Psoriasis is a skin disease in which skin cell turnover is faster than the usual cycle. This results in notable red and silvery skin patches that are often itchy and inflamed.
Some people with psoriasis end up developing psoriatic arthritis (PsA), which is an autoimmune disease in which the body attacks itself. In this type of arthritis, the immune system destroys healthy joint tissues. PsA can affect a variety of joints — not everyone experiences the same effects.
The Cleveland Clinic estimates that 1 percent of Americans have PsA. Given the relatively low percentage of affected patients, it’s easy to confuse PsA with other types of diseases. Check out some common myths surrounding this autoimmune condition, and learn the facts about risk factors, diagnosis, treatment, and self-care.
Myth: Having psoriasis automatically means you’ll get PsA
Fact: Only 10 to 30 percent of people with psoriasis get PsA
While psoriasis can occur before PsA, not everyone who has psoriasis will get this form of arthritis. In fact, estimates of such an incidence range between 10 to 30 percent. This means that the majority of psoriasis patients won’t get PsA. Some people with psoriasis might develop another type of arthritis, such as rheumatoid arthritis.
It’s important to consider the incidence of autoimmune diseases in your family. Though there is no single identifiable cause of PsA, family history seems to play a large role. The Cleveland Clinic estimates that about 40 percent of people with PsA have a family history of arthritis and/or psoriasis.
Myth: PsA only occurs in older adults
Fact: PsA affects all age groups
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), PsA is the most prevalent in adults aged 30 to 50. Still, PsA can develop in any age group. This includes children. If you’re under the age of 30, you shouldn’t assume that you can’t get PsA.
Though PsA is can develop in anyone, it’s also most common in Caucasians.
Myth: People with PsA generally have the same symptoms
Fact: PsA causes a wide range of symptoms
The difficulty in diagnosing PsA is due to symptoms can vary between individuals. While some experience topical (skin and nail) symptoms, others might only notice joint pain and stiffness. The danger in assuming all PsA symptoms are alike is possible misdiagnosis, and a lack of treatment.
PsA can cause one or more of the following symptoms:
- skin rashes and scaly patches (also noted in psoriasis)
- nail deformities
- eye redness
- swollen, painful joints
- difficulty moving and doing everyday tasks
- morning stiffness
- waking up tired
- excessive fatigue throughout the day
- difficulty sleeping at night (often from joint pain or discomfort)
Myth: If my symptoms go away, it probably isn’t PsA after all
Fact: PsA can cause flare-ups, along with periods of remission
PsA is a chronic condition, which means patients have it for the rest of their lives. Having a flare-up with joint pain and skin symptoms is common with this disease. If your case is mild, you may also have remission periods in which you don’t notice any symptoms at all. But a lack of symptoms merely means that your immune system is dormant in its attacks on cells and tissues — this doesn’t mean that it’s not PsA, or that the PsA has suddenly disappeared.
The only way to be sure about the state of your PsA is to get a diagnosis from a rheumatologist. It’s not wise to rely on symptoms alone as a method of self-diagnosis.
Myth: Most PsA cases are the same
Fact: There are five subtypes of PsA
PsA is currently diagnosed as one of five subtypes. These are based on severity of the condition, as well as the location of the affected joints. As the disease progresses, patients may be diagnosed from one subtype to another.
The five subtypes include:
- Oligoarticular: Affects one to four joints asymmetrically (on different sides of your body).
- Symmetric: Affected joints are the same on both sides of your body.
- Spondylitis: This is PsA of the spine.
- Distal interphalangeal: Finger and toe joints are primarily affected (can also cause nail deformities).
- Arthritis mutilans: A rare form of PsA that mainly causes severe destruction in feet and hand joints
Myth: Joint destruction and disability are inevitable in PsA
Fact: Early treatment of PsA can prevent disability
Just as the causes and symptoms of PsA vary, so does the course of the disease. Not every PsA story is the same: some patients experience mild flare-ups and little pain, while others have a more progressive form of the disease where joint damage is widespread. The key to preventing the latter scenario is early detection and treatment.
Early cases of PsA are often diagnosed as oligoarthritis, meaning that between one and four joints are affected. Polyarticular arthritis refers to instances in which at least five joints are affected. The longer the condition is left untreated, the more joints may be affected.
Disability can occur when irreversible damage is done to your joints, and is often the cause of a lack of diagnosis and treatment. However, disability is not inevitable. Working with the right specialists (including dermatologists and rheumatologists), self-care, and healthy lifestyle habits can all help ward off the debilitating factors of PsA.
Read more in Moderate to Severe Psoriatic Arthritis Pain ResourcesFrequently asked questions about psoriatic arthritis. (2016). Retrieved from https://www.psoriasis.org/psoriatic-arthritis/faqs
Husni, M. E. (2016, October). Disease management: Psoriatic arthritis. Retrieved from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/rheumatology/psoriatic-arthritis/
Psoriatic arthritis. (n.d.). Retrieved from http://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/
Psoriatic arthritis (2014, October). Retrieved from https://www.niams.nih.gov/Health_Info/Psoriatic_Arthritis/default.asp
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