Can Ms Be Misdiagnosed As Psoriatic Arthritis

Diseases That Mimic Rheumatoid Arthritis

• Frequently Asked Questions

A number of diseases can be similar to rheumatoid arthritis . There is notable overlap between symptoms of RAjoint pain, stiffness, fatigueand those of RA-like rheumatic or autoimmune diseases, other types of arthritis, and some viral and bacterial infections.

Ruling out other conditions that mimic RA, such as Lyme disease, lupus, and fibromyalgia is part of diagnosing RA. This process relies on a combination of your physical examination, medical history, laboratory test results, and imaging studies.

Even after you’ve been diagnosed with RA, your healthcare providers may consider other conditions if your symptoms are still not improving, despite treatment with disease-modifying anti-rheumatic drugs .

Research published in the Annals of the Rheumatic Diseases found that more than 40% of people who were diagnosed with RA actually had a different condition.

It’s also possible that you could have RA and another condition.

Verywell Health / Hilary Allison

What Are Your Next Steps

If you have psoriasis or PsA, you should familiarize yourself with the symptoms of the two key autoimmune thyroid diseases and the conditions they cause:

• Hashimotos thyroiditis and the resulting hypothyroidism

• Graves disease and the resulting hyperthyroidism

Common symptoms of Hashimotos and hypothyroidism include fatigue, weight gain, depression, hair loss, constipation, puffiness, hoarseness, neck discomfort, and brain fog. Common include insomnia, weight loss, anxiety, diarrhea, neck enlargement , muscle weakness, and eye and vision problems.

If you have psoriasis/PsA and notice any of these symptoms, your first step should be a complete thyroid screening and evaluation. This should include:

• A hands-on clinical examination to detect irregularities in the size and shape of your thyroid

• Thyroid blood tests, including a thyroid stimulating hormone ,

• free thyroxine and free triiodothyronine

• Blood tests for thyroid antibodies, including , and

Your physician may also order a to check for the thyroid enlargement or shrinkage commonly seen in autoimmune thyroid disease.

Managing Ms And Immunological Comorbidities

How do you approach the management of patients with multiple sclerosis and another autoimmune condition, such as psoriasis?

Multiple sclerosis is associated with a number of comorbidities, some of which are routinely managed by neurologists, such as headaches and sleep problems. However, neurologists do not typically manage the immunological and rheumatologic comorbidities associated with MS. The treatments of immunologically-mediated conditions may complicate or interfere with the treatment for MS.

Common Immunological Conditions Associated with Multiple Sclerosis

Psoriasis, rheumatoid arthritis, and lupus are some of the immunological conditions that are most often diagnosed in patients with MS. A recent Danish study found that patients with psoriasis have two to three times the incidence of MS when compared to the control population, with a higher association among patients who had worse psoriasis. Similar results link multiple sclerosis with autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus.

Management of Multiple Sclerosis Along with Comorbid Conditions

The mainstay of disease control in MS lies in immunosuppressive treatments, particularly interferons, oral prednisone, and IV steroids. Other immunosuppressive agents are used as well.

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How Is Spondylitis Diagnosed

There is no one test that is conclusive for a diagnosis of spondylitis. Spondylitis is generally diagnosed through a combination of a physical examination, family history, blood tests, and imaging scans. The rheumatologist carefully considers many different test results before concluding that spondylitis is the correct diagnosis or ruling it out.

Different types of spondylitis are diagnosed in slightly different ways. Some types, such as psoriatic arthritis and enteropathic arthritis, may develop in people with established diagnoses of, respectively, psoriasis and inflammatory bowel disease.

How Are Axial Psoriatic Arthritis And Sacroiliitis Diagnosed

Your doctor will ask you about your symptoms and health history. Theyâll give you a physical exam, too. They may ask you to move your body in certain directions and put light pressure on your affected joints.

To diagnose psoriatic arthritis in general, your doctor will probably do X-rays of your painful joints. They might also order an imaging test called an MRI, which makes pictures of the inside of your body. These tests can also help diagnose sacroiliitis.

To rule out other health conditions, the doctor might give you blood tests and have a lab check a sample of fluid from one of your swollen joints.

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Medical Treatment For Uveitis

Table 4. Evidence from clinical trials for class of therapeutic options for uveitis.

Despite implicated in the pathogenesis of uveitis, inhibiting IL-17A was not effective for uveitis. In three RCTs, SEC failed to meet the primary efficacy endpoints . In another RCT comparing three doses of SEC, statistical higher response rates and remission on day 57 for the high dose regimen was seen compared to the other two lower dose regimens, suggesting a higher dose intravenous regimen may be required to deliver SEC in therapeutic concentrations . Results are awaiting for two trials using UST in active sight-threatening uveitis and Behçet uveitis , which may provide insight for its potential use in PsA related uveitis.

Minimal data exist for use of JAKi in uveitis. One phase 2 RCT evaluating filgotinib in patients with active non-infectious uveitis is ongoing.

Unusual Symptoms Of Rheumatoid Arthritis Might Cause Misdiagnosis

RA is not just the inflammation of joints. The autoimmune system causes more harm than you think. Your whole body might start reacting to the immune system and that results in damaging the vital organs.

Thats why you might experience unusual symptoms that are actually related to RA. Some of these symptoms include:

• Hearing problems
• Numbness of fingers and toes
• Gum diseases
• Tingling sensation

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Caspar Criteria For Diagnosis

Diagnosing psoriatic arthritis relies on markers in an established system called the Classification Criteria for Psoriatic Arthritis .

The criteria are each assigned a point value. Each one has a value of 1 point except for current psoriasis, which has a value of 2 points.

The criteria are as follows:

• current psoriasis outbreak
• personal or family history of psoriasis
• swollen fingers or toes, known as dactylitis
• nail problems, like separation from the nail bed
• bone growths near a joint that are visible on an X-ray
• absence of rheumatoid factor

A person must have at least 3 points based on the CASPAR criteria to be diagnosed with psoriatic arthritis.

Can Other Conditions Cause Sacroiliitis

Yes. People who donât have axial psoriatic arthritis can get sacroiliitis for other reasons. Some of the things that can take a toll on the sacroiliac joints and cause sacroiliitis are:

Osteoarthritis. This is the most common type of arthritis, known for its wear-and-tear effect on joints.

Ankylosing spondylitis. This type of inflammatory arthritis affects the spine.

Trauma. This includes things like a fall or car accident.Pregnancy. Either the hormones your body makes or the weight of the baby could affect the sacroiliac joints.

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If Not Rheumatoid Arthritis: What Else Could It Be

You and your doctor should sit together and work to figure out whether the diagnosis is right. If not, then you might have one of the following illnesses.

Please note that its not necessary that you have any of these conditions as all these illnesses need a proper diagnosis for the right treatment.

Whats A Rheumatoid Factor And How Does It Help In The Diagnosis

Rheumatoid factor autoantibody in the blood that should be present in the normal range of 0-20 IU/ml. A higher range of rheumatoid factors indicates any autoimmune disease including RA.

This means if your rheumatoid factor is positive then you MIGHT have rheumatoid arthritis but again, its not a litmus test for RA.

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Limitations Of Existing Studies

An inherent limitation of most studies regarding the relationship between PsO and MS is a small sample size, and often, an observational or retrospective design. Large patient numbers and a reduction in selection bias have been attained in some studies that use nationwide databases, but these databases often introduce a lack of diversity and therefore, limit the ability to extrapolate results to larger, more ethnically diverse populations. A limitation of nationwide database use or electronic medical record systems is also a reliance on correct coding, introducing the possibility of unverified or incorrect diagnoses. In studies that included patient-reported conditions or histories, the potential for ascertainment or reporting bias is large. Some of the above studies also used prevalence data available in the literature, without age and sex matching, instead of obtaining a control population from the same or a similar environment. Meta-analyses are limited by the quality of the studies included and the manner in which the information was obtained or collected in those studies. Psoriasis patients may also receive increased medical attention compared to patients without the disease which could lead to earlier, more frequent diagnoses of comorbid MS.

Things To Know About Psoriatic Arthritis

Learn more about what it means to have psoriatic arthritis.

1. PsA Is an Autoimmune Disease

2. It Has Ups and Downs, Called Flares

3. It Can Be a Master of Disguise

4. It Has Distinguishing Features

5. It Affects Up to a Third of People with Psoriasis

6. Its Gender Neutral

7. It May be Hereditary

8. Its Not Contagious

9. It Isnt Just About Your Joints

10. You May Not Look Sick

11. Effective Treatment is Available

Hello,

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What Are The Treatments For Axial Psoriatic Arthritis And Sacroiliitis

Treatment for axial psoriatic arthritis can get your PsA and sacroiliitis under control. Theyâre not treated separately, Husni says.

If your symptoms are mild, meds called NSAIDs are typically the first treatment doctors try. Some NSAIDs youâve probably heard of are aspirin, ibuprofen, and naproxen.

If you have axial psoriatic arthritis thatâs moderate to severe and NSAIDs are not helping, doctors often prescribe meds called DMARDs . The first type of DMARD they tend to use is called a TNF inhibitor. TNF is a protein your body makes that triggers inflammation. People with psoriatic arthritis have higher levels of it in their blood. A TNF inhibitor lowers those levels, controlling inflammation in your joints and skin.

Areas Of Current And Future Research

The most recently identified potential therapeutic target in inflammatory diseases, including PsO and MS, involves IL-35. IL-35 is a more recently identified member of the IL-12 cytokine family and is secreted primarily by regulatory T cells .86,87 IL-35 is also uniquely an immunosuppressive cytokine that plays a pivotal role in the function of Tregs and their immunoregulatory activity.86 Both PsO and MS, among other autoimmune inflammatory diseases, have abnormal IL-35 expression, making IL-35 a potential new focus of therapeutic strategies.87

Another potential treatment for both MS and PsO in recent literature lies in the properties of mesenchymal stem cells . MSCs have the capabilities of modulating immune properties and exerting anti-inflammatory effects making them an alluring potential therapy in autoimmune inflammatory conditions.88 In a recent study, human embryonic -MSC transplantation resulted in the dramatic reduction of Th1 and Th17 cytokines in mice with imiquimod-induced PsO-like dermatitis.88 There have been a relatively larger number of studies regarding MSC transplantation in the treatment of MS, many of them also showing promise, especially in comparison to current disease-modifying options, for the effective treatment of MS.89 Further studies are needed to determine the efficacy of MSC and the most promising cell origin as a therapy for both MS and PsO.

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Demyelinating Disorders Associated With Anti

Another link between MS and PsO is illustrated with the use of anti-TNF-alpha therapy. TNF-alpha inhibitors are a well-known treatment option for PsO. However, a potential link between TNF-alpha inhibitors and demyelinating disease has been suggested.4044 Demyelinating diseases with possible association to anti-TNF-alpha therapy include MS, optic neuritis, GuillainBarre syndrome, transverse myelitis, and other peripheral neuropathies.42,4547 The use of TNF-alpha inhibitors in PsO patients with a personal history of a demyelinating disorder or with a first-degree relative with MS is not recommended. However, one study has suggested that the number needed to treat in patients with PsO and MS is at least an order of magnitude smaller than the number needed to harm across all comparisons of anti-TNF-alpha therapies and first-degree relative relationships, suggesting TNF-alpha-inhibitor therapy could remain a treatment option for these patients after all other systemic treatment classes have been exhausted, in close collaboration with neurology colleagues, and while weighing the risks and benefits with the patient.48 After all, based on prior studies, it is unclear whether TNF-alpha inhibitors cause MS in patients who may be predisposed or rather unmask MS that would have presented at a later date. Several theories regarding the argument both for and against a pathogenic relationship between TNF-alpha inhibitors and demyelination have been proposed.45

Symptoms And Family History

40 percent of people with psoriasis or PsA had a family member with either psoriasis or PsA.

In the study, those with a family history of PsA had a higher risk for developing deformities from PsA, but a lower risk for developing plaque psoriasis, the red, scaly skin patches that are a common symptom of psoriasis.

Researchers are only now beginning to decipher the specific genes associated with PsA. The main challenge is distinguishing genes responsible for psoriasis from those responsible for PsA.

Identifying the genes that lead to PsA may pave the way toward developing gene therapy for treating PsA.

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Living With Psoriatic Arthritis

Many people with arthritis develop stiff joints and muscle weakness due to lack of use, so proper exercise is very important, as it will improve overall health and keep joints flexible.

Walking is an excellent way to get exercise. A walking aid or shoe inserts will help to avoid undue stress on feet, ankles, or knees affected by arthritis. An exercise bike provides another good option, as well as yoga and stretching exercises to help with relaxation.

Some people with arthritis find it easier to move in water. If this is the case, swimming or walking laps in the pool offers activity without stressing joints.

Many people with psoriatic arthritis also benefit from physical and occupational therapy to strengthen muscles, protect joints from further damage, and increase flexibility.

POINTS TO REMEMBER

Lyme Disease And Rheumatoid Arthritis: Similarities Differences And Why A Misdiagnosis Can Be Deadly

Lyme disease is often misdiagnosed as Rheumatoid Arthritis. Learn what makes the conditions different and the dangers of misdiagnosis.

One of the most common Lyme disease misdiagnoses is Rheumatoid Arthritis , a chronic condition with less clear causes than Lyme disease.. Common Symptoms of Lyme Disease Lyme disease symptoms mimic those of many other tick-borne and non-tick related diseases, making it difficult to diagnose.. Early Lyme Disease Symptoms Fatigue Headache Bulls eye rash, or Erythema Migrans . Many consider RA to be an autoimmune disease , and it can even be a complication arising from Lyme arthritis but not all RA stems from Lyme, just like not all arthritis is RA.. Common Symptoms of Rheumatoid Arthritis Its important to understand how Lyme disease and Rheumatoid Arthritis can both overlap and differ in order to properly understand your risk for either disease.. Comparing and Contrasting Lyme Disease and Arthritis Lyme DiseaseRheumatoid Arthritis Bacterial infection transmitted by ticks Wide range of disparate symptoms that mimic other diseases Joint pain often presents in large joints , on one side of the body Joint symptoms intermittent but may become chronic if disease left untreated Treated with antibiotics Can be a risk factor for RA, especially if allowed to progress and worsen

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Blood Tests For Psoriatic Arthritis

Blood tests in themselves will not confirm a PsA diagnosis. These tests are usually given to determine the presence of inflammation and to rule out other conditions.

Read on to learn what types of blood tests may be given to make a PsA diagnosis.

• Erythrocyte sedimentation rate . This gauges your bodys degree of inflammation, though not specifically for PsA. It measures the amount of red blood cells that settle in a vial of blood, which is greater when you have inflammation.
• C-Reactive protein . Your doctor may order this test to check for an elevated C-reactive protein level. This test is not specific for PsA, but it does indicate the presence of inflammation.
• Rheumatoid Factor . Presence of this antibody in your blood indicates rheumatoid arthritis . Its presence means you dont have PsA.
• Anti-Cyclic Citrullinated Peptide test. These antibodies usually indicate RA. However, their presence can occur in other forms of arthritis, and your doctor will probably test for them.
• Human leukocyte antigen B27 . This is a protein found on the surface of white blood cells in some people with PsA.
• Serum uric acid. Your doctor may take a sample of fluid from your joints to check for uric acid crystals. Elevated uric acid in the blood or crystals in bodily fluids indicate gout.

This Chronic Inflammatory Arthritis Can Have Many Different Symptoms Which Is Why Its So Easy To Misdiagnose And Miss Say Rheumatologists

Like many types of inflammatory arthritis, psoriatic arthritis is an autoimmune disease that affects your joints, causing pain, stiffness, and swelling . Men and women tend to develop PsA in equal numbers, and the first symptoms usually appear when people are between the ages of 30 and 50.

People commonly associate psoriatic arthritis with psoriasis, an autoimmune disease that affects the skin, causing flares of red, silvery plaques, although you dont necessarily need to have psoriasis to develop PsA.

Up to 20 to even 30 percent of patients who have psoriasis will go on to develop psoriatic arthritis, says Rebecca Haberman, MD, clinical instructor of rheumatology at the department of medicine, NYU Langone Health in New York City. But its really only recently that psoriatic arthritis has come to the forefront of both rheumatology and dermatology. Dermatologists dont always know all of the signs or the symptoms of psoriatic arthritis to know when to refer people to a rheumatologist.

That helps to explain why some people with psoriasis arent readily diagnosed with psoriatic arthritis, says Dr. Haberman. In fact, a 2015 study published in the Journal of the American Academy of Dermatology found that about 15 percent of patients with psoriasis had undiagnosed PsA.

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