Arthritis is usually associated with joint pain and damage. There are many different types of arthritis that affect various joints in the body. Although each type of arthritis has parallel clinical symptoms, such as joint pain, the causes and treatments are different. In this article, we will look at the similarities and differences between rheumatoid arthritis and psoriatic arthritis.
Here we discuss the two most common forms of arthritis: rheumatoid arthritis (RA) and psoriatic arthritis (PSA). At first glance, these two types of arthritis are very difficult to differentiate, because they have many things in common. In fact, without the presence of a skin rash (i.e., psoriasis) in many cases, PSA, most people would not be able to notice the difference at first glance.
What is psoriatic arthritis?
PSA is an autoimmune disease that affects up to 30% of the population living with psoriasis. In the vast majority of diagnosed cases of PSA, people have a previous and chronic history of psoriasis. PSA is found approximately the same in both men and women, with an average age of onset from 40 to 50 years.
PSA is chronic and there is currently no cure for it. Inflamed and painful joints are not the only thing affected by this disease. PSA can also damage your organs – such as your heart, lungs, and eyes. Osteoporosis (bone weakening) and tendonitis are also associated side effects of this type of arthritis.
PSA is thought to occur in approximately one percent of the population.
What is rheumatoid arthritis?
RA is also an autoimmune disease when the body mistakenly attacks healthy joints. This attack on the joints leads to inflammation, which leads to a thickening of the tissues (synovial membrane) lining the joints. Under normal conditions, the synovial membrane lubricates the joints to help them move smoothly. When the synovial membrane thickens, this leads to friction, which causes swelling and pain.
RA is considered a systemic disease, that is, it affects the entire body. While this primarily affects the joints, RA can cause secondary conditions, damaging organs and weakening bones, like PSA.
RA is three times more common in women than in men. The onset of the disease usually occurs between 30 and 60. Although in men it occurs later than in women. RA affects about 1.5 million Americans.
What are the symptoms of psoriatic arthritis?
In addition to the classic symptoms of arthritis, including painful and swollen joints, PSA shows a number of symptoms. If you live with PSA, you may have one or more of these symptoms during outbreaks. In addition, the presence of psoriasis is also a classic symptom of PSA. Although a small percentage of people living with PSA have no symptoms of psoriasis at all. In the vast majority of cases, even if psoriasis is absent, there is a family history of this disease.
Some of the most common symptoms of PSA include:
- Joint pain and inflammation.
- Joint stiffness – especially after long periods of rest.
- Sausage-like fingers and toes (i.e. dactylitis).
- Skin rashes.
- Pit for nails and other changes in the nail bed.
- Redness and warmth of the joints.
- Pain in tendons and ligaments.
- Reduced range of motion of the joints.
- Eye problems – including impaired vision, irritability, redness, and pain.
- Outbreaks (i.e. symptoms come and go).
- Metabolic syndrome (affects weight, blood pressure and cholesterol).
- Associated bone conditions (e.g., osteoporosis).
- Depression (as a result of chronic pain).
- Pain in the legs.
- Lower back pain.
What are the symptoms of rheumatoid arthritis?
Many of the symptoms of RA reflect PSA symptoms. This is why often the presence of psoriasis is a hallmark in which you can be diagnosed with the type of arthritis. Outbreaks are also common during RA – when symptoms increase and subside. You may experience periods of minimal symptoms and periods when symptoms “flare-up”. In both RA and PSA, it is important to try to pinpoint the causes of the outbreaks. If you can identify the factors underlying the outbreak (for example, lack of sleep or increased mental stress), you can minimize the presence of these symptoms. As with PSA, the following are symptoms of RA that you may or may not have. You can experience only one or two of these symptoms, or you can experience more.
Some of the most common symptoms of RA include:
- Joint stiffness.
- Swelling, pain, and inflammation in the joints.
- Redness and warmth of the joints.
- Reduced joint movement.
- Bone related problems (e.g. osteoporosis).
- Numbness and tingling.
- Eye problems (red, itchy eyes).
- Metabolic syndrome (increased blood sugar, blood pressure, and cholesterol).
- Skin nodules.
The similarities and differences of rheumatoid arthritis from psoriatic arthritis
As you can see, the vast majority of symptoms between PSA and RA are the same or very similar. This often leads to understandable confusion among people trying to figure out if they live with PSA or RA. Both are autoimmune disorders and affect similar organs. Both have similar related conditions (e.g., depression, metabolic syndrome). And even treated the same way. We have seen a lot in common between the two types of arthritis. So what are the differences?
Many of the differences between the two diseases are visible only at the microscopic level. On the one hand, people living with RA have rheumatoid factor (RF) present in their bloodstream. RF is an antibody and is not observed in patients with PSA. In patients with PSA, on the other hand, the HLA-B27 genotype is often present.
Other differences between rheumatoid arthritis and psoriatic arthritis are which joints are affected and where. As a rule, with RA, the same joints are affected on both sides of the body (for example, wrists on both sides of the body). With PSA, there are types in which joints are affected on both sides of the body. However, usually, there are more cases of joint damage on only one side of the body.
PSA also tends to affect more distal joints (those closest to the nail bed) on both the fingers and toes, while RA affects the first and middle joints of the fingers and toes. Psoriatic arthritis often presents inflamed joints in the lower back and foot, while RA often affects the wrists and fingers.
PSA causes a condition known as dactylitis, due to which the fingers and toes look “like sausages.” In fact, the finger on the hand and the toe are inflamed and swollen. In contrast, edema usually appears only in the affected joint (for example, the first or second joint on the finger) in RA. Enthesitis (inflammation of the tendons and ligaments) is also more common with PSA than with RA.
Reasons and diagnosis
How do doctors determine what type of arthritis you have? When you go on your first visit, your doctor will take your medical history, conduct a physical examination, and collect some blood tests. Other diagnostic tests, such as X-ray and MRI, can also be ordered.
Most people who have PSA have a family history of psoriasis, PSA, or both. Risk factors for developing PSA are your family’s history, your age (PSA most often begins in people between 30 and 50 years old), and whether you have psoriasis. In some cases, some types of physical trauma (such as a bacterial or viral infection – for example, acute pharyngitis) can accelerate the onset of PSA in people already predisposed to the disease.
Risk factors for RA include women over 40, smoking, a family history of RA, and exposure to environmental toxins such as asbestos and silica. As mentioned above, the presence of a rheumatoid factor (RA) antigen can confirm the diagnosis of RA.
While RA and PSA can be very painful and debilitating diseases, treatment options are expanded and lead to significant pain relief. The key is to catch symptoms early and stay on top of the treatment.
The most common form of treatment for both PSA and RA is a combination of prescription and over-the-counter drugs. Disease-modifying antirheumatic drugs (DMARDs) and non-steroidal anti-inflammatory drugs (NSAIDs) are usually prescribed to treat both types of arthritis. NSAIDs relieve pain and reduce inflammation. DMARD slows the progression of joint diseases.
Other common drugs used to treat both PSA and RA are immunosuppressants, TNF-alpha inhibitors, steroid injections into inflamed joints, and joint replacement surgery (in extreme cases).
Sequential exercises that do not create a large load on the joints. Maintaining a healthy weight and deciding on a healthy lifestyle (such as quitting smoking) can often also help minimize the stiffness of joints, joint pain, and fatigue that often accompany both types of arthritis. In this article, we examined the similarities and differences between rheumatoid arthritis and psoriatic arthritis
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