A case of psoriatic arthritis without the appearance of psoriatic skin or nail lesions for 21 years

Abstract In some patients with psoriatic arthritis, arthritis may precede psoriatic skin lesions. In fact, psoriatic skin lesions may not develop for more than 10 years after the onset of arthritis. Making diagnostic and therapeutic decisions in such patients is therefore challenging. We describe a case with classic features of psoriatic arthritis without psoriatic skin or nail lesions for 21 years. We suggest that recognition of psoriatic arthritis sine psoriasis is important for selecting appropriate therapy to prevent joint damage.