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Why Early Psoriatic Arthritis Diagnosis is Critical

Talking to your provider about joint pain, stiffness, and swelling may mean better treatment and less damage.

doctor speaking with a patient about their diagnosis

Medically reviewed in September 2022

Updated on September 29, 2022

If you have psoriasis and start to notice joint pain, stiffness, or swelling, it’s time to make an appointment with a healthcare provider (HCP). Your symptoms may point to psoriatic arthritis (PsA), in which case it’s critical to get a diagnosis and begin a treatment plan sooner rather than later. Waiting to get treatment could put you at risk of permanent joint damage.

A 2015 Irish study published in Annals of the Rheumatic Diseases analyzed 283 people with PsA to see how long a diagnosis took, and what effect a delay had on their condition. Of that group, 30 percent were diagnosed within six months of developing symptoms. Another 30 percent took more than two years to get help. The rest landed somewhere in between.

The study showed that a holdup of six months made people more likely to experience bone and joint damage, deformity, and disability. Worse, once people with PsA did get treatment, the treatments didn’t work as well for them. Those who were diagnosed more than a year after symptom onset were less than half as likely to achieve drug-free remission of their arthritis. 

Many different factors can lead to delays. In one study published in The Journal of Rheumatology in 2021, a team of researchers examined diagnostic delays in 164 PsA cases from 2000 to 2017. Just 23 percent of patients received a formal diagnosis of PsA within six months of symptoms onset. After two years, only 45 percent had been diagnosed. 

Among the factors contributing to a delayed diagnosis of more than two years were younger age, a high BMI, and having enthesitis, or inflammation at the point a tendon or ligament attaches to bone.

Common symptoms of psoriatic arthritis
Psoriatic arthritis affects up to 30 percent of people with psoriasis, an autoimmune disorder that causes patches of itchy, scaly and painful skin. Many people develop PsA about 10 years after their psoriasis, according to the National Psoriasis Foundation. In some cases, it begins before skin symptoms appear, and in others, skin symptoms never appear at all. While PsA can occur at any point in your life, it often starts between ages 30 and 50.

Symptoms of PsA can manifest suddenly or at a very slow rate over a number of years. If you think you may have developed the condition or are at risk because of your psoriasis, watch for the following:

  • Pain, swelling, and throbbing in your hands and feet, particularly in the joints nearest the tips of your fingers and toes
  • Dactylitis, or severe swelling that causes fingers or toes to look like sausages
  • Pain and stiffness in the spine, buttock, or larger joints
  • Enthesitis
  • Decreased range of motion
  • Fatigue, which may be worst in the morning 
  • Eye redness and pain
  • Changes in your nails, including white spots, pitting, cracking, or nails separating from nail beds

When to see the healthcare provider
If joint pain has started, make an appointment with your HCP as soon as possible. They can discuss your symptoms and condition and then refer you to the appropriate specialist—a rheumatologist—to help treat your possible psoriatic arthritis.

Let your HCP and the rheumatologist know how often you have pain, how long it lasts, where it’s located, and how intense the pain can be. These will help them assess your symptoms correctly and make a proper diagnosis, which will lead to treatment and potentially, a better outcome.

Article sources open article sources

Haroon M, Gallagher P, & FitzGerald O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Annals of the Rheumatic Diseases. 2015;74(6), 1045-1050.
Karmacharya P, Wright K, Achenbach S, et al. Diagnostic delay in psoriatic arthritis: a population-based study. The Journal of Rheumatology. 2021;48(9), 1410-1416.
National Psoriasis Foundation. What is Psoriatic Arthritis (PsA)? Page last reviewed: June 2, 2022.
Arthritis Foundation. Psoriatic Arthritis. Accessed September 28, 2022.
Mayo Clinic. Psoriatic arthritis. October 2, 2021.
Viwari V & Brent LH. Psoriatic Arthritis. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

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