The Link Between PsO and PsA, Explained
Despite their similarities, psoriasis and psoriatic arthritis are distinct conditions. Here's what you need to know.
If you have psoriasis, then it’s likely that you’ve heard of its unofficial sister condition: psoriatic arthritis. Both are chronic autoimmune disorders characterized by inflammation in the body, with the main difference being that psoriasis (PsO) manifests itself on the skin, while psoriatic arthritis (PsA) presents itself via joint pain, swelling, and stiffness of the limbs. Here, with the help of two board-certified dermatologists, we’ll be addressing some of your questions about the link between psoriasis and psoriatic arthritis — including quite possibly the biggest inquiry of all: Can you have psoriatic arthritis without having psoriasis? Keep reading to find the full lowdown.
Which Came First: PsA or PsO?
Can you have psoriatic arthritis without having psoriasis? Let’s get this one out of the way first, shall we? The short answer is yes, yes you can have psoriatic arthritis and not psoriasis—however, if you have PsA, you will likely have a history of psoriasis and/or psoriatic arthritis somewhere in your family line. “It is very rare for a patient to develop PsA prior to having psoriasis noticeable on the skin, but it has been reported,” says Robert Finney, M.D., a board-certified dermatologist in New York City. “Psoriatic arthritis occurs in less than 30 percent of patients with psoriasis and is more common in patients with extensive skin disease, who are diagnosed at a younger age.” Additionally, Dr. Finney says psoriatic arthritis more frequently occurs in those who experience nail changes related to psoriasis, such as pitting, lifting, or orange splotches.
Do PsA and PsO Have Overlapping Symptoms?
As we briefly mentioned above, psoriatic arthritis causes joint pain, swelling, and stiffness (especially in the morning), while psoriasis largely affects the skin by way of painful, scaly red or silver patches called plaques. “Psoriatic arthritis often begins with stiffness at rest, meaning [tight] joints when you first wake up,” says Adam Friedman, M.D., a board-certified dermatologist based in Washington, D.C. “Lower back pain and heel pain can also be early signs.”
As for psoriasis, the plaques can appear just about anywhere on the body, including the face, scalp, and genitalia, all of which can be especially debilitating. Other initial symptoms of psoriasis include small scaly spots of skin, itching, and red patches; however, you should always go see your doctor instead of trying to diagnose yourself, as the aforementioned symptoms could be another skin condition, as well. It’s also worth noting that psoriasis ranges in severity, with some people only having minor flare-ups every now and then, and others having acute cases that cover up to 50% or more of their body.
Speaking of severity, PsA symptoms can also range from mild to severe, with some folks only experiencing mild tension in their fingertips and/or spine, and others struggling with immense joint pain, swelling, and discomfort. Other symptoms that are often associated with psoriatic arthritis include inflammation in areas where tendons and ligaments attach to the bone, and eye inflammation.
Are Treatment Plans All That Different?
Despite presenting very differently, there are many of the same treatment options for PsO and PsA, including nonsteroidal anti-inflammatory drugs (NSAIDs) and biologic drugs like Enbrel (etanercept), Cosentyx (secukinumab), and Humira (adalimumab). There are, however, a few variances. For instance, as Dr. Friedman explains, unlike psoriasis, psoriatic arthritis typically doesn’t respond to topical creams, as it primarily affects the joints, and creams are unable to effectively penetrate the dermis and reach the nerves underneath.
“PsA needs to be treated with systemic therapies, such as biologics, for which we have many,” Dr. Friedman says. But there are a good number of treatments approved for both plaque psoriasis and psoriatic arthritis. Biologic drugs, for example, work for both PsA and PsO by blocking certain cells or proteins in our immune system—such as the T-cell or the tumor necrosis factor-alpha protein—that largely contribute to the development of psoriasis and psoriatic arthritis.
Dr. Finney adds that because joint changes associated with PsA (i.e. swelling, stiffness, immobility, and pain) can be permanent, prompt systemic treatment is highly warranted if someone does notice joint symptoms. Below, find a few systemic treatments for PsA and how they work.
Rasuvo (methotrexate): This is an immunosuppressive drug that works by decreasing over-activity of the immune system and thereby lessening symptoms.
Otezla (apremilast): This drug works to regulate inflammation by inhibiting the enzyme PDE4, which is responsible for controlling much of the inflammatory action within cells that can affect PsA.
Neoral (cyclosporine): This is another immunosuppressive medication that slows down the growth of certain immune cells associated with PsA.
There’s no denying psoriasis and psoriatic arthritis are inextricably linked, but there are certain elements—such as symptoms and treatment options—that render these conditions uniquely their own. If you’re experiencing any skin, nail, or joint changes, see your dermatologist ASAP to determine a diagnosis and swift course of action.
- Symptoms of Psoriasis: Mayo Clinic. (2020.) “Psoriasis.” mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840
- PsA Severity: Mayo Clinic. (2019.) “Psoriatic Arthritis.” mayoclinic.org/diseases-conditions/psoriatic-arthritis/symptoms-causes/syc-20354076
- Why Biologics Work: National Psoriasis Foundation. (2020.) “Biologics.” psoriasis.org/biologics/
- Systemic Therapies: National Psoriasis Foundation. (n.d.) “Cyclosporine.” psoriasis.org/cyclosporine/