Psoriatic arthritis without psoriasis?: Hi, does anyone... - NRAS

29,048 members34,573 posts

Psoriatic arthritis without psoriasis?


Hi, does anyone have PsA without any visible psoriasis? This has been raised as a possible diagnosis for me - at the moment I am treated as seronegative RA, but various other conditions get raised a lot as my symptoms and test results are not typical. Could be an ‘as well as RA’ diagnosis or ‘instead of RA’ ie change of diagnosis.

If you have this, what treatment are you on and how effective is it?

Many thanks

32 Replies

I have the same as u hun but don’t have visible rash also have oa I’ve been on methotrexate didn’t agree

With me I have now been on humira injection since December there not doing anything so I shall be trying something new soon x

Thanks, good luck. We have to be so patient waiting for something to work!

Woore in reply to Deejojo

Hi Dee, how long were u on the trexate for? My wife been on it for a few months but nothing but nausea!

Deejojo in reply to Woore

I was on a it 2 months it gave me really bad headaches



I didn't initially have a rash when diagnosed, but later got one. However, I later realised the the scalp issues I'd had were actually psoriasis.

BlightyFiveStar in reply to Hidden

Hi, do you mind if I ask what your scalp issues were? Mine goes through phases of itching, but obviously I can’t see what is in there! My husband has psoriasis so I know what his looks like and I have nothing like it.

Hidden in reply to BlightyFiveStar

Very itchy, lumpy. Always looked like I had dandruff. Sometimes my scalp actually hurt. Then it spread to inside my ears

I have a PsA diagnosis but no psoriasis but my middle son has severe arthritis. I’m on Benepali injections now after failing Humira (worked for 14 months then stopped) Enbrel worked very well but hospital now changed it to biosimilar Benepali although I’m not convinced they are working.


Hi, sorry to hear about your son. That is tough. How did they diagnose PsA without psoriasis, in your case? Thanks

My original diagnosis was steroid neg RA whilst living abroad. MRI of feet showing synovitis, high positive ANA, swelling and pain in many joints, long history of severe back pain ( 20 plus years) and then family history of son having psoriasis. Shortly after my diagnosis of PsA, I was also diagnosed with Lymphocytic Colitis which the rheumatologist told me confirmed his opinion that I had PsA.

My middle son has severe psoriasis not arthritis, lol!


Joharris in reply to Barrister

My original diagnoses was severe erosive OA due to DIP and PIP erroded hand joints since I was 30. I am 52 and was diagnosed with psoriatic arthritis sine ( without psoriasis) at 51 as an ankle a knee hip and spine started being painful and stiff. Was very difficult to get out of bed each day for work. Oh and I have lymphocytic colitis since age 21. Rheumatologist was finally sure of the diagnosis PaA when I developed dactytis, enthesitis, and sacralilitis (inflammation of S1 joint) CRP blood test was .06 when not supposed to be over .03. All other blood tests ok. Seronegative for RA.


I was diagnosed with PsA over 3 and a half years ago and wasn't even aware I had psoriasis. I only had a small patch of itchy scaly skin on palm of my hand and on some on sole of foot but i had put it down to dermatitis.

I have tried various medications including biologics but so far nothing has controlled the inflammation enough for me.

Some people find meds that work almost immediately so fingers crossed you find something that works for you.

Best wishes.

Thanks for reply. Hope you find the right treatment soon.

Hi, I’m in a similar position to you regarding diagnosis . It’s one or the other or both . I don’t have psoriasis but my father does .

I’m on methotrexate and prednisone since January . It’s taken a lot of the stiffness away but still struggling with pain, swelling and fatigue .

I’ve tried sulfasalazine briefly but couldn’t function to look after myself properly let alone my children so stopped that quickly .

Rheumy nurse thinks I will probably need biologicals but have a latent TB infection to treat first ..

Hope any of that ramble helps :)

Thanks, yes I know what you mean with managing children and the illness

Ps good luck with clearing TB and getting new drug

Hi I have recently been diagnosed with this as well as having Osteoarthritis.

Sorry to hear that

I was being treated for Polymyalgia Rheumatica and was getting nowhere, so I got passed to another consultant. All he did was look at my head (scalp) that was it. been treated for it ever since. Chris

Thanks, how do they treat it and is it working?

my psoriasis it doesnt bother me , I only have a few bits. It tends to be the one that builds up on scratches so as long as i dont scratch spots or get scratches im alright. They seem to think that the MTX keeps it under control.

Hope you get sorted , my neighbour has it and his is kept under control now that he is on an Anti TNF injection.


I was diagnosed with polymyalgia and treated with steroids, didn't respond so was diagnosed with various types of arthritis. I tried Hydroxychloroquine, Methotrexate, Benepali, now Humira with Methotrexate plus still on steroids. Nothing seems to work and I had no rash. I have had an itchy scalp for a while and a small bit of eczema on a shoulder that doesn't respond to any of the doctors prescription cream.

Poor you, hope they find the one that works soon. I have also had mixed response. Are you seronegative?

I have been told I was seronegative once, not sure if that is still the case , it was before being told it is PSA. A letter to my doctor also said "Secondary Sjrogrens".

Yes I have had my diagnosis changed to PsA from sero neg RA for now to try cosentyx. It is working and has helped with pain and fatigue. I have no skin involvement and no one in my family has psoriasis. I guess until they figure out what it is we have we fall in to the PsA basket. Probably some completely new form of autoimmune disease!

Thanks for reply. Do you mind saying a bit more about which symptoms led them to change your diagnosis? And how quickly they decided to change approach? I started with typical RA symptoms but now according to the hospital I have a number that could point to PsA. I don’t know enough to know how they distinguish. I am on MTX but not a complete success. Thanks

I have been doing the dance for about 6 years and have tried nearly every DMArD and failed them, enbrel (which worked for more than 12 months then I developed antibodies to it- that was a very sad time) and humira (which they think may have caused pericarditis in me) . So Rheumy said Ok let's change your diagnosis as I had nothing showing on ultrasound re inflammation stuff, but obviously I have something wrong going on with all my symptoms and ESR etc. So started cosentyx, it took 9 months to work, but I know it is as I am off it at present because of surgery. I have no skin issues apart from a bit of dermatitis if I use harsh soap, and no one in my family has any psoriasis. I still think it is a completely new autoimmune disease but they have to plonk us in some group to get treatment.


I’ve got Psa had psoriasis all my life and it is inherit and it also skips generations. Mine is from head to toe normally but since starting methotrexate I’m clear 🙂

I have recently had my diagnosis changed from RA to PsA. I had been on Humira for 2 years due to scleritis and felt wonderful. I had my quality of life back. I came off it in January and had a return of all my old symptoms. I have recently moved so was referred to a new rheumatologist a couple of weeks ago. She changed my diagnosis and apparently I qualify for Humira. Since my teens I have had intermittent psoriasis in my hair and I also have 2 patches on my shins.


They're calling my autoimmune arthritis, psoriatic arthritis, but have never really found any psoriasis. (possibly a small spot of it on some old scar tissue that sometimes is quite itchy) Sadly, nothing has worked so far. (Hydroxycloraquine, Methotrexate, Sulphasalazine, Apremilast, Simponi, Cosentyx, Embrel, Inflectra /Remicade) My rheumatologist also said my diagnosis could be an 'as well as RA' thing. I believe an earlier diagnosis of 'early-onset inflammatory osteoarthritis' for many years kept me from getting treatment early enough to be effective. (some research says the earlier it is diagnosed and treated the more likely treatment will work?) Other Psoriatic 'tests' are atypical with me as well. Could be our disease should have a new name? One that even fewer people have ever heard about :-/

exactly the same as me! Having done lots of reading I think the net result is the same: drugs. Hope you get some answers soon.

Yep. I have psoriatic arthritis but no external signs of psoriasis. Have been on all sorts of Biologics and methotrexate. Am now on Otezla (apremilast) and hydroxychloroquine sulphate xx

You may also like...