If you’ve got sore, swollen joints, there’s a good chance you’ll come across arthritis as you’re searching for a cause of your symptoms. But finding the right treatment requires you to get a lot more specific than that. Arthritis is actually an umbrella term for more than 100 different conditions, according to the Centers for Disease Control and Prevention (CDC). And there are at least two types that might be responsible for your tender, achy joints: psoriatic arthritis and rheumatoid arthritis.
Even though they have some overlapping symptoms, the two conditions are decidedly different. Here’s what you need to know about psoriatic arthritis and rheumatoid arthritis.
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 (times when symptoms are especially aggravated). And while there’s 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 it’s important to work with your doctor to manage your disease.
Psoriatic arthritis often affects people who have psoriasis.
Having psoriasis, a disease that often causes inflamed, scaly patches of skin on areas like your knees, elbows, and scalp, puts you at greater risk of getting psoriatic arthritis down the road. The Cleveland Clinic estimates that up to 30% of people with psoriasis get diagnosed with psoriatic arthritis. However, it’s possible to get psoriatic arthritis even if you don’t have psoriasis, and vice versa. Psoriatic arthritis affects people of all genders at relatively equal rates and typically shows up in people between the ages of 30 and 50, says the Cleveland Clinic.
NYU Langone Health explains there are five types of psoriatic arthritis, and depending on which one you have, the disease can show up in very different ways in your body. Around three-quarters of people with the condition have a type called asymmetric oligoarthritis, which impacts up to five joints, though not necessarily the same ones on each side of the body. When the same joints are affected on each side, it may be due to symmetric arthritis, a type of psoriatic arthritis that’s similar to rheumatoid arthritis. There’s also spondylitic arthritis, which affects the spine, and distal interphalangeal predominant psoriatic arthritis, which mainly involves the joints near your fingernails and toenails. The rarest form of psoriatic arthritis is arthritis mutilans. It’s a severe form of the disease that can destroy the bones in your hands, per the Mayo Clinic.
Up to 80% of people with psoriatic arthritis have nail changes, like pitting, crumbling, or grooves and ridges. In addition, foot pain, particularly in the back of your heel or sole, where the tendons and ligaments link up with bones, is common with psoriatic arthritis, as is lower back pain, per the Mayo Clinic.
The inflammation from psoriatic arthritis can also cause eye problems, such as uveitis. This condition can lead to permanent vision loss, so look out for early warning signs, like eye pain, redness, light sensitivity, and “floaters” blocking parts of your sight.
Rheumatoid arthritis doesn’t have that psoriasis link.
The Cleveland Clinic reports that women are diagnosed with rheumatoid arthritis at 2.5 times the rate of men. A common misconception about rheumatoid arthritis is that it’s an elderly person’s disease, but the truth is that it’s often diagnosed between the ages of 20 and 50.While rheumatoid arthritis can affect people in different ways, its signature characteristics include tenderness, pain, and swelling in more than one joint, per the CDC. And although psoriatic arthritis may impact different joints on each side of the body, rheumatoid arthritis usually causes more symmetrical symptoms, says David Wanalista, D.O., rheumatologist at Atlantic General Rheumatology. It’s a progressive disease, so it usually worsens with time, starting with the joints between your fingers and toes and in your hands and feet. The inflammation from rheumatoid arthritis can wear down your cartilage, and without that tissue acting as a shock absorber, your bones can eventually erode, which can lead to fusion of the joint.
There are some other symptoms to know when it comes to rheumatoid arthritis. In particular, you might get firm lumps, known as rheumatoid nodules, around pressure points like your elbows, notes the Mayo Clinic. When the disease flares, it can also come with a low-grade fever. Morning stiffness that lasts more than an hour (but usually a few hours) is especially common in people with rheumatoid arthritis (although this can be a symptom of any inflammatory arthritis), per the Johns Hopkins Arthritis Center. And as with psoriatic arthritis, rheumatoid arthritis can cause eye problems, according to the Mayo Clinic. This may include dryness, redness, and pain.
Treatment for psoriatic arthritis and rheumatoid arthritis is similar, but figuring out which disease you have can be tricky.
No single test can diagnose rheumatoid arthritis or psoriatic arthritis, reports the Mayo Clinic. Rather, your doctor will check your medical history and closely examine your symptoms to see if you have signs of either disease. Symptoms like ongoing morning stiffness, swelling of three or more joints (especially the wrist, hand, or fingers) on the same sides of the body for at least six weeks, and rheumatoid nodules may make your doctor suspect rheumatoid arthritis, the Cleveland Clinic says. To diagnose psoriatic arthritis, your doctor will likely examine your joints to search for swelling and stiffness, your fingernails for any issues like pitting, and your feet for soreness, according to the Mayo Clinic.
“[Diagnosis] is very much an art, and the skills and experience of a rheumatologist are necessary,” John M. Davis III, M.D., M.S., a clinical rheumatologist, vice chair and practice chair of the division of rheumatology, and associate professor of medicine at the Mayo Clinic College of Medicine and Science, tells SELF. “There is a great need for more sensitive and specific diagnostic tests.”
Certain medical tests available now can help inform a doctor’s diagnosis. Elevated levels of proteins involved with immune cells may also help a doctor determine whether you have psoriatic arthritis or rheumatoid arthritis (though the results won’t say for sure), the Mayo Clinic says. Arthur Kavanaugh, M.D., associate professor of medicine and rheumatologist at UC San Diego Health, tells SELF that around 85% of people with rheumatoid arthritis have positive antibody tests for rheumatoid factor antibodies, among other blood test results, compared with just 15% of people with psoriatic arthritis with similar blood test results.
Your doctor may also order imaging tests, like X-rays and MRIs, to help determine if you have psoriatic arthritis. Keep in mind, though, that certain symptoms and test results don’t show up in everyone with these diseases, and they may also overlap with other conditions, making it a challenge to get a firm diagnosis.
Regardless of the diagnosis, though, you may be exploring some of the same treatment options for either disease. Nonsteroidal anti-inflammatory drugs (NSAIDs), like Advil and Aleve, are often the starting point for treatment of rheumatoid arthritis and psoriatic arthritis. Doctors may also use disease-modifying antirheumatic drugs (DMARDs) to slow the progression of either disease, according to the Mayo Clinic. A newer type of medication known as a JAK inhibitor, a special kind of DMARD, may help calm inflammation and prevent joint damage. Biologics may curb inflammation as well. The exact drugs your doctor prescribes from these classes of medicines may vary depending on whether you have psoriatic arthritis or rheumatoid arthritis, particularly when it comes to biologics, says Lisa F. Imundo, M.D., a rheumatologist at Columbia University Irving Medical Center.
It’s important to understand that there’s no one-size-fits-all approach to treating either disease, and how effective a particular medication is can vary from person to person.
“Treatments can fully restore function and well-being in some people, whereas that is more difficult to achieve in other people,” Ana-Maria Orbai, M.D., M.H.S., director of the psoriatic arthritis program at Johns Hopkins University School of Medicine, tells SELF.
Plus, each medication comes with the risk of potential side effects. Weigh out the pros and cons of each option with your doctor to help strike the right balance for your long-term health.
Bottom line: If you’re having joint pain or other symptoms of arthritis, talk to your doctor.
It’s impossible to pinpoint psoriatic arthritis, rheumatoid arthritis, or any of the other dozens of types of arthritis based on symptoms and an online search alone. But some of these diseases can cause serious long-term damage, so talk to your doctor about a diagnosis and treatment options so you can find relief sooner rather than later.