Diseases that mimic psoriatic arthritis (PsA) often involve joint pain and inflammation, with common culprits being Rheumatoid Arthritis (RA), Osteoarthritis (OA), and Gout, but also conditions like Lupus, Fibromyalgia, Ankylosing Spondylitis, Enteropathic Arthritis, and even Lyme Disease, making accurate diagnosis challenging and requiring a rheumatologist's expertise to differentiate by specific symptoms like skin/nail involvement, joint patterns, and enthesitis.
Exams, along with blood and imaging tests, help your doctor diagnose PsA and monitor your response to treatment. The early warning signs of psoriatic arthritis (PsA) can be subtle and hard to spot.
When the pain of PsA is severe or when it does not go away with traditional PsA treatments, you may want to talk to your health care provider about medication that helps reduce your sensitivity to pain. Prescription pain medications such as Gabapentin and Pregabalin are used to treat neurological pain.
The most common misdiagnoses prior to receiving a diagnosis of PsA were psychosomatic disorder (26.6%), osteoarthritis (21.7%), anxiety or depression (18.2%), and orthopedic problems (18.2%) (Figure 2).
PsA can occur in any joint or wherever your ligaments and tendons connect to bone. You may experience PsA symptoms in certain areas of your body, which are commonly called domains. The six domains of psoriatic arthritis include spondylitis, enthesitis, dactylitis, peripheral arthritis, psoriasis, and nail changes.
The red flags or most common symptoms of psoriatic arthritis are joint pain and joint stiffness, especially if you have psoriasis.
Psoriatic arthritis can sneak up on you, so it is vital to know the red flags. Watch out for joint pain, stiffness, swelling in fingers or toes, nail changes such as pitting, and fatigue. These symptoms can come and go, so it's easy to dismiss them, but if they persist, reach out to our rheumatologist at our practice.
It is based on the “rule of nines”, which was originally developed to assess the area of involvement in a burn case. In this, each of the following 11 body parts is awarded 9% of BSA (head and neck, 2X arms, 2X anterior and posterior legs, 4X trunk) and the remaining 1% is for genitalia.
IL-17 Inhibitors
In September 2024, the FDA approved a new member of this class for psoriatic arthritis, bimekizumab, a humanized monoclonal IgG1 antibody that binds to and inhibits both IL-17A and IL-17F. IL-17A and IL-17F share some overlapping inflammatory properties, but IL-17F is more elevated in psoriatic issues.
Apremilast (Otezla) is a pill that lessens inflammation. It's often used for mild to moderate psoriatic arthritis, especially if you don't want to or can't take conventional DMARDs or biologics. Common side effects include diarrhea, nausea and headaches.
Gabapentin may cause vision changes, clumsiness, unsteadiness, dizziness, drowsiness, sleepiness, or trouble with thinking. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert, well-coordinated, or able to think or see well.
Widespread pain from fibromyalgia syndrome (FMS) is observed in patients with psoriatic arthritis (PsA). We hypothesized that there is increased frequency of FMS in patients with PsA that contributes to fatigue and pain.
The criteria includes: An examination by the physician determining if the joints are swollen or tender. The most commonly affected joints are the joints of the fingers and/or toes. The doctor will also look for inflammation in the tendons, spine, and swelling of fingers or toes known as “sausage digit”.
It's considered severe when more than 10% of the body is covered. Eyes. PsA or psoriasis can also affect your eyes. You might get pink eye (conjunctivitis); dry eye syndrome, which causes dry, burning, gritty-feeling eyes; or swelling in the white part of the eye (scleritis).
Conclusion Our group of psoriatic arthritis patients shows a high prevalence of ANA positivity. Although the frequency of patients with sacroiliitis, family history of psoriasis and psoriatic arthritis is greater in the ANA positive group we were not able to show differences with statistical significance.
Chinese Medical View
According to Chinese Medicine theory acupuncture and Chinese herbs can be prescribed to treat psoriasis. Treatment is mainly herbal. It can be either internal (herbal infusion to drink) or external (herbs to wash with or herbal cream to apply on the skin) or both. There are no bad side-effects.
The five main types of psoriasis are plaque, guttate, inverse, pustular, and erythrodermic. Plaque psoriasis, also known as psoriasis vulgaris, makes up about 90% of cases. It typically presents as red patches with white scales on top.
Steroid creams or ointments (topical corticosteroids) are commonly used to treat mild to moderate psoriasis in most areas of the body. The treatment works by reducing inflammation. This slows the production of skin cells and reduces itching.
Depression and anxiety are seen in around one third of patients with psoriatic arthritis (PsA), and have a bidirectional association with pain. Inflammation is considered to be a core pathogenic feature of depression in PsA patients.
Some natural and non-medication therapies that may help with psoriatic arthritis include exercise, occupational therapy, and acupuncture. Other therapies that are still being researched include massage, energy healing, and biofeedback. While research is limited, some people may find these therapies to be helpful.
TL;DR
Currently, there is no single gold standard test for psoriatic arthritis. Instead, doctors rely on a combination of clinical evaluations, lab tests, and imaging studies. This detailed diagnostic process helps ensure an accurate diagnosis and guides the most effective treatment plan.
Here's what the research says about some supplements that have been studied for psoriatic arthritis.
If the GP thinks you may have psoriatic arthritis, they'll refer you to a specialist (rheumatologist). Tests you may have include: blood tests. joint fluid test – where fluid is removed from an affected joint and tested.