What Is Psoriatic Rheumatoid Arthritis

Types Of Psoriatic Arthritis

The three most common types of arthritis, osteoarthritis, rheumatoid arthritis, and psoriatic arthritis, have many overlapping symptoms, sometimes making the diagnosis of psoriatic arthritis difficult. In many cases, the presence of psoriasis is the determining and distinguishing factor that helps a physician to make the diagnosis of psoriatic arthritis.

Once a psoriatic arthritis diagnosis has been made, your doctor will likely classify you into one of five types of psoriatic arthritis. We discuss these types below.

• Symmetric psoriatic arthritis
• Arthritis mutilans

Symmetric psoriatic arthritis

In this form of psoriatic arthritis, joints on both sides of the body are affected. The most common type of psoriatic arthritis is symmetric psoriatic arthritis. It affects about 50% of the psoriatic arthritis population. Symptoms of symmetric psoriatic arthritis are similar to rheumatoid arthritis symptoms.

Asymmetric psoriatic arthritis

Affecting approximately 35% of the population with psoriatic arthritis, asymmetric psoriatic arthritis appears in different joints on different sides of the body. Instead of both knees being inflamed, your knee might be affected by psoriatic arthritis on the right side of your body and your left elbow might be inflicted with pain and inflammation at the same time.

Distal psoriatic arthritis

Spondylitis

Arthritis mutilans

How Is Psoriatic Arthritis Treated

Treatment will depend on your symptoms, age, and general health. It will also depend on the severity of your condition.

Boththe skin condition and the joint inflammation are treated. Early diagnosis andtreatment helps prevent joint damage. Some medicines used to treat psoriatic arthritisinclude:

• Nonsteroidal anti-inflammatory medicines to ease symptoms
• Corticosteroids for inflammation
• Immunosuppressive medicines such as methotrexate to reduce inflammation if NSAIDs don’t work
• Biologic medicines to ease inflammation
• Vitamins and minerals such as calcium and vitamin D to slow bone deformation

Other treatment may include:

• Obesity

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.

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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.

Key Points About Psoriatic Arthritis In Children

• Psoriatic arthritis is a rare form of arthritis or joint inflammation that affects both skin and joints. It can occur in people who have the skin disease psoriasis.

• It is most common in adults ages 30 to 50. But it can start in childhood.

• This condition causes inflamed, swollen, and painful joints. It also causes eye pain and fatigue.

• Treatment may include medicines, heat and cold, splints, exercise, physical therapy, and surgery.

• Early treatment can help the disease go into remission. Delayed treatment may lead to long-term disability.

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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.

When To Visit A Doctor For Psoriatic Arthritis

If youre experiencing any of the symptoms mentioned above, see your doctor. Its essential to be diagnosed and evaluated by a medical professional as soon as possible because psoriatic Arthritis can cause permanent damage over time. Your doctor will likely perform a physical exam, including checking for tenderness, swelling, or redness in your joints. They may also ask about specific pains you experience at night or when you wake up in the morning. Depending on your initial diagnosis, they may also order imaging tests such as MRIs, X-rays, or CT scans to check for structural problems with your joints.

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Occurrence In The United States

According to the National Psoriasis Foundation, psoriatic arthritis affects about 1 million people in the United States, or about 30% of all persons with psoriasis. However, prevalence rates vary widely among studies. In one population-based study, less than 10% of patients with psoriasis developed clinically recognized psoriatic arthritis during a 30-year period. A random telephone survey of 27,220 US residents found a 0.25% prevalence rate for psoriatic arthritis in the general population and an 11% prevalence rate in patients with psoriasis. However, the exact frequency of the disorder in patients with psoriasis remains uncertain, with the estimated rate ranging from 5-30%.

Moreover, since the late 20th century, the incidence of psoriatic arthritis appears to have been rising in both men and women. Reasons for the increase are unknown it may be related to a true change in incidence or to a greater overall awareness of the diagnosis by physicians.

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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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.

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.

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How Is Psoriatic Arthritis Diagnosed In A Child

Psoriatic arthritis is easier to confirm if your child already has psoriasis. If the skin symptoms have not yet occurred, diagnosis is more difficult. Your childs healthcare provider will take your childs medical history and do a physical exam. The provider will ask about your child’s symptoms. Your child may have blood tests such as:

• 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 blood’s 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 are linked to psoriatic arthritis.

• Complete blood count . This test checks for low counts of red blood cells , white blood cells, and platelets.

• Antibody blood tests. These tests are done to look for certain kinds of proteins, called antibodies, in your blood. These tests can be positive for many kinds of rheumatic diseases. Younger children are more likely to have a positive antinuclear antibody test.

Other tests may include:

• X-rays. This test uses a small amount of radiation to create images of organs, bones, and other tissues.

• Eye exam. This is done by a pediatric eye doctor . The exam looks for uveitis, a swelling of the middle layer of the eye.

Do We Know What Causes Psoriatic Arthritis

• The cause of psoriatic arthritis is the subject of much research.
• You cannot catch psoriatic arthritis or psoriasis from someone else. Therefore they are not contagious.
• The cause of psoriatic arthritis is not proven but experts believe it to be a combination of genetic, immunological and environmental factors. 2 out of 5 people with psoriasis or psoriatic arthritis have a first-degree relative with the condition. This means you have a higher chance of developing psoriasis or psoriatic arthritis if you have relative who has the condition. Some experts believe infections such as streptococcal infections may provoke psoriatic arthritis, though this is not proven.
• The role of bacteria in the gut and developing psoriatic arthritis is the subject of current research.
• Trauma and stress may be contributing factors, although this is not proven.
• The genetic make-up of an individual is likely to determine the risk of developing psoriasis and psoriatic arthritis and probably influences the severity.
• Being overweight is now understood to be linked to developing psoriatic arthritis and is the subject of ongoing research.
• There are certain genetic markers linked to the immune system which are now being used to predict the severity of psoriatic arthritis. Much more is known about the mechanisms that lead to inflammation in other conditions and it is likely advances in science will lead to much more effective treatments with fewer side effects.

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What Are The Symptoms Of Psoriatic Arthritis In A Child

The skin condition psoriasis may start before or after the arthritis. Psoriasis causes a scaly, red, itchy rash on the knees, elbows, scalp, face, and the folds of the buttocks. It can also cause pitting of fingernails or toenails.

Each childs symptoms may vary. Symptoms of psoriatic arthritis may include:

• Inflamed, swollen, and painful joints, usually in the fingers and toes

• Morning stiffness in the joints

• Reddened skin over the affected joints

• Sausage-like swelling of fingers and toes, plus swollen wrists

• Deformed joints from chronic inflammation

• Symptoms in the spine or sacroiliac joint

• Eye pain

• Lack of energy

The symptoms of psoriatic arthritis can seem like other health conditions. Make sure to see your childs healthcare provider for a diagnosis

Serological Features Of Ra And Psa

RA is a seropositive arthropathy, with approximately 80% of patients having a positive test result for RF or CCP antibodies. CCP antibodies are a more specific marker for RA than RF, but both biomarkers are considered to be distinct and complementary predictors of disability and joint erosion.

In contrast, PsA is a seronegative inflammatory arthropathy. RF and CCP are absent in most patients with PsA, and if patients do have positive test findings for RF or CCP, the titres are usually low. In a study comparing patients with RA or PsA and controls, the mean RF and anti-CCP titre values were substantially higher in patients with RA compared with PsA . Titres in patients with PsA were similar to values in controls. Although the presence of serum RF or CCP antibodies is generally not used to exclude diagnosis of non-rheumatic diseases , data suggest that at anti-CCP titre values 11.6 U/mL, it is highly probable that patients have RA rather than PsA. In both patients with RA and PsA, the presence of anti-CCP antibodies is associated with bone destruction, suggesting that the osteocatabolic effect of anti-CCP antibodies is not found only in RA as previously thought.

Increased ESR and CRP levels are markers of inflammation, but not necessarily just in RA. Other rheumatological diseases associated with elevated ESR and CRP levels include polymyalgia rheumatica, Sjögrens syndrome and ankylosing spondylitis.

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How Are Psoriatic Arthritis And Rheumatoid Arthritis Diagnosed

Some MyPsoriasisTeam members have shared that diagnosing PsA and RA can be tricky. One member asked, How can they know for certain if you have psoriatic arthritis or rheumatoid arthritis? Ive had all kinds of blood tests done!

Another member shared, Its difficult, but they know what to look for. affects different joints in the fingers than rheumatoid arthritis. The best way to find out is to see a rheumatologist.

Ultimately, there are several ways a rheumatologist can diagnose PsA and RA.

So What Is Psoriatic Arthritis And How Does It Differ From Rheumatoid Arthritis

Well, just like rheumatoid arthritis, it is an auto-immune disease. Both cause an erosive inflammatory arthritis in addition to chronic fatigue. And both can have symptoms that vary greatly from person to person. However the distribution of joint involvement differs between the two diseases and psoriatic arthritis involves the skin as well as the joints.

Both diseases can cause destruction of the small joints in your hands and feet as well as larger joints such as knees, hips, shoulders and even the vertebrae in your spine. Classic rheumatoid arthritis primarily involves the PIP joints and wrist, and is generally a symmetrical disease effecting both sides of the body equally. Also with rheumatoid arthritis, nodules specific to this disease are often present.

Both diseases can involve inflammation and scarring of major organs such as your heart and lungs and as in my case can involve your eyes. In addition, both can increase your risk of osteoporosis due the condition itself and also from some of the medications that are used to treat these conditions. After years of taking steroids for my arthritis, it resulted in a couple of compression fractures in my thoracic spine. And, both disorders can also result in joint destruction leading to severe crippling disabilities.

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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.

Consider Natural Supplements And Spices

Omega-3 fatty acids have anti-inflammatory properties. These healthy fats, found in many supplements, reduce inflammation and stiffness in joints.

While research suggests there are health benefits, the Food and Drug Administration doesnt monitor the purity or quality of supplements. Its important to talk with your doctor before you begin taking supplements.

Turmeric, a potent spice, also serves up a dose of anti-inflammatory properties and may help reduce inflammation and PsA flare-ups. Turmeric can be added to any dish. Some people even stir it into tea or lattes, like golden milk.

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Can Psa And Ra Co

It is possible to have both PsA and RA, but it is extremely rare. It is more likely for PsA or RA to exist with fibromyalgia or gout. RA might also co-exist with psoriasis.

There are very few prevalence studies on the co-existence of PsA and RA. One study reported in 2019 in the journal Therapeutic Advances in Chronic Disease found the prevalence of RA among people with psoriatic disease was 1.02%.

Light Therapy And Other Psa Medications

Light therapy uses medication, followed by exposure to bright light, to treat psoriasis skin rashes.

A few other medications also treat PsA symptoms. These include secukinumab and ustekinumab . These drugs are injected under your skin. Stelara comes with a warning that it can increase your risk for infections and cancer.

There are things you can do at home to help improve your symptoms:

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