Tuesday, September 27, 2022

How To Get Diagnosed With Psoriatic Arthritis

Psoriatic Arthritis Blood Test: Anemia

Diagnosed with Psoriatic Arthritis

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 .

What Is Psa And Why Is It So Hard To Get Diagnosed

PsA is a type of arthritis in which the immune system attacks the joints by mistake, leading to painful symptoms like stiffness and swelling. Its associated with psoriasis, which is an inflammatory skin condition that can cause scaly patches on the body, says Minna Kohler, M.D., director of the rheumatology musculoskeletal ultrasound program at Massachusetts General Hospital in Boston.

Most people are diagnosed with psoriasis years before they get diagnosed with PsA, Dr. Kohler says. The majority of people with PsA have psoriasis and while its not super common, its also possible to have PsA without having psoriasis, says the NPF. That said, having psoriasis doesnt guarantee you will get PsA: Only about 30% of people with psoriasis also develop PsA.

Often, PsA is misdiagnosed as something else, delaying your ability to get the treatment you need. This is particularly likely if you dont have obvious psoriasis symptoms, or youre in the 15% of people with PsA and psoriasis whose arthritis symptoms show up before any skin symptoms, according to the arthritis nonprofit Creaky Joints. Without those skin manifestations, it can be tricky to pinpoint PsA as the cause of your symptoms.

There are a few key reasons why PsA gets misdiagnosed, whether you have psoriasis or not. For one, theres no blood test that specifically tests for PsA, says Dr. Kohler. The other main factor is that PsA symptoms can look a heck of a lot like other diseases.

Getting Tested For Psoriatic Arthritis

Testing for psoriatic arthritis is ordered by your doctor or a specialist, such as a rheumatologist, a doctor who specializes in joint diseases, or a dermatologist, a doctor whose specialty is treating the skin. Blood and urine specimens used in testing can be provided in a doctors office or laboratory.

Synovial fluid analysis involves collecting a small amount of joint fluid using a process called arthrocentesis. During this procedure, a needle is used to withdraw fluid from the space around a joint. It is usually done at a doctors office.

Some diagnostic imaging tests, like x-rays, may be done in a doctors office. Others may need to be performed at an imaging center or hospital radiology department.

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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.

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:

  • Tender, painful, or swollen joints
  • Pain in your feet, ankles, and lower back
  • An indication of psoriasis
  • Dactylitis
  • Enthesitis

Laboratory tests and imaging procedures:

Your doctor may order tests and procedures to help rule out other diseases or confirm your diagnosis. Some of these tests may include:

Which Dmards Are Used To Treat Psoriatic Arthritis

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The following are some of the medications that doctors often use to treat psoriatic arthritis. Your doctor will recommend certain treatments based on the involved joints and organs, as well as severity, allergies, and other medical conditions you may have.

Ive broken down the different medications into the following broad categories.

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Shortage Of Rheumatologists May Be Worsening The Problem

Even if a persons primary care doctor or another physician suspects psoriatic arthritis and makes a referral to a specialist, a shortage of rheumatologists could lead to a delay in diagnosis. It can be difficult to get an appointment sometimes thats a bit of an obstacle for some people, says Rosian.

The 2015 Workforce Study of Rheumatology Specialists found there were 14 percent fewer full-time rheumatologists than would be considered ideal, a problem expected to worsen over time. By 2030, the study projected the number of full-time rheumatologists would decrease from 5,415 to 4,133.

During this same time period, the adult patient demand for arthritis care is expected to increase between 25 and 50 percent, mainly due to the growing and aging U.S. population.

The researchers calculated that by 2030, the number of rheumatologists will be half of what is considered optimal.

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.

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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.

Past Research And Achievements In This Area

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In 2015, research led by our centre for genetics and genomics at the University of Manchester identified genetic variants associated with psoriatic arthritis, but not with psoriasis or rheumatoid arthritis. This helped to establish psoriatic arthritis as a condition in its own right. The findings could lead to the development of drugs specifically for psoriatic arthritis.

Later in the same year, our TICOPA trial looked at the benefits of early aggressive drug treatment for people with psoriatic arthritis followed by an increase in drug dosage if initial treatment isnt working. The trial found that patients treated this way, required fewer hospital- and community-based services than patients receiving the standard care.

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Axial Inflammatory Joint Pain

Axial joints are those that involve the spine. Inflammation involving the back causes symptoms that are very different from your usual mechanical back pain. Here are some of the following key characteristics:

  • Back pain present for more than three months.
  • Pain improves with exercise.
  • Pain improves with anti-inflammatory medications like naproxen or ibuprofen.
  • Rest usually worsens the pain.
  • Back pain that wakes you up during the second half of the night.
  • Pain and prolonged stiffness in the morning, typically lasting more than an hour.
  • Alternating deep buttock pain.

Knowing My Body Helped Me Get A Psoriatic Arthritis Diagnosis

My diagnosis story isnt like most others. I got lucky, if you can call being diagnosed with arthritis in your mid-20s lucky. I had been noticing pain and stiffness for a little while. I remember having to soak in the tub for about half an hour and take four over-the-counter ibuprofen pills just to loosen up enough to function each day.

It became much more noticeable after I started a job where I had a 1-hour commute and where I was seated more. I would grunt while getting out of my car or out of my work chair. On the job, I had to crouch down several times a day to switch out boxes of paper. Once, I let out a literal scream when I got up because I was in so much pain.

I knew that wasnt normal at my age. I asked my mother if she thought I had arthritis. She said maybe, but to see a rheumatologist, youll need a referral. So, off to an urgent care I went. To be honest, I wasnt expecting much there, just enough to hopefully get that magical referral.

The doctor came in, looked at my chart, and looked at me and said, You have psoriatic arthritis. He looked at the psoriasis on my skin, pitting of my fingernails and, of course, my pain and stiffness, and quickly came back with the diagnosis.

The pictures of skin and fingers and toes were quite jarring, so I had to remember that my joints and skin didnt look like that, although my skin wasnt great. Also, who knew that psoriasis and arthritis could go together? I didnt, but I was learning.

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Psa Vs Rheumatoid Arthritis

Rheumatoid arthritis , like PsA, is an inflammatory type of arthritis related to problems with the immune system, according to the NPF. Both may appear similar on the surface, but there are key differences when you look deeper. Here are some of the main ones:

Treatments for PsA and RA are similarincluding nonsteroidal anti-inflammatory drugs , steroids, and biologicsbut because of all the differences in these two conditions on a microscopic level, they may respond differently to medsso its important to get the right diagnosis.

How Is Arthritis Diagnosed

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The prognosis for those diagnosed with arthritis becomes worse the longer the condition goes undiagnosed, so it is important to seek medical attention if you think you might have symptoms of arthritis. A physical examination combined with a review of your medical history and X-ray imaging are used to confirm a diagnosis of arthritis and identify the affected joints.

Blood tests that examine levels of rheumatoid factor, anti-cyclic citrullinated peptide, erythrocyte sedimentation rate, and C-reactive protein can help confirm a diagnosis of rheumatoid arthritis or psoriatic arthritis since these substances are typically elevated in these inflammatory conditions.

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Who Will Be Responsible For My Healthcare

Youre likely to see a team of healthcare professionals.

Your doctor, usually a rheumatologist, will be responsible for your overall care. And a specialist nurse may help monitor your condition and treatments. A skin specialist called a dermatologist may be responsible for the treatment of your psoriasis.

You may also see:

  • a physiotherapist, who can advise on exercises to help maintain your mobility
  • an occupational therapist, who can help you protect your joints, for example, by using splints for the wrist or knee braces. You may be advised to change the way you do some tasks to reduce the strain on your joints.
  • a podiatrist, who can assess your footcare needs and offer advice on special insoles and good supportive footwear.

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:

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Psoriatic Arthritis: Prognosis Life Expectancy And Quality Of Life

The big questions

If you or a loved one has been diagnosed with psoriatic arthritis , youre likely wondering how this condition might impact your life, both now and in the future.

It may help to know that there are several treatment options for easing symptoms, and researchers are always searching for new ones.

PsA can be a serious chronic inflammatory condition that can cause significant pain and, in severe cases, disability. But its possible to manage your condition through medications and lifestyle changes.

In most cases, the joint pain and inflammation caused by PsA respond well to treatment.

PsA is a chronic condition, which means theres no cure. Medications can treat its symptoms, however, and PsA isnt life-threatening.

Some research suggests that people with PsA have a slightly shorter life expectancy than the general population. This is similar to other autoimmune conditions, like rheumatoid arthritis. It might be because people with PsA are also at an increased risk of developing heart disease.

If you have severe PsA, talk to your doctor about the best treatments to ease your symptoms and prevent chronic inflammation.

Its hard to predict exactly how PsA will affect your life because people experience symptoms differently. For some, the condition progresses quickly and causes more severe symptoms, while others may go quite some time without noticing a huge change.

PsA symptoms can include:

Work And Psoriatic Arthritis

Siobhan Donohoe – Living with Psoriatic Arthritis

Having psoriatic arthritis may make some aspects of working life more challenging. But, if youre on the right treatment, its certainly possible to continue working.

Help and support is available, and you have rights and options.

The Government scheme Access to Work is a grant that can pay for equipment to help you with activities such as answering the phone, going to meetings, and getting to and from work.

The 2010 Equality Act, and the Disability Discrimination Act in Northern Ireland makes it unlawful for employers to treat anyone with a disability less favourably than anyone else. Psoriatic arthritis can be classed as a disability if its making every-day tasks difficult.

Your employer may need to make adjustments to your working environment, so you can do your job comfortably and safely.

You might be able to change some aspects of your job or working arrangements, or train for a different role.

In order to get the support youre entitled to, youll need to tell your employer about your condition. Your manager or HR department might be a good place to start.

Other available support might include:

  • your workplace occupational health department, if there is one
  • an occupational therapist. You could be referred to one by your GP or you could see one privately
  • disability employment advisors, or other staff, at your local JobCentre Plus
  • a Citizens Advice bureau particularly if you feel youre not getting the support youre entitled to.

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What To Expect At The Doctors Office

You may be seeing various health care providers during your journey to figure out whats causing your symptoms. Its common for people to see their internist/general practitioner, a dermatologist to treat their psoriasis, or other types of doctors to manage specific areas that are causing pain, such as a podiatrist to treat foot pain. However, if you or any of the health care providers you are currently seeing suspect it could be psoriatic arthritis, ask for a referral to a rheumatologist. These doctors specialize in arthritis and have the training to determine whether your joint symptoms are due to PsA or could be something else.

Psoriatic arthritis can be challenging to diagnose for a number of reasons, including:

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
  • Heel pain
  • 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.

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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
Test Name
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.

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