Medications For People With Rheumatoid Arthritis
Inflammation in RA is associated with a different interleukin than those in PsA. The IL-6 inhibitor drugs Actemra and Kevzara work against RA, but have not been proven to help with PsA.
In addition, Rituxan and Kineret can be helpful for RA that has not responded to other types of treatment. However, these drugs are not useful in treating PsA.
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.
Treatment Options For Ra And Psa
Because of the differences in disease pathogenesis, clinical manifestations and response to therapy between RA and PsA, treatment strategies may differ. provides a summary of current Food and Drug Administration -approved treatments for RA and PsA. Agents targeting more upstream factors are effective in both PsA and RA, while agents targeting more downstream cytokines are more disease-specific, demonstrating significant efficacy in either RA or PsA , but not in both diseases.
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How Is Psoriatic Arthritis Diagnosed
Psoriatic arthritis is easier to confirm if you already have psoriasis. If you donthave the skin symptoms, diagnosis is more difficult. The process starts with a healthhistory and a physical exam. Your healthcare provider will ask about your symptoms. Youmay have blood tests to check the following:
- Erythrocyte sedimentation rate . This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the bloods proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.
- Uric acid. High blood uric acid levels can be seen in psoriatic arthritis but are not used for diagnosis or monitoring.
- Imaging. X-rays, CT scans, ultrasound, MRI, and skin biopsies may all be used to help diagnosis.
Clinical Characteristics Of Ra And Psa
For RA, the American College of Rheumatology /European League Against Rheumatism classification criteria were designed for patient characterisation and use in clinical trials. The key clinical characteristic is the confirmation of definite, persistent, clinical synovitis in at least one joint. The criteria include the number of joints involved, duration of symptoms, and the demonstration of serological markers and an elevated acute-phase reactant. For PsA, the Classification Criteria for Psoriatic Arthritis help categorise patients with inflammatory articular disease for clinical trials. Key clinical characteristics include a personal or family history of psoriasis, psoriatic nail dystrophy and dactylitis. Neither classification criteria should be confused as diagnostic criteria.
Joint involvement is predominantly symmetric in RA and often, but not always, asymmetric in PsA. In both RA and PsA, most patients have polyarthritis , although joint involvement can be oligoarticular or polyarticular. Monoarticular disease is less common in PsA however, 5%10% of patients may present with isolated distal joint involvement. In PsA, prognosis worsens and symmetry of joint involvement tends to increase as the number of affected joints increases.
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Symptoms Of Psoriatic Arthritis
The severity of the condition can vary considerably from person to person. Some people may have severe problems affecting many joints, whereas others may only notice mild symptoms in 1 or 2 joints.
There may be times when your symptoms improve and periods when they get worse .
Relapses can be very difficult to predict, but can often be managed with medicine when they do occur.
Psoriatic Arthritis Versus Osteoarthritis
Joint pain and stiffness, especially in the morning or after resting, can be a symptom of either psoriatic arthritis or osteoarthritis the most common type of arthritis.
Unlike autoimmune forms of arthritis, osteoarthritis is the result of wear-and-tear damage to cartilage the slippery covering that allows bones to easily slide over each other when joints bend, says the Arthritis Foundation.
Damage to the cartilage can result in bone grinding directly on bone, which causes pain and restricts movement.
Osteoarthritis primarily affects the hands, knees, hips, and spine, and can create a grating sensation, along with popping or crackling, when you use the joint, says the Mayo Clinic. You may also notice hard lumps of bone near the joint or the joint may look distorted.
While psoriatic arthritis symptoms tend to flare and subside, osteoarthritis-related pain and swelling usually become progressively worse over time.
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Pathogenesis Of Ra And Psa
A combination of genetic factors and environmental triggers is thought to elicit autoimmune inflammatory responses in both RA and PsA. The pathogenesis of RA and PsA is not completely understood. In addition to the known association with human leucocyte antigen -DR4 in RA, one theory is the development of lung inflammation, typically prior to joint symptoms, with production of antibodies to citrullinated protein antigens that mediate pathogenesis. Gut dysbiosis has been linked with the pathogenesis of PsA. While there is some overlap in the development of inflammation in PsA and RA, some important differences are evident. For example, in both PsA and RA, HLA alleles have been shown to affect disease susceptibility and severity however, the primary genotypes associated with each disease are different. In PsA, HLA-B27 is associated with the development of enthesitis and symmetric sacroiliitis, and HLA-B08 is associated with joint fusion, asymmetric sacroiliitis and dactylitis. In RA, HLA-DRB1 alleles are associated with disease susceptibility and severity in patients who have positive findings for rheumatoid factor and cyclic citrullinated peptide antibodies.
Pathogenesisof PsA and RA. Reprinted from Coates et al and Perera et al. IFN, interferon IL, interleukin MHC, major histocompatibility complex PsA, psoriatic arthritis Pso, psoriasis RA, rheumatoid arthritis TCR, T cell receptor TGF-, transforming growth factor- Th, T helper TNF-, tumour necrosis factor-.
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.
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Spondylitis With Or Without Sacroiliitis
This occurs in approximately 5% of patients with psoriatic arthritis and has a male predominance.
Clinical evidence of spondylitis and/or sacroiliitis can occur in conjunction with other subgroups of psoriatic arthritis.
Spondylitis may occur without radiologic evidence of sacroiliitis, which frequently tends to be asymmetrical, or sacroiliitis may appear radiologically without the classic symptoms of morning stiffness in the lower back. Thus, the correlation between the symptoms and radiologic signs of sacroiliitis can be poor.
Vertebral involvement differs from that observed in ankylosing spondylitis. Vertebrae are affected asymmetrically, and the atlantoaxial joint may be involved with erosion of the odontoid and subluxation . Therapy may limit subluxation-associated disability.
Unusual radiologic features may be present, such as nonmarginal asymmetrical syndesmophytes , paravertebral ossification, and, less commonly, vertebral fusion with disk calcification.
One Side Or Both Sides
Another difference between the two diseases is whether they affect one or both sides of the body. PsA tends to be asymmetric, meaning it affects different joints on either side of the body. RA is more likely to cause symmetrical joint pain and stiffness it affects the same joints on both sides of the body, such as both hands or wrists.
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Early Diagnosis And Appropriate Treatment
Now the good news: treatment has come a long way in recent years.
There are a number of good treatment paradigms for psoriatic arthritis, and the likelihood of severe deformity like there was in the past is close to zero with the new therapies we have, Hylland says.
There are also effective treatments for managing rheumatoid arthritis. And while its possible to have both psoriatic arthritis and rheumatoid arthritis at the same time, that wont necessarily complicate your treatment plan.
The initial treatments are the same for both, says Bauer, noting that tumor necrosis factor inhibitors work well for both types of arthritis, especially for people who cant take methotrexate, which is another first-line treatment.
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Another med that can be used to treat either RA or psoriatic arthritis is a Janus kinase inhibitor, or JAK inhibitor, like tofacitinib. This type of drug interrupt your immune systems urge to overproduce lots of inflammation-causing proteins called cytokines. They may work better for you than other kinds of drugs and they have the bonus of being available in pill form, rather than an injection or infusion.
With either condition, its crucial that you dont ignore the symptoms until they become very severe. Early diagnosis is critically important for slowing the progression of these diseases.
The earlier we catch it, the less we have to do to quiet itthe less medication we have to use it quite it, says Hylland.
Whats The Outlook For Someone Living With Arthritis
Since theres no cure for arthritis, most people need to manage arthritis for the rest of their lives. Your healthcare provider can help you find the right combination of treatments to reduce symptoms. One of the biggest health risks associated with arthritis is inactivity. If you become sedentary from joint pain, you may face a greater risk for cancer, heart disease, diabetes and other serious conditions.
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What Causes Psoriatic Arthritis
The cause of psoriatic arthritis is unknown. Researchers suspect that it develops from a combination of genetic and environmental factors. They also think that immune system problems, infection, obesity, and physical trauma play a role in determining who will develop the disease. Psoriasis itself is neither infectious nor contagious.
Recent research has shown that people with psoriatic arthritis have an increased level of tumor necrosis factor in their joints and affected skin areas. These increased levels can overwhelm the immune system, making it unable to control the inflammation associated with psoriatic arthritis.
What Is Psoriatic Arthritis
Youve likely heard of psoriasis. And youve likely heard of arthritis. But, have you ever heard of psoriatic arthritis? If you havent, you should. Its one of the most common types of arthritis, right behind osteoarthritis and rheumatoid arthritis. Although all three types of arthritis have overlapping symptoms, one of the most distinguishing characteristics of psoriatic arthritis is that 85% of individuals living with this disease also have psoriasis.
Equally affecting men and women, psoriatic arthritis most often has an onset in adults between the ages of 30 and 50. While juvenile psoriatic arthritis can occur, it is far less common. Does this mean if you have psoriasis that you will also develop psoriatic arthritis? Not necessarily, but your chances do increase significantly. Around 30% of individuals who experience psoriasis will go on to develop psoriatic arthritis.
The symptoms of psoriatic arthritis include the classic joint pain and inflammation. But, individuals living with the disease may develop problems such as tendonitis, generalized fatigue, dactylitis , heel pain, back pain, nail pitting, and reduced joint mobility. While there are five different types of psoriatic arthritis, the most common type affects joints asymmetrically. In contrast, rheumatoid arthritis typically affects joints symmetrically that is, the same joints on both sides of the body.
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What Are The Symptoms Of Psoriatic Arthritis And Rheumatoid Arthritis
Most people who develop psoriatic arthritis show the skin symptoms of psoriasis first, although some individuals experience PsA without ever having psoriasis symptoms. About 30 percent of people with psoriasis will eventually develop PsA.
The severity of a persons psoriasis symptoms is not linked to the severity of their PsA symptoms. Some people may have severe psoriasis skin lesions but mild PsA symptoms, and others may have mild skin lesions but severe PsA joint pain.
Can Imaging Exams Detect Arthritis
Imaging exams can help your healthcare provider get a clear picture of your bones, joints and soft tissues. An X-ray, MRI or ultrasound can reveal:
- Bone fractures or dislocations that may be causing you joint pain.
- Cartilage breakdown around your joints.
- Muscle, ligament or tendon injuries near your joints.
- Soft tissue inflammation.
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Causes Of Psoriatic Arthritis
Almost 1 in 3 people with psoriasis also have psoriatic arthritis.
It tends to develop 5 to 10 years after psoriasis is diagnosed, although some people may have problems with their joints before they notice any skin-related symptoms.
Like psoriasis, psoriatic arthritis is thought to happen as a result of the immune system mistakenly attacking healthy tissue.
But it’s not clear why some people with psoriasis develop psoriatic arthritis and others do not.
Are People With Psoriatic Arthritis At Greater Risk For Covid
This is an ongoing area of research.
The National Psoriasis Foundations guidance says that it is not known with certainty if having psoriatic disease meaningfully alters the risks of contracting SARS-CoV-2 or having a worse course of COVID-19 illness. It notes that existing data, with some exceptions, generally suggest that patients with psoriasis and/or psoriatic arthritis have similar rates of SARS-CoV-2 infection and COVID-19 outcomes as the general population.
The ACRs guidance says that autoimmune and inflammatory rheumatic disease patients are at higher risk for being hospitalized due to COVID-19 and having worse outcomes compared to the general population.
However, this is likely affected by factors such as age, other comorbidities such as heart disease or obesity, which is common in PsA, and taking steroid medications, rather than simply having psoriatic arthritis alone.
Some data suggests that patients with inflammatory rheumatologic diseases who get COVID-19 may have higher risk of developing serious complications, depending on their disease activity and other medical conditions such as high blood pressure, diabetes, and chronic kidney and lung disease, adds Dr. Zhu.
For more information, check out this summary of research on inflammatory arthritis and rheumatic disease patients and their risk for COVID-19 complications.
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Radiographic Features Of Ra And Psa
Use of imaging can provide important information to help practitioners identify and differentiate between types of inflammatory arthritis. Conventional radiography can be used to identify juxta-articular bony proliferations, which can be used to help discern PsA from other types of inflammatory arthritis, and to visualise osteodestructive lesions characteristic of RA. Other characteristic radiographic changes observed in patients with severe PsA are bone resorption, pencil-in-cup deformities and ankylosis. However, conventional radiographs are not as sensitive as ultrasound or MRI for detection of bone erosions and may not help clinicians detect soft-tissue changes well. Additionally, in our experience, radiologists will often report changes consistent with osteoarthritis in patients with PsA, and it is necessary for rheumatologists to interpret these findings in the proper clinical context.
Ultrasound imaging can be used to identify characteristic features of inflammatory arthritis, including enthesitis, cortical bone erosions, cartilage lesions, synovitis and tenosynovitis. Bone erosions are an important diagnostic criterion of RA that can be identified based on intra-articular discontinuity of the bone surface. Ultrasound evaluations of bone erosions are more reliable for joints that are easily accessible than for carpal or tarsal bones, which cannot be viewed circumferentially.
What Are Beneficial Diet Plans For Psoriatic Arthritis
Youre no stranger to the fact that there are multiple diet plans in the market. These include fad diets, low-carb diets, heart healthy diets, lemonade diets, juice diets, and the list goes on. Is there a specific diet plan for individuals living with psoriatic arthritis to follow? There are several, actually.
- Paleo diet: Also known as the Caveman Diet, the Paleo diet avoids grains, nuts, processed foods, and dairy. Key staples of the Paleo diet include fish, eggs, meat, fruits and vegetables . The benefits of this type of diet for individuals living with psoriatic arthritis is that the main staples of the Paleo diet can reduce swelling often caused by processed and sugary foods and dairy.
- Anti-inflammatory diet: One of the most prevalent symptoms of psoriatic arthritis is joint inflammation. Eating foods with anti-inflammatory properties can reduce swelling. Fatty fish, leafy greens, and a variety of fruits are great food choices for less inflammation.
- Weight loss diet: To lose weight, you need to limit your intake of carbohydrates, sugars, and fats. Keeping your weight down keeps pressure off of your joints. Additionally, individuals who are overweight tend to have more severe forms of arthritis and are more prone to develop psoriatic arthritis.
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Similiarities Between Psa & Ra
Taking a large step back, these two could be completely indistinguishable, leading to much confusion. It isnt until we really scrutinize what someone is going through on a daily basis, that we can really tell them apart. From a further away standpoint however, both PsA and RA possess many of the same defining features:
- Both PsA and RA are auto-immune conditions: This means that the body mistakenly attacks its own healthy cells in both conditions. This is why individuals with RA and PsA both experience erosive joint symptoms, such as swelling, pain, and stiffness, as well as chronic fatigue from an immune system working in overdrive.
- Both affect internal organs: Long-term progression of both PsA and RA can lead to scarring, inflammation, and damage to major internal organs, such as the heart and lungs. This process is incredibly similar in both!
- Accompanying osteoporosis: Both PsA and RA can lead to a weakening of bones, otherwise known as osteoporosis. This can make additional fracturing of bones or joints incredibly easy for individuals with PsA and RA.
- Similar treatment algorithms: Treatment of RA and PsA can be virtually identical at times, and include anti-inflammatory medications , corticosteroids, DMARDS , and even surgery to stabilize affected joints in serious cases.