Is It Psoriatic Arthritis, Gout, or Something Else?

If you have psoriasis, you are at greater risk for inflammatory joint problems such as osteoarthritis and rheumatoid arthritis (RA). You are particularly susceptible to developing psoriatic arthritis and gout. That’s why it’s so important to understand the differences between the conditions and to spot their signs early on.

According to the National Psoriasis Foundation, nearly one-third of people with psoriasis also develop psoriatic arthritis (PsA). Psoriatic arthritis can affect multiple joints, producing significant pain and stiffness. The symptoms can flare, subside, and even change location in your body. The condition often strikes the fingers and toes, especially those joints closest to the fingernails, which can lead to brittle or cracked nails. This can cause the fingers to swell, a phenomenon known as dactylitis, or sausage fingers.

Psoriatic arthritis can also affect the lower back, wrist, knees, ankles, and tendons, leading to tendinitis or tender spots where the tendons and ligaments attach to the bone (enthesitis). Diagnosing psoriatic arthritis can be tricky because the symptoms frequently mimic other forms of inflammatory arthritis.

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Signs of Gout

Individuals with psoriasis are about three times more likely to have high levels of uric acid in their blood, and those who have both psoriasis and psoriatic arthritis have a five-times-greater risk of developing gout.

Gout arises from deposits of uric acid in joints and the soft tissue that surrounds joints, especially the big toe. Uric acid, which is produced naturally and from the breakdown of certain foods, can form sharp crystals, producing intense joint pain and swelling. Fortunately, these symptoms usually subside after an initial flare.

The Right Diagnosis

Getting a timely, accurate diagnosis from a rheumatologist, a specialist in arthritis and musculoskeletal diseases, is essential. You want to be sure you receive proper treatment and prevent long-term damage or complications.

“We will use all the tools we have [to get an accurate diagnosis],” says Zhanna Mikulik, MD, a rheumatologist at the Ohio State Wexner Medical Center in Columbus, Ohio. “[Your rheumatologist] will look at what joints are affected, what the pattern is [in the body] and how it started.”

A comprehensive evaluation includes a physical exam, blood work to measure inflammation, imaging to determine the extent of joint damage, and an assessment of your family history. About 40 percent of people with psoriatic arthritis have a family member who has psoriasis or arthritis.

If you have joint pain, here are a few tips from the Arthritis Foundation to help you distinguish between psoriatic arthritis, gout, and other diseases:

  • If a single joint swells and becomes extremely painful quickly, you probably have gout. “Patients who have gout won’t let you touch the joint,” says Dr. Mikulik. “The pain usually starts around 4 a.m., gets really severe, and then starts to subside. Patients can’t put on their shoe.”
  • If you have little or no joint swelling, but the joint hurts the most after you’re active, it’s probably osteoarthritis.
  • If the joints on both sides of your body hurt, you’ve likely developed rheumatoid arthritis. “Rheumatoid arthritis usually starts in the small joints and is symmetrical,” Mikulik says.
  • If your joint pain is worse in the morning or after inactivity, that’s a sign of psoriatic arthritis. “Psoriatic arthritis usually has a broad presentation,” says Mikulik. “You’ll see one or two larger joints affected in addition to small, distant joints [for example, fingers]. Most patients [with psoriatic arthritis] have psoriasis first.”

The Best Treatment

Treatment depends on which type of inflammatory joint disease you have. With gout, the first order of business is to stop the flare using medications, says Mikulik. “To prevent gout, we’ll use the same medications at lower doses to decrease the uric acid in the body.” Your doctor may use steroids to treat gout initially, but steroids can cause psoriasis to flare.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, usually help in mild cases of psoriatic arthritis. If your disease symptoms are severe, your rheumatologist may recommend disease-modifying anti-rheumatic drugs (DMARDs) or biologics.

If you have joint pain or stiffness, it’s important to see a rheumatologist to ensure you get the right diagnosis.

“They are all different diseases, and while they may share symptoms and some pathophysiology [changes due to disease], they are all separate [diagnoses],” says Jeffrey Weinberg, MD, an associate clinical professor of dermatology at Mount Sinai School of Medicine in New York City. “There may be some treatment overlap for RA and PsA, but all [musculoskeletal] conditions must be evaluated and treated separately.”

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