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-.
Joint Symptoms In People With Psa And Ra
Both psoriatic arthritis and rheumatoid arthritis cause similar joint symptoms. Joints affected by PsA or RA can feel painful, stiff, swollen, and hot. The symptoms of PsA and RA tend to show up in different joints.
The two diseases, for instance, affect different parts of the spine. PsA sometimes leads to a condition called spondylitis that causes lower back pain. Spondylitis involves inflammation in the joints of the spine and between the spine and pelvis. Up to half of people with PsA will experience spondylitis pain. RA, on the other hand, often causes problems in the cervical spine, in the neck. Up to 80 percent of people with RA experience neck pain.
RA is also more likely than PsA to affect the hands, such as the joints in the wrists and fingers, whereas PsA is more likely to affect the feet. Additionally, PsA and RA affect different small joints within the fingers and toes. RA affects the first two joints, and PsA attacks the joint closest to the nail bed.
People with PsA can experience dactylitis, a condition in which the fingers or toes swell up and resemble sausages. Dactylitis is often the first symptom of PsA, and it may be the only joint symptom a person experiences for several years. PsA also affects the nails. People with PsA often have pitted, ridged nails, which appear similar to nails with a fungal infection.
Psoriatic Arthritis And Rheumatoid Arthritis Are Both Chronic Inflammatory Conditions
With both diseases, an overzealous immune system mistakenly attacks healthy cells in your body. That can result in joint pain, stiffness, and swelling, along with perpetual fatigue and other symptoms more specific to either disease.
The causes of psoriatic arthritis and rheumatoid arthritis are still up in the air, but doctors suspect the diseases have an underlying genetic component that may make a person more susceptible to certain environmental triggers.
In any case, psoriatic arthritis and rheumatoid arthritis are both lifelong diseases that can occur in flares . And while theres no cure for either disease, treatments for both psoriatic arthritis and rheumatoid arthritis have come a long way toward keeping symptoms at bay, sometimes even putting the disease into remission. Plus, the right medication can help protect your body from the permanent damage these conditions can cause if left untreated, so its important to work with your doctor to manage your disease.
What Are The Causes Of Psoriatic Arthritis And Rheumatoid Arthritis
We don’t have an understanding of what causes many autoimmune conditions, including RA and PsA, but there are common links among people who develop these diseases.
“We don’t know exactly what causes RA or PSA, but we do know there are genetic components and stress components to both,” Magdalena Perez-Rivera, MD, rheumatology specialist with Conviva Care Centers tells Health.
Here are some of the primary risk factors for RA and PsAyou’ll see there is a good amount of overlap.
Blood Tests For Psa And Ra
Blood tests can also help tell the difference between PsA and RA.
About 80 percent of people with RA are said to have seropositive RA, which means they test positive for rheumatoid factor or for cyclic citrullinated peptide antibodies.
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Ra Vs And There Are At Least Two Types That Might Be Responsible For Your Tender Psa Can Range From Mild To Severe Of Course It Causes Stiffness And Painanother Notable Difference From Ra Psoriatic Arthritis: How Do You Tell The Difference
Both rheumatoid arthritis and psoriatic arthritis are conditions that damage your joints, Mild PsA is sometimes referred to as oligoarticular, Synovial membrane histology and immunopathology in rheumatoid arthritis and osteoarthritis, Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints in your hands and feet.PsA vs, and swelling in
What Tests To Perform
The most important role of lab testing is to exclude other considerations in the differential diagnosis. Anti-cyclic citrullinated peptide antibodies and antinuclear antibodies may be helpful in some patients if there are symptoms that suggest a diagnosis of RA or systemic lupus erythematosus . However, some patients with psoriatic arthritis alone may have positive tests. Acute phase reactants may provide insights into disease activity, although many patients with active PsA have normal acute phase reactants.
It is also important to check a comprehensive metabolic and lipid profile since obesity, metabolic syndrome, type 2 diabetes, fatty liver, and hyperlipidemia are very common features in PsA and the presence of these conditions will influence treatment considerations. In patients who are under consideration for a DMARD, such as methotrexate of leflunomide, it is recommended to check hepatitis B and C serologies and baseline transaminases testing for exposure to tuberculosis should be done if a biologic, such as an anti-TNF agent, is anticipated. An increased rate of progressive liver fibrosis based on serial biopsies was reported in psoriasis patients with obesity or type II diabetes treated with methotrexate. It is also critical to ensure that women of child-bearing age are not pregnant so a pregnancy test may be required.
Controversies in diagnostic testing
How Are Ra And Psa Diagnosed
Because these two conditions share similar symptoms, it’s important to get an accurate diagnosis from a rheumatologist. A rheumatoid factor blood test is one way your doctor can tell which condition you have. RF is a protein found in people with rheumatoid arthritis. People with PsA usually don’t have it. Blood tests looking for other antibodies such as anti-CCP can also help differentiate the two.
Another way to tell is to look at your skin and nails. If you have scaly patches on your skin, pitting and flaking on your nails, or both, you have PsA.
Once you’ve had the disease for a while, X-rays might also be able to distinguish the two conditions.
It is possible to have RA and PsA together, but it’s rare. If you do have both, many of the treatments, including some medications, will work for both conditions.
Imaging Tests For Psa And Ra
Imaging tests, such as X-rays and magnetic resonance imaging , are useful in diagnosing both PsA and RA, as well as learning how far the disease has advanced.
X-rays are the first line of diagnosis for both conditions, as they are inexpensive and easy to reproduce. More sensitive technologies, like MRI, are costlier and are therefore used as second-line diagnostic tools.
PsA and RA can produce different patterns of inflammation on imaging scans, and ultrasound can be useful in detecting these patterns and getting a definitive diagnosis.
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Sex Fertility And Pregnancy
Sex can sometimes be painful for people with psoriatic arthritis, particularly a woman whose hips are affected. Experimenting with different positions and communicating well with your partner will usually provide a solution.
Psoriatic arthritis wont affect your chances of having children. But if youre thinking of starting a family, its important to discuss your drug treatment with a doctor well in advance. If you become pregnant unexpectedly, talk to your rheumatology department as soon as possible.
The following must be avoided when trying to start a family, during pregnancy and when breastfeeding:
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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Psoriatic Arthritis And Osteoarthritis: Overlapping Features
So why can psoriatic arthritis be mistaken for osteoarthritis when it sounds so different? This is due to the fact that osteoarthritis and psoriatic arthritis have overlapping features.
Both OA and PsA often begin after the age of 40 and are commonly linked to excess body weight. They are both associated with joint injury. It is important to understand that even though OA is a wear and tear disease, there can be inflammation in the early stages. It is also possible that someone can have OA and PsA at the same time. Another shared characteristic is pain in the spine. While this is more common in OA, it can also happen in PsA sufferers.
Although more research is underway, there is some suggestion that psoriatic arthritis may possibly trigger secondary osteoarthritis. In other words, some inflammation from PsA may be able to cause wear and tear.
Osteoarthritis can start with a small joint swelling that looks like psoriatic arthritis. However, it can later develop into a bony growth known as Heberdens or Bouchards nodes. Often, these growths indicate osteoarthritis in the diagnosis, but they can take several years to form.
Comorbidities Occurring In Ra And Psa
Differences in patient comorbidities may help clinicians differentiate between RA and PsA . Overall, comorbidity burden may be higher in RA than in PsA, but both diseases are similarly associated with increased risk for comorbidities linked to systemic inflammation . Han and colleagues found that patients with RA and PsA had similarly increased prevalence ratios of ischaemic heart disease, atherosclerosis, peripheral vascular disease, congestive heart failure, cerebrovascular disease, hyperlipidaemia and hypertension compared with healthy controls. However, registry data suggest that the rates of obesity, diabetes mellitus and metabolic syndrome are significantly higher in patients with PsA compared with those with RA. Notably, most patients with PsA are overweight or obese. Cardiometabolic comorbidities of PsA are associated with higher levels of systemic inflammation and increased disease severity. In addition, psoriatic skin lesions are associated with an increased risk for cardiovascular disease and mortality. Of interest, PsA is an independent predictor of non-alcoholic fatty liver disease in patients with psoriasis, while in patients with RA, the rates of NAFLD are similar to those observed in the general population.
Summary of differences in common comorbidities associated with PsA and RA
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Treatment For Psoriatic Arthritis Differs From Other Forms Of Arthritis
The main goals of all arthritis treatment are to reduce symptoms and improve quality of life. Methods vary depending on the type of arthritis.
Rheumatoid arthritis can be very destructive if its not treated, which is why we treat it aggressively with biologics, says Ruderman. But psoriatic arthritis doesnt manifest that way. Fewer than half of people with psoriatic arthritis develop a particularly aggressive form, which makes treatment challenging because we dont want to over-treat it.
Even so, the pain and discomfort associated with psoriatic arthritis can be significant. A study published in 2015 in the journal PLoS One found that the overall pain, joint pain, and fatigue reported by psoriatic arthritis patients was significantly greater than that reported by people with rheumatoid arthritis.
Unless someone has an existing condition, such as elevated blood pressure or kidney disease, nonsteroidal anti-inflammatory drugs are recommended for joint symptoms in milder forms of psoriatic arthritis, says Husni.
Topical creams, ointments, and lotions are often used to address the scaly, itchy skin rashes that occur with psoriasis.
If there are signs of joint damage, doctors treat psoriatic arthritis more aggressively with medications like the ones used to treat rheumatoid arthritis, says Ruderman. These include disease-modifying anti-rheumatic drugs and biologics.
Additional reporting by Becky Upham.
Bottom Line: If Youre Having Joint Pain Or Other Symptoms Of Arthritis Talk To Your Doctor
Its impossible to pinpoint psoriatic arthritis, rheumatoid arthritis, or any of the other dozens of types of arthritis based on symptoms and an online search alone. But some of these diseases can cause serious long-term damage, so talk to your doctor about a diagnosis and treatment options so you can find relief sooner rather than later.Related:
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Fingers Toes And Skin
Another telling clue is the presentation of the disease on the fingers and toes. With PsA, the distal joints will be the focus of pain, swelling, and stiffness. By contrast, RA primarily involves the proximal joints .
With severe PsA, the fingers can also take on a sausage-like appearance , making it difficult to ball your fist. While this can occur with RA, it is not the hallmark that it is with PsA.
Around 85% of people of PsA with also have the most typical form of psoriasis, characterized by dry, flaky skin plaques. Moreover, half will have nail psoriasis at the time of their diagnosis. Neither of these occurs with RA.
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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What Happens To Patients With Psoriatic Arthritis
Genes implicated in the pathogenesis of PsA include Cw6,IL-23 R alleles and Act1, a molecule in the IL-17R signaling pathway and other MHC Class I alleles , Class I major histocompatibility complex chain-related gene A . Environmental events have also been associated with the onset of psoriatic arthritis, including rubella vaccination, injury sufficient to require a medical consultation, recurrent oral ulcers, moving house and fracture requiring hospitalization.
From a clinical perspective, PsA patients can present with features of RA or spondyloarthritis . The synovial pathology is more akin to findings in spondyloarthritis than RA with infiltrating neutrophils, CD163+ macrophages, and the lack of an antibody response to the shared epitope as observed in RA.The importance of local biomechanical properties in disease pathogenesis, particularly as it relates to the enthesis, has been emphasized. The model of the synovio-entheseal complex delineates an innate immune response triggered by biomechanical and inflammatory events at the enthesis, which subsequently involve adjacent synovium and cartilage.
Mortality rates for PsA were higher than age-matched controls but recent evidence indicates that mortality may not be higher than observed in the general population. PsA patients do have higher rates of mortality from cardiovascular disease than controls.
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.
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.