Arthritis, in general, is related to joint pain and joint disease. There are many different types of arthritis, affecting many different joints in the body. While each type of arthritis has a commonality of joint pain, the symptoms, causes, and treatments are different.
Here, we discuss two of the most common forms of arthritis: Rheumatoid Arthritis (RA) and Psoriatic Arthritis (PsA). At first glance, these two types of arthritis are very hard to differentiate, because they share so many overlapping traits. In fact, without the presence of a skin rash (i.e., psoriasis) in many cases of psoriatic arthritis, most people would not be able to tell a difference at first glance.
Psoriatic arthritis is an autoimmune disease that affects up to 30% of the population that lives with psoriasis. In the overwhelming majority of diagnosed cases of psoriatic arthritis, individuals have a previous and chronic history of psoriasis. Psoriatic arthritis occurs about equally in both men and women, with an average onset age between 40 and 50 years old.
Psoriatic arthritis is chronic and no cure is available. Inflamed and painful joints are not the only thing affected by this disease. Psoriatic arthritis can also damage your organs – such as your heart, lungs, and eyes. Osteoporosis (weakening of the bones) and tendonitis are also related side effects of this type of arthritis.
Psoriatic arthritis is thought to occur in about one percent of the population.
Rheumatoid arthritis is also an autoimmune disorder, where the body attacks healthy joints. This attack on the joints leads to inflammation caused by the thickening of the tissues (synovium) lining the joints. In normal conditions, the synovium provides a lubricant to the joints to help them move smoothly. When the synovium thickens, this leads to friction, swelling, and pain.
Rheumatoid arthritis is considered a systemic disease, meaning it can affect the entire body. While it primarily affects the joints, rheumatoid arthritis can cause secondary conditions, damaging the organs and weakening the bones, similar to psoriatic arthritis.
Rheumatoid arthritis is much more prevalent in women than in men. . .3 times so. The onset of the disease typically occurs between 30 and 60; though, the onset in men is later than in women.
Rheumatoid arthritis affects approximately 1.5 million Americans.
Beyond the classic symptoms of arthritis, including painful and swollen joints, psoriatic arthritis presents itself with a number of symptoms. If you are living with psoriatic arthritis, you may have one or several of these symptoms during flare-ups. Additionally, the presence of psoriasis is also a classic symptom of psoriatic arthritis. Though, in a smaller percentage of individuals who live with psoriatic arthritis, no symptoms of psoriasis appear at all. In the overwhelming majority of cases, even if no psoriasis is present, there is a family history of it.
Some of the more common symptoms of psoriatic arthritis include:
Many of the symptoms of rheumatoid arthritis mirror those of psoriatic arthritis. Which is why oftentimes, the presence of psoriasis is a distinguishing factor in what type of arthritis you might be living with. Flare-ups are also common during rheumatoid arthritis – where the symptoms wax and wane – you might experience time periods of minimal symptoms and times when symptoms “flare-up.” In both rheumatoid arthritis and psoriatic arthritis, it is important to try to pinpoint what causes flare-ups. If you can determine underlying factors of the flare-ups (e.g., lack of sleep), you might be able to minimize the presence of these symptoms. As with psoriatic arthritis, the following are rheumatoid arthritis symptoms that you may or may not have. You might only experience one or two of these symptoms and you might experience more.
Some of the more common symptoms of rheumatoid arthritis include:
As you can see, the overwhelming majority of symptoms between psoriatic arthritis and rheumatoid arthritis are the same or similar. This often leads to much confusion among individuals trying to figure out if they are living with psoriatic or rheumatoid arthritis. Both are autoimmune disorders. Both affect similar organs. Both have similar related conditions (e.g., depression, metabolic syndrome). Both even are treated similarly. We have seen many similarities between the two types of arthritis. So, what are the differences?
Many of the differences between the two diseases are on a much more microscopic level. For one, individuals living with rheumatoid arthritis have Rheumatoid Factor (RF) present in their bloodstream. RF is an antibody and is not seen in psoriatic arthritis patients. On the other hand, psoriatic arthritis patients often have the presence of the HLA-B27 genotype.
Another difference between rheumatoid arthritis and psoriatic arthritis is what joints are affected and where. Typically, in rheumatoid arthritis, the same joints on both sides of the body are affected (e.g., the wrists on both sides of the body). With psoriatic arthritis, there are types of psoriatic arthritis where the joints are affected on both sides of the body, but typically there are more cases of joints being affected on only one side of the body with psoriatic arthritis.
Psoriatic arthritis also tends to affect the more distal joints (those closest to the nail bed) in both the fingers and toes, whereas rheumatoid arthritis affects the first and middle joints of the fingers and toes. Psoriatic arthritis often presents inflamed joints in the lower back and foot, whereas rheumatoid arthritis more commonly affects the wrists and the digits.
Psoriatic arthritis causes a condition known as dactylitis, which makes the fingers and the toes look “sausage-like.” In essence, the entire finger and entire toe becomes inflamed and swollen. In contrast, swelling normally only appears in the affected joint (e.g., first or second joint on the finger) with rheumatoid arthritis. Enthesitis (inflammation of the tendons and ligaments) is also more common in psoriatic arthritis than rheumatoid arthritis.
How do doctors make the determination of what type of arthritis you have? When you go in for your first visit, your doctor will take your medical history, perform a physical exam, and also collect some bloodwork. Other diagnostic tests, such as x-rays and MRIs, may also be conducted.
Most people who have psoriatic arthritis have a family history of psoriasis, psoriatic arthritis, or both. Your risk factors for developing psoriatic arthritis are your family history, your age (psoriatic arthritis mostly starts in individuals between 30 and 50), and whether you have psoriasis. In some cases, some type of physical trauma (such as a bacterial or viral infection – like strep throat), can jumpstart the onset of psoriatic arthritis in individuals predisposed to the disease.
Risk factors for rheumatoid arthritis include being female, being over the age of 40, smoking, having a family history of rheumatoid arthritis, and exposure to environmental toxins, such as asbestos and silica. As mentioned above, presence of the Rheumatoid Factor (RF) antigen can confirm a diagnosis of rheumatoid arthritis.
While both rheumatoid arthritis and psoriatic arthritis can be very painful and debilitating diseases, treatment options are advanced and cause great relief. The key is to catch the symptoms early and stay on top of your treatments.
The most common form of treatment for both psoriatic arthritis and rheumatoid arthritis are medications. DMARDs and NSAIDs are the usually prescribed medications for treatment of both types of arthritis. Non-steroidal anti-inflammatory drugs (NSAIDs) relieve pain and reduce inflammation. Disease-modifying antirheumatic drugs slow the progression of joint disease.
Other common medications used in the treatment of both psoriatic arthritis and rheumatoid arthritis are immunosuppressants, TNF-alpha inhibitors, steroid injections into inflamed joints, and joint replacement surgery (in extreme cases).
Consistent exercise that does not place much stress on the joints, maintaining a healthy weight, and resting often can also help minimize joint stiffness, joint pain, and fatigue that often accompany both types of arthritis as well.