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Psoriatic arthritis vs. rheumatoid arthritis: What to know

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About PsAAbout RADifferencesTreatmentSummary
Psoriatic arthritis (PsA) and rheumatoid arthritis (RA) are autoimmune conditions causing joint pain, swelling, and stiffness. But, there are key differences to note for accurate diagnosis and treatment. 
Medically reviewed by Nancy Carteron, M.D., FACR
Written by Suan Pineda
Updated on

PsA and RA are chronic conditions that have some similar symptoms and treatments, but some are specific to each.

Let’s take a look at the characteristics of both conditions, their differences and similarities, as well as medical treatments and home remedies to help manage them.

About PsA

Close up of older adult female touching her wrist with her hand depicting psoriatic arthritis vs. rheumatoid arthritis
Tatiana Timofeeva/Stocksy United

PsA is arthritis that develops primarily in people with psoriasis but can also develop in people without. It causes inflammation resulting in swelling, stiffness, and joint pain. It is a chronic, autoimmune inflammatory condition where the immune system mistakenly attacks healthy joint tissue, ligaments, tendons, and skin.

Experts do not know the exact cause of PsA, but a genetic component does exist. About 40% of people with the condition have a close family member with psoriasis or PsA. 

The condition is not contagious, but an infection could trigger it. Other triggers include stress and injury.

About 8 million people have psoriasis in the United States, and 30% of them develop PsA. The condition can progress and worsen, but early diagnosis and treatment can slow progression and avoid permanent joint damage. 

Symptoms

Symptoms of psoriatic arthritis include:

  • fatigue
  • swelling in the fingers and toes, resulting in a sausage-like appearance
  • tendon pain, tenderness, and swelling
  • joint pain, stiffness, and swelling
  • nail pitting
  • eye pain (uveitis)

Learn more about psoriatic arthritis symptoms.

Characteristics

PsA affects both males and females and usually develops between the ages of 30 and 50 years. There’s no cure for this condition. 

Although the condition appears to affect males and females equally, a 2021 study shows some differing characteristics, as females often experience more pain, fatigue, and lower remission rates, while males seem to experience more spinal symptoms. 

People with PsA can experience flare-ups and remission. During flare-ups, people may develop plaques on their skin due to a buildup of excess skin cells. 

Learn more about how psoriatic arthritis looks.

Diagnosis 

It’s difficult to diagnose PsA because its symptoms are often similar to RA. 

There’s no specific test to help with diagnosis, but a doctor may perform imaging scans to rule out other conditions. These scans include ultrasound, magnetic resonance imaging (MRI), and X-rays to assess for tendon, ligament, or joint inflammation.

They may also order blood tests that look at C-reactive protein, joint fluid, and red blood cells, as certain changes in these substances may indicate PsA.

About RA 

Rheumatoid arthritis is an autoimmune condition in which your immune system tries to destroy healthy cells in the joint lining, causing swelling and pain in your hands, wrists, and knees. The condition can also affect your eyes, heart, and lungs. Symptoms are typically symmetrical, so they will affect the same spot on both sides of the body at the same time.

About 1.5 million people in the United States have RA.

Symptoms

Common symptoms of rheumatoid arthritis include:

  • joint stiffness, tenderness, and swelling
  • pain or aching in more than one joint
  • weight loss
  • fatigue
  • fever
  • weakness
  • symptoms that appear on both sides of your body

If you have an RA diagnosis, you may also experience more serious symptoms, such as:

  • inflammation of the blood vessels, known as vasculitis, resulting in nerve or other organ damage
  • skin vasculitis rash, in which the skin breaks down. This can lead to ulcers without early diagnosis and treatment
  • lung inflammation
  • heart muscle inflammation
  • eye inflammation that can lead to corneal ulcerations and loss of sight without early diagnosis and treatment

Learn more about rheumatoid arthritis symptoms. 

Characteristics

One of RA’s key characteristics is symmetrical symptoms. This means symptoms are present on both sides of the body, like in both hands, feet, or ankles.

Although RA can affect females and males, females are three times more likely to develop the condition. According to the Arthritis Foundation, the condition develops between the ages of 30 and 60 years among females, while it is rarely seen in males younger than 45 years.  

The exact cause of RA isn’t known, but experts believe it has a strong genetic component, with environmental factors, infections, and stress triggering symptoms. 

RA has no cure, but early diagnosis and treatment are key to managing the condition and preventing permanent damage. 

Diagnosis 

Your doctor will use several tests to rule out other conditions and make an accurate RA diagnosis. 

Your doctor will consider your medical history and overall physical health when diagnosing the condition but may also order blood tests to identify substances linked to RA, such as:

  • c-reactive protein
  • cyclic citrullinated peptide antibody test (CCPAb)
  • rheumatoid factor (RF)
  • erythrocyte sedimentation rate

Your healthcare team may also suggest imaging tests, like X-rays, which can show erosions due to specific RA subsets, like RA nodules. They may also recommend these tests if you have a family history of the disease. Other imaging tests may include ultrasounds or MRIs. 

How are they different?

PsA and RA are chronic autoimmune conditions in which your immune system mistakenly attacks healthy tissue. The symptoms of both conditions present in your joints with swelling, pain, and stiffness.

However, these conditions have some key differences, including:

  • Symmetry: People with a PsA diagnosis experience pain and swelling in one side of the body. For example, they may have pain and stiffness in the right hand but not in the left. People with RA experience symptoms on both sides of the body.
  • Entheses vs. synovium: PsA often affects areas where tendons and ligaments attach to your bones. This is called the entheses. RA affects the synovium, the connective tissue that lines the inside of your joints.
  • Sex: Females and males have the same risk of having PsA, though studies show characteristics differ between them. RA affects females more than males.

What are the different treatment options?

Treatment for PsA and RA are similar in some ways, such as helping to relieve pain, slow the progression of the condition, and improve quality of life.

Psoriatic arthritis treatments

Medical treatments for psoriatic arthritis include:

  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • corticosteroids
  • disease-modifying anti-rheumatic drugs (DMARDs), such as leflunomide (Arava), sulfasalazine (Azulfidine), and methotrexate (Trexall)
  • biological therapies and newer oral immune modulators, such as adalimumab (Humira), apremilast (Otezla), certolizumab (Cimzia), etanercept (Enbrel), risankizumab (Skyrizi), and tofacitinib (Xeljanz/Xeljanz XR)
  • phototherapy
  • surgery

DMARDs are often useful to treat peripheral arthritis, which typically affects larger joints, such as the arm and leg. Doctors may recommend biological therapies when the disease affects the spine.

Learn more about treatment for psoriatic arthritis.

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Rheumatoid arthritis treatments

Medications to manage rheumatoid arthritis include:

Other treatments for rheumatoid arthritis include:

  • surgery
  • physiotherapy
  • occupational therapy

Natural management

You may find some at-home practices can help with RA and PsA symptoms. These include:

  • physical activity, such as walking, yoga, and tai chi
  • eating a balanced diet
  • quitting smoking
  • bathing in mineral-rich water, such as Epsom salt baths, which are high in magnesium
  • avoiding alcohol
  • reaching or maintaining a moderate weight
  • trying complementary therapies, such as acupuncture and osteopathy
  • minimizing processed and high-sugar foods that can cause inflammation
  • ensuring good oral health

Summary

PsA and RA are both autoimmune conditions where your immune system mistakenly attacks healthy tissue. Both conditions cause pain, swelling, and stiffness in the joints.

Although some symptoms are similar, doctors and healthcare professionals will look for key differences between PsA and RA to ensure correct diagnosis and treatment.

Talk with your doctor if you experience chronic pain, swelling, and stiffness in your joints.

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