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What’s The Difference Between Rheumatoid And Psoriatic Arthritis

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

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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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Biomarkers That Can Facilitate Differentiation Of Psa Ra And Oa

One challenge in the diagnosis of PsA is the lack of validated biomarkers detectable in the serum or synovial fluid that are unique to PsA however, there are serologic, genetic, and inflammatory markers that can be screened to substantiate clinical findings.

Serologic analyses for rheumatoid factor and cyclic citrullinated peptide can be used to facilitate the distinction between PsA and RA. Approximately 80% of patients with RA are RF positive and CCP positive, while nearly all patients with PsA are RF and/or CCP negative . However, it is important to not rule out PsA solely on the basis of CCP- and/or RF-negative status, as an estimated 13% of patients with PsA are RF positive . Additionally, C-reactive protein and erythrocyte sedimentation rate have been shown to be markers of inflammation in patients with RA and PsA. Both ESR and CRP were reported to significantly predict radiographic progression in RA . Patients with PsA, on average, have lower ESR and CRP levels than patients with RA, yet elevations of both have been significantly correlated with the number of swollen joints, structural damage, and abnormalities detected with US . Elevated ESR and CRP levels that are attributed to PsA are considered markers of severe PsA by the American College of Rheumatology /National Psoriasis Foundation, and tumor necrosis factor inhibitors and/or anti-interleukin-17 biologic disease-modifying antirheumatic drugs are recommended for earlier use in these patients .

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.

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What To Do About Your Symptoms

If youre experiencing any of the symptoms above and have psoriasis, seek help from your health care provider to consider a possible evaluation with a rheumatologist. Getting treatment early can help you avoid further joint damage and pain.

To find a Banner Health specialist near you, visit

Serological Features Of Ra And Psa

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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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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.

Pattern Of Joint Involvement

PsA often causes enthesitis, which is inflammation where tendons insert onto bones . This is not seen with RA.

The symmetry of joint involvement differs between these conditions:

  • With PsA, the pattern of joint involvement is often asymmetricalthe joints affected on one side of the body will not necessarily be affected on the other. Only 15% of people with PsA will have symmetrical arthritis, a condition considered more advanced and severe than asymmetrical arthritis.
  • The pattern with RA is characteristically symmetricalthe same joints on both sides of the body are affected.

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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.

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Spondylitis With Or Without Sacroiliitis

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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.

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What Is Psoriatic Arthritis Video

Psoriatic arthritis can cause pain, swelling and stiffness inand around your joints.

It usually affects 3 in 10 people who already have the skin condition psoriasis .

Psoriasis causes patches of red, flaky skin which is covered with silvery-like patches.

Some people may develop psoriatic arthritis before the psoriasis is even present. In rare cases people have psoriatic arthritis and never have any noticeable patches of psoriasis.

Psoriatic arthritis and psoriasis are both autoimmune conditions, caused by a fault in the immune system.

Our immune system protects us from illness and infection. But in autoimmune conditions, the immune system becomes confused and attacks healthy parts of the body, often causing inflammation.

Psoriatic arthritis is a type of spondylarthritis. This is a group of conditions with some similar symptoms.

People with psoriasis are as likely as anyone else to get othertypes of arthritis, such asosteoarthritisorrheumatoid arthritis. Theseconditionsare not linkedto psoriasis.

Symptoms Of Ra And Psa

Both RA and PsA cause joint swelling, stiffness, and pain. Although both conditions affect joints in the fingers and toes, they do it in slightly different ways. And each one can cause other symptoms, too.

Rheumatoid arthritis:

  • Often starts in the smaller joints, like the ones in your fingers and toes over time, it may affect other joints, too, like your wrists, knees, hips, and ankles.
  • Usually shows up on the same joints on both sides of your body that means it’s symmetric.
  • Often makes joints feel stiffer in the morning
  • Can lead to fatigue, low-grade fever, and weight loss

Psoriatic arthritis:

  • Can affect joints in the back and pelvis in addition to the ones in fingers and toes
  • Often affects only one side of your body that means it’s asymmetric.
  • Sometimes causes foot pain, especially on the sole of your foot or the back of your heel
  • May make your fingers swell up like sausages
  • May make your nails pit and flake
  • Tends to affect entheses, areas where tendons or ligaments attach to bones

With both conditions, you’ll probably have times when your symptoms get worse. These are called flares. In between these flares are times without symptoms called remissions.

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Rheumatoid Arthritis & Psoriatic Arthritis

Arthritis is a condition that causes pain, stiffness and swelling in the joints. Osteoarthritis is a common form of arthritis caused by the wearing down of the cartilage that protects the bones of a joint. Rheumatoid arthritis is an autoimmune condition caused by an inflammation in the lining of the joints. Both forms of arthritis, cause pain, tenderness, and swelling, and may result in loss of movement in the affected joints. Over time, joints affected by arthritis may become severely damaged. Arthritis occurs more frequently in older individuals, however it sometimes develops in athletes from overuse of a joint or after an injury. It can however, affect people of any age, including children.

In addition to rheumatoid arthritis and osteoarthritis, there are other types of arthritis, and depending on the cause, may affect people of different ages. Gout is a form of arthritis caused by a build-up of uric acid within the body, that causes painful, swollen, red and inflamed joints. Psoriatic arthritis affects people who have psoriasis, a skin condition characterized by red and scaly patches of skin. Psoriatic arthritis is considered an autoimmune disorder and causes joint inflammation, stiffness and pain.

Statement Of Literature Search

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For the development of this narrative review, publications were identified by a series of searches on PubMed between September 2020 and July 2021. Search terms included AND AND AND AND . Publications that detailed the characteristic clinical manifestations, comorbidities, pathogenesis, biomarkers, treatment recommendations, and differential diagnosis for PsA, RA, and OA were included. References that were determined to be irrelevant on the basis of the authors judgment were excluded from consideration. Relevant references that were cited within the publications included in this review and articles previously known by authors were considered on the basis of the criteria. This review is based on studies that were previously completed and does not contain any novel studies with human participants that were conducted by any of the authors.

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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.

Managing Symptoms Of Autoimmune Arthritis

Several medications work for both psoriatic arthritis and rheumatoid arthritis:

  • Nonsteroidal anti-inflammatory medications reduce pain and swelling.
  • Disease-modifying antirheumatic drugs protect joints and slow the disease, and less of the joint is destroyed, meaning theres less swelling, pain and less loss of joint function.
  • Biologics target the specific parts of the immune system that drive inflammation.

As researchers learn more about the causes of inflammatory arthritis, theyre developing new medications to manage these diseases. Some of these new drugs are designed to specifically target one disease or the other.

Both psoriatic arthritis and rheumatoid arthritis are chronic diseases. They cant be cured, but they can be managed, Dr. Rosian says. By working with your doctor to get the correct diagnosis, you can manage symptoms to feel your best.

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Psoriatic Arthritis Vs Osteoarthritis Differences In Symptoms Causes And Treatment

Written byDr. Victor MarchionePublished onJune 30, 2016

Psoriatic arthritis and osteoarthritis can both affect small joints and can easily be mistaken for each other, but they are two different conditions that require separate treatments.

Osteoarthritis is a wearing away of cartilage, usually associated with aging. Psoriatic arthritis is an inflammatory condition in which the joints become inflamed and damaged. There can be inflammation in osteoarthritis, but it is not a major characteristic of the condition, so if a person simply treats their osteoarthritis pain with anti-inflammatories, they may not experience much relief. Both osteoarthritis and psoriatic arthritis can lead to bone spurs, so the two conditions sometimes look the same. Researchers report that osteoarthritis is the most common misdiagnosis for psoriatic arthritis.

People who suffer from osteoarthritis experience the bones of the joint rubbing against each other, which causes friction and pain. In the majority of cases, this rubbing affects the hands, knees, hip, and spine. More people have osteoarthritis than any other form of arthritis.

What Causes Ra And Psa

RA runs in families. If you have a close relative with the disease, your chances of having it are higher. Women are more likely than men to get RA. Usually the symptoms start between ages 40 and 60.

PsA also runs in families. Certain genes may be linked to the condition. Compared to RA, PsA often starts between ages 30 and 50.

Researchers don’t know exactly what triggers either type of arthritis. But they think it probably comes from a mix of genes and other factors, including hormones and bacterial or viral infections that may send the immune system into overdrive.

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Tips For Identifying Oa

OA isnt a disease that cycles, like PsA. Instead, it can gradually get worse.

OA pain may be mild at first. You might notice a slight twinge in your knee when you bend it, or your joints might ache after a workout.

The pain, swelling, and stiffness will get worse as the joint damage increases. Along with the pain, your joints will feel stiff especially when you first wake up in the morning.

OA will most likely affect the joints of your body that move the most.

This includes the joints in your:

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.


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.


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

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