medication my doctor suggested. That should have been a clue, but it was only after ten years of pain, fatigue and joint destruction that they looked at my nails and said "psoriasis".

Since being diagnosed with PsA, I'm wondering if, one morning, I will wake up and find myself covered with psoriasis plaque. Thanks, Karen, for asking the question!

Seenie

I had my first flare up of PsA at 22, just joints and no rash. Fortunately it went dormant for over a decade and flared up about 18 months ago. Lots of inflamed, painful joints and toenail “fungus” same as Seenie. Still no rash for which I am grateful I have to say.

For what ever its worth, 20% or so never develop the “rash” Psoriac nails are mre common, but can be mild enough they are easily overlooked. The rash isn’t all bad. It sometimes takes your mind off the pain.

Thanks for your insights. My daughter does have toenail psoriasis, but that is about it. In fact, as I think back....that was probably the first visual sign and it was this past summer. Then, the strep throat infection, then two weeks later the joint pain, locked jaw, tight hands in the morning and swelling.... in high gear.



GwynnethP said:

I had my first flare up of PsA at 22, just joints and no rash. Fortunately it went dormant for over a decade and flared up about 18 months ago. Lots of inflamed, painful joints and toenail "fungus" same as Seenie. Still no rash for which I am grateful I have to say.
When your PsA went into remission, were you on medication the whole time? If so, what was it? I sure hope that happens to my daughter :) It would be a nice decade.

The first time it went into remission was just through rest. I had just left uni in the June and wasn't starting work until the September so I had the luxury of two months rest and doing nothing (at that age I had no responsibilities and my parents fed me for free!). I didn't take anything apart from painkillers.

This most recent flare up was caused by stress and burning the candle at both ends and if I could take two months off life again that would be great. However I have responsibilities now!

Karen, I too have itching on my legs and arms (sun makes it worse), but no rash (thank God). I was diagnosed with PsA in 2006 but was not treated until 2009 (moved twice and no rheumy). I have the nail issues on my hands and that is what really told my rheumy.

Gwynneth, you are so right that stress and overdoing really flares up the PsA.

I haven't hit a remission yet, but my rheumy tells me that is the goal...I am not holding my breath.

All great info that I will pass on to my daughter. Many thanks! Karen

I've never had the rash and I hope I never do. For what it's worth, my Rhuemy said the fact that I moisturise religiously every day probably helps. I use Aveeno anti itch cream because I do get itchy.

Hi, I don't have psoriasis on my skin either. I'm 39 and have nail pitting and ridges since childhood. I just thought I was born with ugly nails lol. I was just diagnosed in Feb with psoriasis and PsA. However, my mother and grandmother have mild psoriasis. I have mild PsA. Like someone else posted though I mosturize 24/7 and have since High School. Maybe that's helped I don't know.

My doc says the nails are more telling than the rash. More telling is if its only one side Based on the big toe.

I did not know they created an anti-itch cream.....I will look for it. Thanks!

LaraRipkens said:

I've never had the rash and I hope I never do. For what it's worth, my Rhuemy said the fact that I moisturise religiously every day probably helps. I use Aveeno anti itch cream because I do get itchy.

okay, so please tell me a little more about this big toe thing. If it is only on one side, it is an indicator of PsA - or you'll eventually get the skin psoriasis? thanks!



tntlamb said:

My doc says the nails are more telling than the rash. More telling is if its only one side Based on the big toe.

80% of folks with nail psoriasis on their big toe have PsA. If only ONE toe is involved then it is most likley that you have Symmetrical polyarthritis (arthritis that involves the same few joints on both sides of the body): This pattern was recently recognized as one of the most common types and the least deformative. (unless of course you are male then all bets are off)

If it first appears in a 9 - 10 girl and there is pitting while not good news as its likley Juvenile Psoriac arthritis., it could be worse as it is usually mild but occasionally it is severe and lasts into adulthood. Usually only one joint at a time eithere symetrically or asymetrical (which is really two joints - same on both sides) However there are other forms that involve tendons which are much more serious.

If BOTH big toes are involved and there is joint pain in the tips of the toes, it is often indicitive of Arthritis mutilans which is a long-term psoriatic arthritis in which the joints are severely damaged and deformities can be seen, especially in the hands and feet. The bone may soften and become absorbed by surrounding tissues (called osteolysis), and the joint may dissolve.

Of course none of this is a "rule" and only a part of any diagnosis. However on most scales the Big Toe is what is used to determine nail dystrophy whic gives one point towards diagnoses You only need three. Current skin involment is 2. So pretty much if you have the Rash and the Nail you have PsA. here is a link:

http://www.ncbi.nlm.nih.gov/pubmed/16871531

BTW 20% or more NEVER have skin involvement. A fair number more have skin involvement and never know it. I know one person who thought he had Hemorrhoids. only to find out it was psoriasis (thats a common spot but the itching and burning is the same) Another person though she had canker sores. So the rash isn't as clear (no pun intended) as it seems.......

I have the toe thing on one side. I don't have the skin psoriasis. I do have PsA (which is currently being crushed into submission by a combination of prednisone and MTX). Does that help?

Karen said:

okay, so please tell me a little more about this big toe thing. If it is only on one side, it is an indicator of PsA - or you'll eventually get the skin psoriasis? thanks!



tntlamb said:

My doc says the nails are more telling than the rash. More telling is if its only one side Based on the big toe.

My daughter is also on prednizone and MTX......some anti-depressants and the other one where you must watch your eyes. She is in pain everyday (spine, tendons, fingers, elbows and wrists) - she has only had 3 doses of the MTX so far. What do you think about the people on this site that say don't mess with MTX and just go straight to biologics? I have heard research that with early use of the biologics it can also be pushed into remission. Will the doctor just see if this combo of drugs works without the biologics for awhile? Is it just insurance that keeps them from prescribing it right away? I am so glad your meds are working. Do you still have pain?

GwynnethP said:

I have the toe thing on one side. I don't have the skin psoriasis. I do have PsA (which is currently being crushed into submission by a combination of prednisone and MTX). Does that help?

Karen said:

okay, so please tell me a little more about this big toe thing. If it is only on one side, it is an indicator of PsA - or you'll eventually get the skin psoriasis? thanks!



tntlamb said:

My doc says the nails are more telling than the rash. More telling is if its only one side Based on the big toe.

Hi,

Thanks for the good information. I went to that site, but it was much easier to understand you :) I feel like my daughter has many of the symptoms:

1. lower spine - the pain wakes her up at night where she has to twist and crack her back for relief twice each night.

2. swollen finger - she has some deformity in the first finger - joint nearest the nail - that was her initial joint pain - along with her jaw. Now, she is has a swollen finger (other hand - also first finger - but it is the middle knuckle and whole finger is swollen)

3. jaw is still in a locked position on one side....she cannot open it more than an inch or so - has to push some food in and then chew.....the doctor tried mass amounts of predisone for 10 days but it remains unchanged.

4. elbows and wrists hurt on occasion

5. tendons are affected - feels the pulling/pain in arms and fingers

6. pits in toenails - that actually look a little better

7. no skin psoriasis yet

She is so young (will be 21 next month) and I am trying everything to understand this disease so that I can understand the decisions her rheumy is making. She is living away from home but considering moving home this summer to get a handle on things and rest.

Thanks again.

tntlamb said:

80% of folks with nail psoriasis on their big toe have PsA. If only ONE toe is involved then it is most likley that you have Symmetrical polyarthritis (arthritis that involves the same few joints on both sides of the body): This pattern was recently recognized as one of the most common types and the least deformative. (unless of course you are male then all bets are off)

If it first appears in a 9 - 10 girl and there is pitting while not good news as its likley Juvenile Psoriac arthritis., it could be worse as it is usually mild but occasionally it is severe and lasts into adulthood. Usually only one joint at a time eithere symetrically or asymetrical (which is really two joints - same on both sides) However there are other forms that involve tendons which are much more serious.

If BOTH big toes are involved and there is joint pain in the tips of the toes, it is often indicitive of Arthritis mutilans which is a long-term psoriatic arthritis in which the joints are severely damaged and deformities can be seen, especially in the hands and feet. The bone may soften and become absorbed by surrounding tissues (called osteolysis), and the joint may dissolve.

Of course none of this is a "rule" and only a part of any diagnosis. However on most scales the Big Toe is what is used to determine nail dystrophy whic gives one point towards diagnoses You only need three. Current skin involment is 2. So pretty much if you have the Rash and the Nail you have PsA. here is a link:

http://www.ncbi.nlm.nih.gov/pubmed/16871531

BTW 20% or more NEVER have skin involvement. A fair number more have skin involvement and never know it. I know one person who thought he had Hemorrhoids. only to find out it was psoriasis (thats a common spot but the itching and burning is the same) Another person though she had canker sores. So the rash isn't as clear (no pun intended) as it seems.......

The poor kid.... If it is any of any hope (and I hope it is) there are studies out there that indicate young folks often (about half the time) have a pretty good flair early on and go into remission for sometimes years.

I have no pain now. The prednisone worked quickly to alleviate all the swollen joints (five at the time) and the MTX seems to be keeping everything under control. This was combined, however, with a lifestyle change of reducing as much stress as possible, taking a sabbatical from work, resting and generally stopping dashing around from one thing to another. The combined effect is that i feel great. The best for about 18 months.