Diagnosing PsA — Why So Challenging?
Whether you’ve had psoriatic arthritis (PsA) for years, or are just in the diagnostic process, chances are you and your healthcare provider had some difficulty determining the cause of your symptoms. This is because, oftentimes, the hallmark symptoms of PsA mimic those of other inflammatory arthritic conditions such as gout and rheumatoid arthritis. Symptoms may even present similarly to other conditions as well, including osteoarthritis. If you’re still struggling with a diagnosis or just want to take a walk down memory lane of your diagnostic frustrations, read on for information on the typical, albeit tricky, diagnostic process.
Visiting a Rheumatologist
After seeing your primary care physician, you will most likely be referred to a rheumatologist for further investigation of what’s going on. These doctors specialize in arthritis and musculoskeletal disease, and will often start with asking about your medical history. Medical history is incredibly important because some of these similar conditions are genetic, while others are not, just as some present in very characteristic symptom patterns. Some questions you may be asked include a description of your symptoms, details and location of the pain and when it started or when it comes, other medical conditions that you or your family may have that could contribute to what’s going on, and how your symptoms affect your quality of life and routine activities.
After obtaining a medical history, your doctor will typically perform a physical exam, looking for both psoriasis and signs of swelling or inflammation around joints. Even if you didn’t think you had psoriasis before your appointment, it may be hiding in locations that are hard for you to see. These include behind your ears, in your belly button, or on your scalp.
Tests and Procedures
Several diagnostic tests can be performed to rule out certain conditions or confirm the presence of PsA. X-rays can detect bone or joint changes, while blood tests can check for inflammation and its characteristics. Some typical blood tests include tests for RF (rheumatoid factor) or C-reactive protein. RF factor is typically a sign of rheumatoid arthritis and often may rule out PsA or other inflammatory conditions. Blood testing can also check the sedimentation rate in the body. The higher the rate, the greater the level of inflammation. Joint fluid can also be tested to rule out infectious arthritis or gout.
Symptoms to Look for to Help Your Diagnosis
Since misdiagnosis is so common, it isn’t unusual for someone to get diagnosed with another condition, only to find out they really had PsA all along. Be aware of certain trends in your symptoms that you can tell your doctor that may lead to a speedier diagnosis. For example, gout pain is often rapid and intense, and affects one area, while symmetrical pain that occurs most of the time may be a sign of rheumatoid arthritis (RA). PsA is usually asymmetrical and can come on in the morning or after inactivity. Pain experienced in joints after you have engaged in some activity is most likely osteoarthritis. Also, individuals with PsA often report having dactylitis, or sausage fingers or toes, as well as nail pitting.
Since symptoms look so much like other musculoskeletal conditions, including typical overuse, it can be hard to get an accurate diagnosis of PsA right away. It is also important to keep in mind that just because someone has psoriasis, doesn’t mean their joint pain has to be psoriatic arthritis. It can really be many different things! Share with us your diagnosis success or failure stories, and how you ended up at the correct diagnosis!
- “Psoriatic Arthritis Diagnosis.” Arthritis Foundation. Available from: http://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/diagnosing.php