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Psoriatic Disease: Why Some Symptoms Get Missed

Reviewed by Brunilda Nazario, MD on April 21, 2021

By David Chandler, as told to Kara Mayer Robinson

I’ve seen hiccups in the process of diagnosing psoriatic disease. I also know about it firsthand. I’m 62 years old, and I’ve had psoriasis since I was a teenager.

I first got it when I was 15. Not too long after that, when I was 17, I started to have pain in my lower back. I had years of appointments, doctor visits, and tests, but I didn’t discover that I had psoriatic arthritis (PA) until I was 30.

Once, when my psoriasis flared, I decided to see a dermatologist. They recognized I had arthritis and then referred me to a rheumatologist. It was then that I found out I had psoriatic arthritis. So it took more than 10 years to get a proper diagnosis once I started to have symptoms.

My doctor didn’t connect my psoriasis with PA.

If you have psoriatic disease, the sooner you can get an accurate diagnosis, the better. In my case, the slow diagnosis meant I didn’t get the right treatment right away. That left me with joint changes and fused bones, mainly in my feet, back, and neck. Early diagnosis might have helped me avoid the disability that stemmed from that.

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With psoriatic disease, it’s common for symptoms to be missed and diagnoses to take a long time. Symptoms often go unreported or overlooked for a variety of reasons.

I've learned that often comes from a lack of awareness about the link between psoriasis and psoriatic arthritis. You may think of psoriasis as an external disease and arthritis as an internal one. But actually, they’re both autoimmune disorders related to your immune system.

Why Psoriatic Arthritis Symptoms Get Missed

It’s common for doctors to miss psoriatic arthritis, even when you have psoriasis.

People don’t always associate arthritis with psoriasis. You may not think symptoms like joint pain, swelling, and fatigue have anything to do with it. That's especially common with younger people, who are less likely to think that arthritis is something that can happen to them.

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If you see your doctor to assess your psoriasis, you might not think to mention joint changes or swelling because they seem unrelated. Or you may have just one swollen joint, perhaps in your hand or foot, so you might not see that as something that matters.

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But when your joints feel hot and tight, and moving around gets harder, it may be psoriatic arthritis.

When your fingers swell up and start to look like sausages -- very puffed up but solid -- it’s a sign of PA.

Psoriatic arthritis can make basic things difficult, like:

  • Opening and closing buttons
  • Doing work on a keyboard
  • Writing
  • Gripping things like cups, glasses, and knives

If you have trouble with tasks like these, tell your doctor right away.

Why Psoriasis Symptoms Get Missed

On the flip side, if you don’t have skin issues, the possibility that you have psoriasis might slide by. You might ignore skin issues that are signs of psoriasis. That can delay the right diagnosis.

It’s common to misunderstand skin issues. You may think you have dandruff when it’s really scalp psoriasis. It’s also common not to report problems with your nails, which may be nail psoriasis. About half of people with psoriatic arthritis have nail psoriasis.

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If you have only one skin symptom, like nail problems or what you think is dandruff, you may not think it’s something you should talk to your doctor about. But it’s best to let them know about all symptoms you have.

If you have problems with your skin, you may not realize they’re symptoms of psoriasis. Your medical chart may reflect dry skin or eczema. If you see a new doctor, they might not think to ask about signs or symptoms of psoriatic disease.

Other Reasons Symptoms Get Missed

Symptoms of psoriatic disease also go unreported because they can often be vague. Test results or X-rays may not show anything. What you feel may not seem to change much over time. You might dismiss or doubt your symptoms because they’re not obvious or consistent.

Symptoms might also be intermittent -- they may come and go. If you go to the doctor when things like joint pain or swelling aren’t happening, you may not think to tell your doctor about them.

What You Can Do

Report all symptoms to your doctor, regardless of whether you think they’re connected to your psoriasis. Make sure you consider symptoms you’ve had before, even if you don’t have them when you go to your appointment.

Think about your family history. Do any family members have conditions that might have gone misdiagnosed? Do they have symptoms that could relate to psoriasis or psoriatic arthritis?

Remember that psoriasis skin symptoms are a visual sign that something may be wrong with your immune system. So it’s possible you may have other issues, like joint pain and fatigue. If you've had these, talk to your doctor about the possibility of psoriasis and psoriatic arthritis.

WebMD Feature

Sources

SOURCE:

David Chandler, chief executive, Psoriasis and Psoriatic Arthritis Alliance, St. Albans, England.

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