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Psoriatic Arthritis Without Skin Symptoms

Is it possible to have PsA but no psoriasis plaques?

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Q: Is it possible to have PsA but no psoriasis symptoms?

A: Yes, it is certainly possible to have PsA with no psoriasis/skin symptoms. For the majority of people with PsA, psoriasis precedes the onset of arthritic symptoms, but some people develop the skin disease after the onset of arthritis, so there may be a period of arthritis without psoriasis. Less commonly people with psoriatic arthritis may never develop psoriasis, but they often have a family history of  psoriasis or psoriatic arthritis.

Whether a patient has psoriasis or not, the diagnosis of psoriatic arthritis is made on the basis of clinical symptoms, as there are no diagnostic laboratory tests. Patients with psoriatic arthritis typically present with joint pain and swelling and morning stiffness. Other symptoms include inflammatory low back pain, which improves, rather than worsens, with activity; enthesopathy, or inflammation at the sites where tendons and ligaments attach to the bone (Achilles tendonitis and plantar fasciitis are examples of this); dactylitis (“sausage digit”); nail changes; and eye inflammation.

Steven R. Feldman, MD, PhD
Department of Dermatology
Wake Forest Baptist Medical Center
Winston-Salem, N.C.

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