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 psoriatic disease had affected my joints until I was 30.
Once, when my psoriasis flared, I decided to see a dermatologist. They recognized I had joint inflammation and then referred me to a rheumatologist. It was then that I found out I had psoriatic disease involving my joints. So it took more than 10 years to get a proper diagnosis once I started to have symptoms.
My doctor didn’t connect my skin problems with the joint trouble I was having.
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.
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 the skin and joint involvement. You may think of skin lesions as an external disease and joint inflammation as an internal one. But actually, they’re both autoimmune disorders related to your immune system.
Why Psoriatic Disease Symptoms Get Missed
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. 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.
You also may not think symptoms like joint pain, swelling, and fatigue have anything to do with your skin issues. That's especially common with younger people, who are less likely to think that joint pain is something that can happen to them.
It’s best to let your doctor know about all symptoms you have.
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 psoriatic disease?
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 psoriatic disease.
David Chandler, chief executive, Psoriasis and Psoriatic Arthritis Alliance, St. Albans, England.