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!

View References
      “Psoriatic Arthritis Diagnosis.” Arthritis Foundation. Available from: http://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/diagnosing.php

Comments

View Comments (13)
  • Jax53
    3 months ago

    Hi, I understand that I do have Psoriatic Arthritis, and Osteoarthritis, Both Diagnosed by Rheumatology.

  • Jax53
    7 months ago

    Hi, Rebecca, I have not heard of this? Is it widely used? Can I get my Rheumatologist to give me that? The thing is Because they had exhausted all treatments I had been discharged, by my Dermatologist, I now have a different one, and we clashed the minute I set eyes on her. I am left in the dark, what other treatments have I missed out on?

  • CathyD moderator
    7 months ago

    Hi @jax53,

    We have some information on Humira within this article (it actually talks about a lot of different biologics – this is the type of medication that Humira is), which I thought may be helpful: https://psoriatic-arthritis.com/medications/biologics-how-well-works-side-effects/ A rheumatologist (or dermatologist) would have to prescribe this to you – you can’t get it from your regular doctor.

    We also have some information on other treatments which are available, here: https://psoriatic-arthritis.com/medications/ Often, but not always, the medications are trialled/prescribed in a specific order. So if traditional DMARDs don’t work (you will recognise sulfasalazine under this category), then you may be considered for biologics. As I mentioned, this is not always the case and everyone/ every situation is different.

    I hope this information is helpful. Let us know if you have any questions!
    -Catherine, Community Moderator

  • Jax53
    7 months ago

    I have both, P Arthritis, and osteoarthritis, My knees are shot, My ankles stiff and painful, My toes hurt and look unlike any toes I know, Nodules on my fingers, some I can move, which makes people sick to look at, But it is a party trick, No joke It is hard when your whole body is one large pain, but differences in severity of all joints, now my hips are going too, Although I have osteoarthritis in my hips I get shooting pains down my leg when my hip refuses me a walk. How on earth will we all survive if no cure is found, But from our Death comes knowledge, and in that faraway land they will find a cure, for all those who are like us unfortunates who will be diagnosed this disease?

  • mickey
    12 months ago

    Hi, I’m a new member, going on 78 years of age. I have had a myriad of ailments over the years but most of the time, being a NYC guy, I would just lie down and sort of wait for the pain, swelling, stiffness to go away. It’s a NYC thing.
    I was diagnosed with PSA about 10 years ago and was immediately put on 20mg of Methotrexate and Humira. About 2 years ago we switched to Enbril. So far, they have not done what I thought they would do. I have so many flare ups that it’s just about constant. The worst areas are my feet, hands, shoulders. The problem is I have severe leg Cramps that the Drs call nerve fasciculation. Very often I can’t tell the difference between PSA or Nerve Fasciculation. To round thing up – I’m also diabetic, and I had a triple bypass 5 years ago. I used to be very active but now, my legs just won’t hold up. I try to stay as active as I can but, it’s super depressing not to be able to hold anything are do my regular morning exercises anymore. I really hope someone can offer some advice. Thank you in advance.
    Mickey

  • Jax53
    7 months ago

    Hi, Mickey, good to meet you, I am 65 in a few weeks, and like you have several illnesses, all linked to the autoimmune system, Ok, Mickey Try some gentle Pilates, you can do those sitting down, I wear gloves because of the band to hurt my hands, But they do work, and it does not hurt too much, it is a matter of trial and error, Give it a go.

  • cantstandlong
    2 years ago

    I don’t think I can be a candidate for humira because there is a history of gbs&lephoma.

  • Jax53
    7 months ago

    Hi, Cantstanddlong, What is Humira please? and is that in America? or England?

  • Rebecca moderator
    7 months ago

    Hey Jax53 – Humira is a biological pharmaceutical. I believe it’s available worldwide?

  • Casey moderator
    2 years ago

    Hmmmm interesting, cantstandlong. I’m glad to hear you’re being cautious regarding different treatment options and other conditions you have or are at risk for, however if this is a treatment you’re interested in we recommend talking to your doctor about it’s appropriateness for you. They may be better able to assess your risk and potential benefits from Humira. If you get a chance to talk to your provider, let us know what they say! We’re here for you and interested in hearing what advice they provide! -Casey, Psoriatic-Arthritis.com Team

  • Ladybug
    2 years ago

    I have had chronic psoriasis since the age of 4 (now age 52). This summer, I had a back injury, which after MRI was dx as 2 herniated discs, and arthritis. After that, i had a huge flate up in my skin, and random joints began to swell and ache. I had only had minor joint problems before this, and could usually associate it with over use. Now I wake up in pain, and my feet hurt when they hit the floor. Xrays show osteoarthritis in feet, hands and knees. Blood work was negative for RA. The dx of psoriatic arthritis has not been made. My pain, and the joints affected seems to change every day. The rheumatologist suggests I ask my dermatologist for Humira, and says if it works, it can confirm the dx. Im not sure I want to go right to biologics, but I am afraid of further damage to my joints. Any advice? Is this a common presentation? Should I get a second opinion?

  • CathyD moderator
    2 years ago

    Hi there Ladybug!

    I’m sorry to read that you are suffering with pain and swelling in your joints. I can understand your hesitation to start Humira in order to confirm a PsA diagnosis, do you/your dermatologist feel you need to use a biologic for your skin? I would say if you aren’t sure that a second opinion is a great idea – the more the better! There are also more tests which can be done to help build a picture of what is going on – we have an article which talks about this, if you haven’t seen it already you can find it here: https://psoriatic-arthritis.com/how-doctor-diagnose/ I hope this is helpful. Please reach out to us if you have any more questions, or if you need support – we are here for you.

    Best,
    CathyD

  • Ladybug
    2 years ago

    That should say flare up.

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