Imaging Tests For Psoriatic Arthritis
Imaging tests can help your doctor closely examine your bones and joints. Some of the imaging tests your doctor may use include:
- X rays. X-rays arent always useful in diagnosing early stage psoriatic arthritis. As the disease progresses, your doctor may use imaging tests to see changes in the joints that are characteristic of this type of arthritis.
- MRI scans. An MRI alone cant diagnose psoriatic arthritis, but it may help detect problems with your tendons and ligaments, or sacroiliac joints.
- CT scans. These are used primarily to examine joints that are deep in the body and not easily seen on x-rays, such as in the spine and pelvis.
- Ultrasounds. These tests can help determine the progression of joint involvement and pinpoint the location.
Living With Psoriatic Arthritis
There is no cure for psoriatic arthritis. However, by understanding the disease and knowing what to expect, you can learn different ways to complete daily tasks or plan activities at times of the day when you are least bothered by its effects. Once you understand and learn to predict the ways in which your body responds to the disease, you can use exercise and therapy to help decrease discomfort, stress and fatigue.
There is a significant list of comorbidities related to PsA. These include these 11 conditions:
Who Is At Risk For Psoriatic Arthritis
Psoriasis affects 2-3 percent of the population or approximately 7 million people in the U.S. and up to 30% of these people can develop psoriatic arthritis. Psoriatic arthritis occurs most commonly in adults between the ages of 35 and 55 however, it can develop at any age. Psoriatic arthritis affects men and women equally.
It is possible to develop psoriatic arthritis with only a family history of psoriasis and while less common, psoriatic arthritis can occur before psoriasis appears. Children of parents with psoriasis are three times more likely to have psoriasis and are at greater risk for developing psoriatic arthritis. The most typical age of juvenile onset is 9-11 years of age.
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Imaging Studies For Diagnosing Psoriatic Arthritis
In addition to laboratory tests, imaging studies can help your rheumatologist see whether the appearance of your bones and tissues suggests you could have PsA or another condition. Depending on your case and circumstances, your doctor may order one or more of the following tests:
X-ray: A radiograph image of your affected joints as well as your spine if that appears to be affected will help your doctor see marginal bone erosions, which means bone being eaten away where it meets a ligament or tendon. This would suggest PsA. Ankylosis may also be seen in very severe PsA. But a negative X-ray may simply mean the PsA is in an early stage, so additional imaging could be needed.
Ultrasound: A sonogram of the affected joints can help your doctor see disease activity and damage in tendons and ligaments. In cases of psoriatic arthritis, your doctor may see inflammation of tendons and joints or erosions where bone has been eaten away by immune cells.
MRI: Magnetic resonance imaging can be especially helpful in allowing your doctor to investigate back pain you might have associated with PsA.
Chances are, if youre seeing a rheumatologist because you have concerns about having psoriatic arthritis, youve already seen quite a few different doctors or health care providers by now. We know this process can be exhausting and exasperating. We are here for you to help make things easier.
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Does Medicare Cover The Cost
The costs of different types of blood tests may vary. Medicare generally covers all or part of the cost for blood tests. Most blood tests are bulk billed, so you dont have to pay anything. Check with your doctor about how much the blood test will cost and whether Medicare will cover all or part of the amount.
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Key Points About Psoriatic Arthritis
- Psoriatic arthritis is a form of arthritis with a skin rash.
- Psoriasis is a chronic skin and nail disease. It causes red, scaly rashes and thick, pitted fingernails. The rash may come before or after the arthritis symptoms.
- Psoriatic arthritis causes inflamed, swollen, and painful joints. It happens most often in the fingers and toes. It can lead to deformed joints.
- Treatment may include medicines, heat and cold, splints, exercise, physical therapy, and surgery.
What Are The Symptoms Of Psoriatic Arthritis
The symptoms of psoriatic arthritis may be gradual and subtle in some patients in others, they may be sudden and dramatic. It may be mild, affecting only one joint or can be severe, affecting multiple joints. Not all patients experience all symptoms.
The most common symptoms of psoriatic arthritis are:
- Pain or aching, tenderness, and/or swelling in one or more joints – most commonly hands, feet, wrists, ankles, knees.
- Joint stiffness most notable in the morning or with prolonged inactivity such as sitting for a long time.
- Reduced range of motion in affected joints.
- Pain or stiffness in the lower back.
- Tenderness, pain, or swelling where tendons and ligaments attach to the bone , such as the Achilles tendon of the heel.
- Swelling of an entire finger or toe with a sausage-like appearance .
- Silver or gray scaly spots on the scalp, elbows, knees, and/or the lower spine.
- Small, round spots called papules that are raised and sometimes scaly on the arms, legs and torso.
- Pitting of the nails.
- Detachment or lifting of fingernails or toenails.
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A Thorough Medical History
Your personal medical history is an important factor to consider when diagnosing PsA. Your doctor will ask questions about your symptoms, including their severity and when you first noticed them.
Additionally, your doctor will ask about any personal or family history of psoriasis, PsA, and other autoimmune conditions. Psoriasis may increase your chances of developing PsA, and both conditions can run in families.
Having a family history of autoimmune diseases may also increase your personal risk of developing PsA even if your parents or relatives have other types of autoimmune conditions.
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Access To Care Challenges
Serious racial disparities exist when it comes to access to care, both when it comes to psoriatic arthritis and in general.
Studies show differences in psoriatic arthritis based on skin color and race. For example, Black people tend to have more severe:
- Skin involvement
Despite that, they’re less likely than White people to be put on immunosuppressive drugs.
Furthermore, according to 2021 research, psoriatic arthritis is diagnosed less often in:
- Black people
- People of Asian descent
- Latinx people
People in these groups who have psoriatic arthritis often have a higher disease burden and lower quality of life because of disparities in care.
Some studies show implicit, often unconscious biases against people of color throughout the healthcare community. This is believed to have negative effects when it comes to treatment decisions and outcomes.
Some facilities have looked at disparities in their own patients. They found that poverty plays a role. But when comparing Black and White people of the same socioeconomic status, it became clear that outcomes remained worse for Black people.
Researchers call for more investigation into the impacts and disparities caused by bias in the medical profession and better education aimed at eliminating these issues.
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Types Of Psoriatic Arthritis Tests
If your doctor suspects you may have psoriatic arthritis, a number of tests may be used to help diagnose psoriatic arthritis and rule out other conditions. Several tests are designed to detect antibodies, which are proteins that help coordinate immune responses. The table below lists tests that are often used during the process of diagnosing psoriatic arthritis:
|Tests Related to Diagnosing Psoriatic Arthritis|
|Detects and measures a number of substances in urine||Excess protein in the urine is common in PsA.|
Imaging tests are commonly used in the diagnosis of psoriatic arthritis. They can detect certain types of joint damage and deformity that are more common in psoriatic arthritis than in other joint diseases. X-rays are most typically used, but other tests like MRIs and CT scans may also be ordered.
Many doctors use the Classification of Psoriatic Arthritis criteria to make a diagnosis of psoriatic arthritis. This tool takes into account many typical features of psoriatic arthritis, such as skin psoriasis, nail lesions, swelling of the fingers or toes, a negative rheumatoid factor test, and new bone formation seen on imaging tests.
If psoriatic arthritis is diagnosed, your doctor may order additional lab tests before you begin treatment. Health issues such as heart disease, kidney or liver abnormalities, or infections may be taken into consideration when your treatment is planned. Sometimes, infections will be treated before treatment begins.
Diagnosis Involves A Process Of Elimination
To diagnose you with psoriatic arthritis, healthcare providers use your medical history, a physical examination, and X-rays or other imaging studies.
If it’s not adequately treated, it may lead to permanent joint damage and disability.
Psoriatic arthritis can be well managed with certain medications. But treatments for other types of arthritis aren’t effective against psoriatic arthritis. That makes getting an accurate diagnosis extremely important.
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Inflammation And Other Forms Of Arthritis
Some infections can lead to joint destruction and this occurs much quicker than with other forms of arthritis. It is crucial to rule out an infection when arthritis affects a single joint.
Gout: A common and painful condition that affects the joints and tendons. Small crystals of uric acid form in and around the joint which causes inflammation, pain and swelling. An attack of gout usually comes on very quickly, often overnight. The joint becomes red, swollen and painful. It often affects one joint at a time, such as the big toe.
Inflammation: A localised physical condition in which part of the body becomes reddened, swollen, hot, and often painful. Inflammation is a common symptom of arthritis, and is the cause and the result of all forms of arthritis.
This info sheet was reviewed and updated by Prof. Susanna Proudman, Medical Director, Arthritis Australia and Dr Stephen Adelstein, Pathology Awareness Australia ambassador.
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Having Psoriasis Isnt Always A Reliable Clue
Around 70 percent of people with psoriatic arthritis develop psoriasis first, but in the other 30 percent of the time, the arthritis and skin symptoms occur around the same time, people have psoriasis but dont realize it, or the psoriasis may develop later on after the arthritis-like symptoms show up. Some people can develop psoriatic arthritis without having psoriasis.
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You Can Have Psoriasis And A Different Kind Of Arthritis That Is Not Psa
People with psoriasis can develop different types of arthritis including rheumatoid arthritis, gout, osteoarthritis, and reactive arthritis so diagnosing PsA involves ruling out those other conditions.
Its often difficult to say in a first visit whether a patient definitely has psoriatic arthritis or another type of arthritis that just co-exists with psoriasis, says Dr. Kumar. PsA can take a long time to diagnose because a patient can delay seeing the doctor, then confirming PsA can require multiple labs and imaging tests.
The good news is that the diagnosis process for psoriatic arthritis is improving. Whereas PsA wasnt even recognized as a distinct condition decades ago , doctors are now better equipped with improved lab tests and imaging studies that help identify this disease so more patients can find relief.
What Are The Symptoms Of Psoriasis
There are different types of psoriasis. The most common is chronic plaque psoriasis. This causes patches of red, raised skin, with white and silvery flakes.
It can occur anywhere on the skin, but most commonly at the elbows, knees, back, buttocks and scalp.
Psoriasis can cause small round dents in finger and toe nails, this is known as pitting. Nails can also change colour, become thicker and the nail may lift away from your finger.
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Will Drug Treatments For Psoriatic Arthritis Make My Psoriasis Worse
Some drug treatments may make psoriasis worse, but then again, some can also make it better too. Before you start any treatments offered, discuss this both with your dermatologist and rheumatologist. DONT FORGET to politely request that both consultants let each other know of your treatment regimes, this helps both of them evaluate your treatment and any side effects that you may be likely to experience. Some people find that when their psoriasis is bad their arthritis is also bad and as one improves, so does the other. This most often occurs when the skin and joint disease start simultaneously. Some of the arthritis treatments also help the skin and this is can help the doctors decide which is the best drug to use.
Blood Tests For Psoriatic Arthritis
Diagnosing psoriatic arthritis can be a complicated process. In some cases, a doctor can make an initial diagnosis based on medical history and a physical exam. If a person already has the skin symptoms associated with psoriasis and begins experiencing joint pain, the odds that they have PsA are relatively high. But identifying psoriatic arthritis isnt always simple. And while PsA usually starts about a decade after psoriasis, it has been found to appear before the skin condition in about 15 percent of cases. When this occurs, doctors will need to run blood tests to rule out other types of arthritis and inflammatory conditions before making a psoriatic arthritis diagnosis.
When you attend your diagnostic appointment, your rheumatologist will likely draw some blood and conduct routine tests to make a PsA diagnosis. A few of the most common blood-based screenings are listed below.
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Does Psoriatic Arthritis Hurt All The Time
PsA causes painful joint and skin symptoms, which can reduce quality of life and interfere with daily activities. The pain tends to be worse when the condition is active. Doctors may prescribe one or more DMARDs to reduce disease activity and relieve symptoms such as pain.
What autoimmune disease is seronegative? Here, we analyze briefly the meaning of autoantibody negativity in the seronegative autoimmune diseases, focusing in particular on the specificities associated with systemic lupus erythematosus, antiphospholipid syndrome, and rheumatoid arthritis.
Is seronegative arthritis an autoimmune disease?
Rheumatoid arthritis is an autoimmune disease that attacks the bodys joints and other parts of the body. Seronegative rheumatoid arthritis is a type of rheumatoid arthritis in which certain antibodies are not present in the blood .
What are the symptoms of seronegative arthritis? The symptoms of seronegative RA are similar to those of seropositive RA. They include: tenderness, swelling, and redness in the joints. stiffness, especially in the hands, knees, ankles, hips, and elbows.
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When To Seek A Diagnosis
Aches and pains in your joints may be a sign of psoriatic arthritis . This is a chronic inflammatory condition that benefits from early diagnosis and treatment. You should see your doctor if you have symptoms of PsA. There are no specific tests to confirm PsA, but your doctor can use several diagnostic methods to determine your condition.
Symptoms of PsA include:
- pain and inflammation in the joints
- stiffness and tiredness, particularly in the morning
- mood swings
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Psoriatic Arthritis Blood Test: Anemia
By measuring your blood levels of hemoglobin , your doctor can determine if you have anemia. A normal reading for women is 12 to 16 grams of hemoglobin per deciliter of blood 14 to 18 grams is normal for men, according to the Mayo Clinic.
If blood work reveals anemia, your doctor will give you an exam and other blood tests to find the cause. In people with psoriatic arthritis, treatments that reduce inflammation also help with anemia, explains Cadet.
Frequency of Testing Doctors may order tests to be done several times a year to see if the anemia has worsened or improved.
Additional reporting by .
Psoriatic Arthritis Imaging Test: Chest X
Doctors often order a chest X-ray in conjunction with a TB test to increase the chance of detecting infection, says Cadet. The X-ray may show scarring from prior exposure to TB, or if theres an active or new infection, she explains.
Frequency of Testing As with the TB skin test, doctors may order a chest X-ray prior to prescribing biologics, repeating the test annually as long as the patient is taking the medication, says Cadet.
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Psoriatic Arthritis Blood Test: Serum Uric Acid
Uric acid is a substance that forms when the body breaks down purines, which are found in human cells and many foods, according to the Arthritis Foundation. Elevated blood levels of uric acid are sometimes identified in people with psoriatic arthritis and can also be linked to gout, heart disease, and high blood pressure, according to Cadet.
Frequency of Testing Testing may be done several times a year, says Cadet.