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Why Psoriatic Arthritis Is So Difficult to Diagnose

In 2019, psoriatic arthritis made its prime-time debut on an episode of Keeping Up With the Kardashians, thrusting the chronic disease into the spotlight. Sure, a reality-TV show plotline may not seem to offer the most accurate take, but the depiction of Kim's experience, which was marked by joint pain, psoriatic flare-ups, and major fatigue, was spot-on — after her experience had initially been misdiagnosed for an entire episode. Unfortunately, that's fairly common with this disease, which is often invisible.

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Featured

 Skyrizi: A Breakthrough Biologic for Psoriasis, Psoriatic Arthritis, and Crohn’s Disease

Skyrizi is a biologic therapy that targets a specific protein in the immune system called interleukin-23 (IL-23). IL-23 plays a key role in inflammatory pathways. By selectively blocking this protein, Skyrizi helps reduce inflammation at the source—without broadly suppressing the entire immune system.

 The Burden of Psoriatic Arthritis

For many patients, psoriatic arthritis encompasses not only joint disease but also psoriasis. Our literature review reveals that the emotional toll of the disease can be higher than that of other arthritic conditions. Similar to the other inflammatory rheumatic conditions, PsA is progressive, erosive, and destructive, resulting in diminished functional capacity and poor quality of life.

Articles of Interest

Psoriasis and Psoriatic Arthritis: What’s the Connection?

Surprisingly, many people with psoriasis don’t even know about PsA and, for about 30 percent of patients, it takes more than five years to get diagnosed. This is partly because PsA can easily be misdiagnosed, especially if the person does not have psoriasis. “In this case, it may be missed or mistaken for another type of inflammatory arthritis,” says Dr. Haberman. “If only one joint is involved, such a toe, it can be mistaken for gout.”

Psoriatic arthritis

Psoriatic arthritis (PsA) is a chronic inflammatory joint disease which develops in patients with psoriasis. It is characteristic that the rheumatoid factor in serum is absent. Etiology of the disease is still unclear but a number of genetic associations have been identified. Inheritance of the disease is multilevel and the role of environmental factors is emphasized. Immunology of PsA is also complex.

The Danger of Optimism

This is a bit hard to write, but I think others with illness, especially invisible illnesses might find comfort and company in my words. Yet, I know by putting them out there its a bit counter productive for me, making me a bit more vunerable than I prefer to be, maybe some in my life will feel like I am ‘guilting’ them, that isn’t my intention.

The Winding Road to Psoriatic Arthritis Relief

About 1 in 4 people with psoriasis will also have psoriatic arthritis, according to a 2019 meta-analysis in the Journal of the American Academy of Dermatology.1 But both diagnoses can be hard to come by, particularly for people of color, as widespread racial bias in medical education and research has caused the disease to be often overlooked in people with darker skin tones. “Psoriatic arthritis is often difficult to diagnose in people with darker skin tones because the actual skin psoriasis may be missed,” explains César E. Fors Nieves, MD, rheumatologist and clinical assistant professor in the department of medicine at NYU Langone Health.

The worldwide prevalence of psoriatic arthritis—a systematic review and meta-analysis

There is wide variability between continents, and data in some geographical areas are sparse, but available evidence suggests that PsA is more common in Europe and North America compared with Asia and South America, and current best estimates suggest a global prevalence of 112 per 100 000 adults.

Think Like a Doctor: Hurting All Over

One possibility she was considering was a condition called psoriatic arthritis, or PsA, an unusual and aggressive type of inflammatory arthritis that can affect people with psoriasis. The geographic tongue, the ridged nails, the family history of Crohn’s disease were all seen in psoriatic arthritis. And in PsA, the usual tests for arthritis will be negative.

What is psoriatic arthritis, the condition Kim Kardashian West lives with?

Psoriatic arthritis occurs in one or more joints. It can affect peripheral joints, such as the hands and feet, the spine, and the entheses, where ligaments and tendons attach to bones (such as where the Achilles tendon connects to the heel). In around 40-50% of patients, the entire toe or finger can swell like a small sausage, known as dactylitis. It particularly affects the tips of the fingers and toes, known as the distal joints, as well as the buttocks and lower back.

Why Was Her Thumb Turning Black?

A few years earlier she started to see a rheumatologist, who told her she had something called psoriatic arthritis — an aggressive type of arthritis caused by the body’s immune system, which mistakenly attacks itself. Left untreated, this disease can destroy bone. He started her on strong immune-suppressing medicines, and she did feel better.

Resources

Psoriasis and Psoriatic Arthritis Alliance

To put people with psoriasis and psoriatic arthritis at the centre of care, deserving of recognition and effective management.

The Psoriatic Arthritis Club

You don’t have to manage PsA alone. This podcast can help.

City Girl Flare

A day in the life of a city girl living with psoriatic arthritis.

It's Just a Bad Day

I was officially diagnosed with psoriatic arthritis in January of 2013, but if I was a betting gal I’d guess it first reared it’s ugly head back when I was in 5th grade.

Living with Psoriatic Arthritis

My name is Katinka and I have been diagnosed with PsA for about four years, after 10 years of searching for the right diagnoses. I developed Psoriasis at about 11 years old at about the same time my hair started turning grey. I have tried several medications both before and after diagnoses as well as dozens of natural, and holistic approaches. I am trying to reach a healthy balance between the medications I must take, proper health choices, and managing my energy. Join me on my journey.

Living with Psoriatic Arthritis: Memo to Me

Don't ever give up living a normal life.

National Psoriasis Foundation

Up to 30 percent of people with psoriasis develop psoriatic arthritis, an inflammatory form of arthritis.

Overcoming Psoriasis

Psoriasis and Psoriatic Arthritis.

Psoriatic Arthritis & Ankylosing Spondylitis

This blog details my journey before and after receiving the diagnosis for both Psoriatic Arthritis and Ankylosing Spondylitis. Those with chronic illnesses often suffer from a complex web of conditions, and I am no exception to this rule.

Arthritis.org

Some people might hear “psoriasis” and think of the skin disease that causes itchy, scaly rashes and crumbling nails. It's true, psoriasis is an autoimmune disease that primarily affects the skin. But about 30 percent of people with psoriasis also develop a form of inflammatory arthritis called psoriatic arthritis (PsA).

Versus Arthritis

Biological therapies are newer drugs that may be used if other DMARDs aren’t working well. These are given by injection into the skin or through a drip into a vein (an intravenous infusion).

Rheumatology.org

Approximately 15% of people with psoriasis develop psoriatic arthritis. At times, the arthritis can appear before the skin disorder.

StatPearls

Psoriatic arthritis is a chronic, heterogeneous inflammatory arthritis associated with psoriasis that affects nearly 20% of adults with psoriasis and carries significant potential for joint destruction, functional disability, and reduced quality of life. Despite the availability of validated classification criteria, advanced imaging modalities, and an expanding arsenal of targeted therapies, many clinicians lack the competence needed to recognize the varied clinical presentations of psoriatic arthritis, apply evidence-based treatment algorithms, and effectively manage associated comorbidities.