Tuesday, May 21, 2024

How Do You Diagnose Psoriatic Arthritis

Loss Of Significant Joint Mobility

Diagnosing Psoriatic Arthritis

For example, you were able to flex your wrist 60 degrees, and two years later, you lost 50 percent of that range of motion. Its possible to feel okay and still experience loss of range of motion, says Dr. Domingues. But the idea is to prevent joint damage and to make you have less pain. If you have less pain and are still progressing, that means your treatment could be working better.

How To Talk To Your Health Care Provider About Symptoms

By taking this short screening assessment, the Psoriasis Epidemiology Screening Tool , you may help your health care provider make a diagnosis.

Bring your quiz results and the diagram to your appointment. Circle all of the places on the diagram where your body feels tender or sore. This way, you wonât forget to mention important symptoms. Even if youâre not feeling them on the day of your appointment, you should still bring them up with your provider.

Describe symptoms as precisely as possible. For example, instead of saying, âMy knee hurts,â say âThere is a sharp, piercing pain on the outside of my left knee, under the kneecap.â

Prepare five main questions youâd like to ask your provider. Youâre probably wondering about many things concerning your health right now. Boiling them down to five main questions will help focus your conversation with your provider, and give your provider enough time to give you complete answers.

For example, you could ask about:

  • Symptoms you are experiencing
  • New medications or dietary supplements
  • Information from other health care providers you see
  • Treatments you are interested in
  • How treatments might affect you

Be specific, open and honest. If you donât understand anything your health care provider is saying, speak up. Also, if your provider is recommending a treatment that you donât think is right for you, say so. Itâs OK to ask about other treatment options.

Is There A Test For Psoriatic Arthritis

Although there is no one test for psoriatic arthritis, your doctor may do the following to see if you have the condition:

  • Ask if you have a family history of psoriasis or psoriatic arthritis.
  • Talk to you about your symptoms and give you a physical exam.
  • Take a blood sample to check for other conditions.
  • Order imaging tests.

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Tests To Diagnose Psoriatic Arthritis

Blood Tests

These tests can help confirm psoriatic arthritis and rule out other conditions, like rheumatoid arthritis.

  • Erythrocyte sedimentation rate : Gives a rough idea of how much inflammation is in your body, which could be caused by psoriatic arthritis. But higher levels can come from other autoimmune diseases, an infection, a tumor, liver disease, or pregnancy, too.
  • Rheumatoid factor and anti-CCP antibody: These tests can rule out rheumatoid arthritis. People with that condition may have higher levels of these in their blood.
  • HLA-B27: More than half of people who have psoriatic arthritis with spine inflammation will have this genetic marker. You can get tested to find out if you do.
  • Iron tests: People with psoriatic arthritis may have mild anemia, or not enough healthy red blood cells.

X-Rays

These can show cartilage changes or bone and joint damage that suggests arthritis in your spine, hands, or feet. Psoriatic arthritis usually looks different on X-rays than rheumatoid arthritis does.

Bone Density Scan

Because psoriatic arthritis may lead to bone loss, your doctor may want to measure your bone strength. You could be at risk for osteoporosis and fractures.

Joint Fluid Test

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Racial Disparities In Psa

PSORIATIC ARTHRITIS (PsA) AND WHY WE NEED TO KEEP TALKING ABOUT IT ...

Serious racial disparities exist when it comes to psoriatic arthritis severity and treatment. For example, Black people tend to have more severe:

  • Skin involvement
  • Psychological impact
  • Impaired quality of life

Despite that, they’re less likely than White people to be put on immunosuppressant drugsâthe preferred treatment for PsA.

Studies suggest psoriatic arthritis is diagnosed less often in:

  • People of Asian descent

Disparities mean a higher disease burden and lower quality of life for people with PsA who are in these groups.

Some studies show implicit, often unconscious biases against people of color throughout the healthcare community. This is believed to negatively affect treatment decisions and outcomes.

Some facilities have found that poverty plays a role. But when comparing Black and White people of the same socioeconomic status, outcomes remained worse for Black people.

Researchers have called for more investigation into these disparities and their impact, as well as better education for eliminating bias.

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Psoriatic Arthritis Blood Test: Anemia

When you have psoriatic arthritis, ongoing inflammation may cause anemia, a decrease in healthy red blood cells that can lead to dizziness, shortness of breath, and exhaustion, says Cadet.

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 .

How Can I Find The Appropriate Care I Need

Initially your GP is the first point of contact, who then should refer you on to a dermatologist/rheumatologist, if this is not already the case. If you are not happy with the advice you receive, remember you are always entitled to seek a second opinion. Remember, If you are seeing a dermatologists for your psoriasis and a rheumatologists for your arthritis make sure each is aware of this, so they can liaise and provide you with appropriate care for both conditons.

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Can Psoriatic Arthritis Affect Other Parts Of The Body

Having psoriatic arthritis can put you at risk of developing other conditions and complications around the body.

The chances of getting one of these are rare. But its worth knowing about them and talking to your doctor if you have any concerns.

Eyes

Seek urgent medical attention if one or both of your eyes are red and painful, particularly if you have a change in your vision. You could go to your GP, an eye hospital, or your local A& E department.

These symptoms could be caused by a condition called uveitis, which is also known as iritis. It involves inflammation at the front of the eye.

This can permanently damage your eyesight if left untreated.

Other symptoms are:

  • blurred or cloudy vision
  • sensitivity to light
  • not being able to see things at the side of your field of vision known as a loss of peripheral vision
  • small shapes moving across your field of vision.

These symptoms can come on suddenly, or gradually over a few days. It can affect one or both eyes. It can be treated effectively with steroids.

Heart

Psoriatic arthritis can put you at a slightly higher risk of having a heart condition. You can reduce your risk by:

  • eating a healthy diet, thats low in fat, sugar and salt
  • not drinking too much alcohol.

These positive lifestyle choices can help to improve your arthritis and skin symptoms.

Talk to your doctor if you have any concerns about your heart health.

Crohns disease

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Diagnosis Of Psoriatic Arthritis

Diagnosing and managing psoriatic arthritis

There is no laboratory test for psoriatic arthritis, and the symptoms may closely resemble other diseases such as rheumatoid arthritis. However, our U-M physicians are experts in recognizing psoriatic arthritis. Blood tests, such as a sedimentation rate test or rheumatoid factor test, may help.

When one or two large joints are inflamed, we can use arthrocentesis to take fluid out of the joints. This fluid is then analyzed for infection, gout and other inflammatory diseases.

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The Role Of Psoriatic Arthritis Tests

Psoriatic arthritis testing is used to help diagnose the disease, to evaluate your suitability for certain treatments, and to monitor for treatment effects.

No single test can diagnose or rule out psoriatic arthritis. This disease is diagnosed by a physician who uses a range of information, including:

  • Family and medical history
  • Swollen fingers or toes

If you have symptoms of psoriatic arthritis, it is a good idea to discuss your concerns with your doctor. Early diagnosis and treatment can help prevent the severe joint damage that may occur if the disease progresses.

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.

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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.

Complete Medical History For Diagnosing Psoriatic Arthritis

Psoriatic arthritis in 2020

Your road to a psoriatic arthritis diagnosis starts with talking to your rheumatologist in order to share symptoms and identify risk factors. While symptoms like joint pain could suggest a number of conditions, in psoriatic arthritis, joint pain often has specific characteristics, including the following:

  • Joint pain that gets better with use
  • Joint redness and swelling
  • Swelling of an entire finger or toe as opposed to just one joint, called dactylitis or sausage digits
  • Morning stiffness that lasts more than 30 minutes
  • Changes in the nails of your fingers or toes, such as holes, pitting, discoloration or softness, which occurs in 80 to 90 percent of PsA cases

When patients talk about these psoriatic arthritis symptoms, rheumatologists like Dr. Kumar hear a number of common concerns, such as My shoes dont fit, I feel stiff all over in the mornings, and I have trouble opening jars or door knobs.

Along with listening to your symptoms, your rheumatologist will want to hear about any possible risk factors for psoriatic arthritis. While this condition can affect patients of both genders at a range of ages, the following can increase your risk:

  • Having psoriasis
  • Having a family history of PsA, psoriasis, or associated conditions, including ankylosing spondylitis, Crohns disease, ulcerative colitis, autoimmune uveitis, and reactive arthritis

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When Should I See A Rheumatologist

It is important to see a rheumatologist as soon as possible when you notice signs of psoriatic arthritis . Common symptoms can include stiffness, pain, swelling and tenderness in the joints, tendons or ligaments. You may also experience swelling, fatigue and changes in the nails . Untreated PsA can cause permanent joint damage.

Early diagnosis and treatment can help slow the disease and control symptoms. It can help keep your joints healthy, improve your range of movement, reduce your pain and tiredness, and prevent permanent joint damage.

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Other Tests For Psoriatic Arthritis

Researchers in a 2014 study concluded that three screening tools can help doctors determine whether you may have PsA. These included the Psoriasis and Arthritis Screening Questionnaire , Psoriasis Epidemiology Screening Tool , and Toronto Arthritis Screen .

These screenings require you to complete a questionnaire. Based on your answers, your doctor will determine if you need further care.

Your doctor may refer you to a rheumatologist if they cant make a diagnosis. A rheumatologist is a doctor who specializes in musculoskeletal conditions such as psoriatic arthritis.

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When To Get Medical Advice

See a GP if you have persistent pain, swelling or stiffness in your joints even if you have not been diagnosed with psoriasis.

If youve been diagnosed with psoriasis, you should have check-ups at least once a year to monitor your condition. Make sure you let the doctor know if youre experiencing any problems with your joints.

Psoriatic Arthritis Diagnostic Criteria

How do we diagnose Rheumatoid Arthritis?

It isnât easy to diagnose psoriatic arthritis — many of the symptoms are similar to other conditions. Your doctor has a set of things to look for called criteria. These include:

Classification of Psoriatic Arthritis

This method uses a points system to scale your symptoms. At least 3 points indicates psoriatic arthritis:

  • You have it now = 2 points
  • You had it = 1 point
  • You have a family history = 1 point
  • Nail lesions = 1 point
  • Dactylitis = 1 point
  • Negative rheumatoid factor: You donât test positive for this blood protein that signals rheumatoid arthritis = 1 point
  • Juxta-articular bone formation that shows up on X-ray and isnât bone spurs = 1 point
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    What Are The Symptoms

    Psoriatic arthritis can affect any joint in the body and symptoms can vary from person to person. It can develop slowly with mild symptoms, or come on quickly and be severe. The most common symptoms are:

    • pain, swelling and stiffness in one or more joints
    • pain and stiffness in the buttocks, lower back or neck
    • pain in tendons, such as at the back of the heel or sole of the foot
    • changes in nails, such as thickening, colour change or separation from the skin
    • pain and redness in the eyes.

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    Lifestyle Changes To Manage Psoriatic Arthritis

    Being knowledgeable about your symptoms, triggers, and treatments can help you successfully manage psoriatic arthritis. When flare-ups occur, keep track of what foods you ate, if you were under a lot of stress, whether you had a cut, whether you had a good nights sleep, etc. Knowing what is triggering your symptoms and educating yourself is half the battle. The other half is managing it.

    How can you take control of your symptoms?

    • Take the medications prescribed by your doctor regularly dont skip doses: Skipping or stopping doses of medications prescribed to treat the inflammation and pain associated with psoriatic arthritis may cause a flare-up of symptoms.
    • Be as proactive as you can about cuts and burns: If youre going to be out in the sun, make sure to wear sunscreen to minimize the occurrence of any sunburns. While you cant prevent cuts and scrapes from occurring in everyday life, you can minimize the probability of an accident by being mindful of your activities. Slow down, dont rush, take your time.
    • Get a good amount of sleep: Try to maintain a full 8 hours of sleep per night. Avoid stimulants that might keep you awake at night . If you dont get enough sleep at night, try to plan a good nap to counter the effects of losing sleep.
    • Take things slower: Because fatigue is a common symptom of psoriatic arthritis, take rest breaks often. Break activities into multiple part. Dont overexert yourself.

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    Psoriatic Arthritis Tests And Diagnosis

    The diagnosis of psoriatic arthritis is largely based on your medical history and a physical exam, and laboratory tests may be used to rule out other conditions. During an appointment, your doctor will likely ask you questions about specific skin and joint symptoms and your overall well-being. When evaluating PsA, some doctors may use an index called MDA to assess symptoms. This index is a tool for PsA specialists like rheumatologists and dermatologists to gauge how the disease is affecting you across several key measurements, including joint pain and swelling, skin symptoms, ability to do daily tasks, and more.Psoriatic arthritis can damage joints over time if not controlled, so the earlier you receive a diagnosis and appropriate treatment, the better. If youre currently seeing a dermatologist for psoriasis, and you are experiencing joint pain, tell your doctor. They may refer you to a rheumatologist. If any of these symptoms seem familiar, talk to your doctor.

    About 1 in 3 people with psoriasis may develop PsA.

    What to expect when getting diagnosed with PsA

    Medical history:

    At your doctor appointment, be prepared to answer questions regarding your medical history as accurately as possible. Some of the questions your doctor may ask you will likely include the following:

    • Which joints hurt?
    • Joints at the ends of fingers and toes

    Physical exam:

    During a physical exam, your doctor will look for several symptoms that are commonly associated with psoriatic arthritis:

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