PsA versus RA: What

PsA versus RA: What’s the Difference?

Psoriatic arthritis (PsA) and rheumatoid arthritis (RA) 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!

Similarities between RA and PsA

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.

Differences between RA and PsA

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.

On the whole, PsA and RA can look extremely similar, especially to an unknowing observer. However, on a smaller scale, they can present completely different! The key to being able to distinguish between the two yourself, or helping others learn the differences, often can come from education about each. It may take time, and it often isn’t clear-cut at all, but knowing what differences to look for can be incredibly helpful!

View References
  1. Martin, Layne. “What is the difference between psoriatic arthritis vs. rheumatoid arthritis?” CreakyJoints.org. Available from: https://creakyjoints.org/blog/psoriatic-arthritis-differ-rheumatoid-arthritis/.
  2. “Psoriatic Arthritis.” Alberta Rheumatology. Available from: http://albertarheumatology.com/inflammatory-arthritis/psoriatic-arthritis/.

Comments

View Comments (9)
  • Sean
    2 months ago

    “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!”

    The above is pretty scary. That said it does NOT mean you won’t live a long and active life. My mother has RA and is about to turn 80. She’s vacationing in Mexico this very week so RA hasn’t slowed her down at all. My mother-in-law also has RA … more severe than my mother’s if her symptoms are any indication. She’s in her mid 70s. So while the internal organ stuff can be frightening, and should NOT be discounted, it does NOT automatically equal an earlier than average death.

  • DonnaC
    8 months ago

    Hi

    I was diagnosed with RA about 12 years ago. I was prescribed methotrexate. Then 6 years ago i started getting these little pus pockets on the soles of my feet and palms of my hands. RA dr then said i have psoriatic arthritis. So i started Humira. Didnt seem like either med helped n the side effects were scary. So now all i take for the pain is tylenol. Not much pain relief, but idk what else to do. My question is about this rash i get now. Its these red raised patches. Not scaly. Itchy and in some places feels like scalding hot water was poured on me. When the rash pops up, it can be there a day n be gone the next day. Then again it can last for dayssss!! PCP wants me to go to an allergist now. Ugh!! Dr Merry Go Round. I wish i could add a picture of this rash, so yall can see it. Idk how to do that here though.

  • KristalJ
    4 months ago

    I know exactly what your talking about! I have the rash! It’s very frustrating!

  • cynthiahieger
    6 months ago

    I was diagnosed for 12 years with a different autoimmune until last year when I broke out with psoriasis with pustuals.” It’s called Pustular psoriasis. Note the clearly defined, raised bumps on the skin that are filled with pus (pustules). … It’s a type of psoriasis, a skin disease marked by scaly red skin that can be itchy and painful. Sometimes, pustular psoriasis can cause pus-filled blisters to cover large portions of your body.” Mine is on my hands and feet also. I hope you have better luck with your dermatologist. I have spent a lot of money with zero results. I have gotten much better advice on google

  • Rebecca moderator
    8 months ago

    Hey @donnac,
    Thanks for commenting! Unfortunately, we don’t yet have the ability to post pics 🙁 You can certainly post a pic on our facebook page at https://www.facebook.com/PlaquePsoriasisdotcom/ and maybe one of our members might have some ideas.
    I know you mentioned you had pus pockets on the soles of your feet – I wonder if this rash is just the psoriasis showing up differently? Obviously, only way to know for sure is dermatologist – let us know what you find out! -Rebecca (psoriatic-arthritis.com team)

  • imschmarte
    8 months ago

    I too have the pus pockets on my palms and bottoms of my feet. It is palm and plantar pustular psoriasis. Basically it gets red and angry, you get the pus pockets, and it itches so bad, I have walked in the snow barefoot to stop it. (Not one of my smarter ideas! LOL) But mine has never disappeared so fast. When it visits, it stays! The only thing to clear mine up is Remicaide, or cortisone shots. I wish I could see your rash, but sure sounds like what I have other than the duration.

  • ggrandma11
    8 months ago

    Hi,
    I was diagnosed almost 20 yrs ago with PsA, I was lucky enough to be able to retire at age 59. I did do some consulting work, until my daughter had a premie baby and I stayed home to take care of her and then her brother.
    I learned to find alternative ways to do the things I couldn’t do the way I used to do them. Some worked some didn’t. I have been on prednisone for 20 yrs, taken Embrel, Humara, and another one, can’t remember the name, that landed me in the hospital. It has since been taken off the market.
    Yes I hurt everyday, it is just a matter of intensity, the only pain meds I take are aspirin and Tylenol. Too many side effects with ibuprofen. If I have a lot to do one day I know I have to rest the next. But, although I use a walker and a scooter, the one thing I refuse to give up is anymore independence!
    I get down once in a while, but I try to stay positive and do as much as I can!
    I am so happy to have found this site as it has helped me to understand and especially helped my friends and family to understand what this is and how I feel. Thank you!

  • Eurotrekker
    1 year ago

    Thank you for the article. It’s difficult for me to let people know. Often, if someone sees I’m having a particularly bad day, she may say, “I know how you feel. After I broke my finger, I have had arthritis. It hurts me.” I don’t like to complain and mostly just say I’m doing ok. However, they don’t understand the depth of this illness. It’s not just my joints. I’ve already had part of my lung removed because it died, though the specialists don’t know why. My eyes water or blur and ache. I’m tired all of the time. It’s not just not one joint, but a myriad. On good days, it’s just a few, though my back pain is continuous and strong. The medication creates a plethora of other symptoms. It’s a most debilitating disease. On the plus side, I don’t take things for granted. I enjoy the days I feel I can go grocery shopping (though I am not a person who loves to shop). I love the times I’m up to socializing. I appreciate the kindness of others. We constantly hear the negative things about the population. However, when people see me using my cane, they are more than welcome to open the door for me, carry my groceries to the car, or pick up things when I drop them. Though I’ve always been a positive thinking person, I focus more on the positive now. I don’t have the time or energy to live life negatively. Small things seldom bother me (unless it’s something I want to do and can’t…I get frustrated at myself, but I’m working on self-patience, as well). Of course, without my faith and the grace of God, I don’t think I could handle this terrible disease. I pray a cure will be found soon.

  • VickiN moderator
    1 year ago

    Hi Eurotrekker! It’s always such a pleasure to see you here 🙂 Focusing on the positive is one of the things we have control over, and can change your perspective so much (though it’s incredibly difficult on the hard days, that’s for sure). One of our contributors, Leanne, as has also found ways to focus on the positive:
    https://psoriatic-arthritis.com/living/saying-goodbye-old-me/
    I also thought you might like to join our Spotting Spoons community, where we share things that lift our spirits or give us joy:
    https://psoriatic-arthritis.com/video/join-hashtag-community-spottingspoons/
    I hope that today is a good one for you, I’m sending you a gentle squeeze through the screen
    -Victoria, Community Moderator

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