Diagnosing psoriatic arthritis (PsA) can be a real challenge, especially since there are

several arthritic conditions that can present similarly to one another. PsA is often
misdiagnosed for rheumatoid arthritis, gout, or osteoarthritis, just to name a few. PsA
is usually distinguished by the types of joints affected or the presence of
accompanying psoriasis. But even so, diagnosis can be a challenge, and take some
time. Osteoarthritis is the most common chronic joint condition and affects nearly 30
million Americans. Some estimates even report that as many as 70% of individuals
between the age of 55 and 78 are affected with osteoarthritis. Despite its
commonality, it is still challenging to separate it from other arthritic conditions,
including PsA. However, there are some common differences between the two you
can look out for.

Underlying cause and type of pain

While PsA presents with joint stiffness and swelling due to an overactive immune
response, osteoarthritis (OA) usually has minimal swelling, and is the result of wear-
and-tear to joints. This is why OA affects primarily major or weight-bearing joints,
such as the hips, knees, spine, or neck, and typically shows up later in life. PsA can
arise across a variety of ages, and often affects the smaller joints of the fingers and
toes first (the reason for their “sausage” appearance). The wear-and-tear of OA is a
result of cartilage breaking down. Cartilage normally keeps joints smooth and allows
them to function without friction, and without it, can lead to clicking or brittle joints.
Additionally, pain and stiffness in PsA is also typically cyclic, with periods of flare-ups
and remission, whereas, OA is a degenerative condition that is constantly getting
worse, despite attempts at movement. Finally, the risk factors that lead to the
development of each condition are also varied. Obesity, advanced age, previous
joint injuries or deformities, repetitive motions, and genetics can all play a role in
developing OA, whereas PsA’s causes are typically genetics, previous trauma (such
as viral or bacterial infections), medications, and stress.

Diagnosis and treatment

OA and PsA are also diagnosed and treated very differently. Diagnosis for PsA often
follows the presentation of psoriasis (which could be hiding in hard to notice
locations), and diagnostic tests that rule out other conditions (such as the lack of RF-
factor in blood tests for rheumatoid arthritis). OA, on the other hand, is a little more
definitive in diagnosis. Joint fluid is directly obtained and tested from an affected
joint, and often presents with crystals indicative of degeneration. Additionally, X-rays
and MRIs, while expensive, have the ability to point pretty definitively towards OA
and cartilage destruction, more than typically ambiguous scans of joints with PsA.
Due to their different causes, different treatments are warranted. Since inflammation is
not the root cause of OA, typical medications used to treat it do not have anti-
inflammatory properties. Many OA medications are strictly pain-focused, while PsA
meds are aimed at reducing inflammation and keeping pain at bay. Both conditions
have the ability to respond to injected steroids, however, OA may also respond to
lifestyle changes, such as dieting to lose weight, in order to relieve stress on joints. In
severe cases of both OA and PsA, surgery could be warranted to replace entire
joints.
Overall, both conditions can present very similarly, and cause confusion for both
individuals with the condition, and the healthcare providers trying to diagnose and
treat them. The most important thing is to remain educated and aware of
your symptoms, in order to best help your healthcare team get to the root of your
struggles!

Psoriatic Arthritis and Rheumatoid Arthritis are two conditions that can often go hand
in hand. This isn’t because they are mirror images of each other—on the contrary,
there are several key differences between the two—but rather, is usually due to a
lack of knowledge on what sets them apart. While there are many overlaps between
them, their differences can be very distinct, if you know what to look for. Let’s take a
look at some of the major similarities and differences between these two common,
and frustrating, conditions!

On the whole, PsA and RA could be twins

Taking a large step back, these two could be completely indistinguishable, leading to
much confusion. It isn’t until we really scrutinize what someone is going through on a
daily basis, that we can really tell them apart. From a further away standpoint
however, both PsA and RA possess many of the same defining features:

 Both PsA and RA are auto-immune conditions: This means that the body mistakenly attacks
its own healthy cells in both conditions. This is why individuals with RA and PsA both
experience erosive joint symptoms, such as swelling, pain, and stiffness, as well as chronic
fatigue from an immune system working in overdrive.
 Both affect internal organs: Long-term progression of both PsA and RA can lead to
scarring, inflammation, and damage to major internal organs, such as the heart and lungs.
This process is incredibly similar in both!
 Accompanying osteoporosis: Both PsA and RA can lead to a weakening of bones, otherwise
known as osteoporosis. This can make additional fracturing of bones or joints incredibly easy
for individuals with PsA and RA.
 Similar treatment algorithms: Treatment of RA and PsA can be virtually identical at times,
and include anti-inflammatory medications (NSAIDS), corticosteroids, DMARDS (disease
modifying anti-rheumatic agents), and even surgery to stabilize affected joints in serious
cases.

Taking a closer look, PsA and RA can be

incredibly different
Although on a large scale these two couldn’t be more similar, when taking a closer
look, their differences couldn’t be more apparent. Many of these differences act on a
more daily level, as opposed to the condition’s progression as a whole, and can be
very distinguishing factors.

 Blood test results: One common difference between PsA and RA comes on the microscopic
blood level. Oftentimes, individuals with RA will have an antibody present in their blood
known as rheumatoid factor. Therefore, to any medical provider, blood tests for these
conditions can be very different!
 Specific joints affected: Although joint pain, swelling, and stiffness are common symptoms in
both conditions, the specific joints affected can be extremely indicative of one over the other.
 For example, PsA often affects distal joints in the fingers and toes (meaning the joints closest
to the nail bed), and in the lower back. This can lead to the appearance of “sausage fingers or
toes.” Conversely, RA tends to affect a different set of joints, such as those in the middle of
fingers and toes, as well as at the wrist. Additionally, joint pain with PsA is
typically asymmetrical versus the more uniform RA.
 PsA affects much more than just joints: While both conditions have wide-reaching, and
debilitating symptoms, PsA can often go beyond just bones to affect tendons, skin, nails, and
even the eyes. This can lead to a wide host of related conditions, such as plantar fasciitis,
conjunctivitis of the eye, and most commonly, psoriasis of the skin. Although one doesn’t
have to have psoriasis to have PsA, it is a very common comorbidity.