Diagnosing Psoriatic Arthritis
Early detection, diagnosis and management is crucial, but it can be more difficult to arrive at the correct diagnosis than you may think. There are several types of psoriatic arthritis, and each can present a slightly different set of symptoms.
Symmetric psoriatic arthritis: half of all psoriatic arthritis cases fall under this category. Symptoms are symmetrical — they show up in the same place on both sides of the body, at the same time. In this sense, it bears more resemblance to rheumatoid arthritis.
Asymmetric psoriatic arthritis: asymmetric psoriatic arthritis doesn’t appear in the same joints on each side of the body. Around 35 percent of psoriatic cases can be classified as asymmetric, and it’s often milder than other forms of the disease.
Distal psoriatic arthritis: targeting the ends of the fingers and toes, the distal type can be more visibly disturbing than other types of psoriatic arthritis. In many cases, the small knuckles will become bulbous and the nails will begin to thicken, pit and lift from the nail bed.
Arthritis mutilans: the most severe form of psoriatic arthritis is also the least common — only about 5 percent of patients develop it. But for those who do, the symptoms can progress quickly, often causing permanent deformity in the tips of the fingers and toes.
Spondylitis: this form affects the joints in the neck and spine, and can mimic other common back pain when it acts up. However, like other forms of arthritis, symptoms sometimes show up in other areas, especially the knees and ankles.
If you have any of these symptoms, it’s time to consult your doctor. They will begin with a physical exam and perhaps blood tests to search for inflammatory markers.
However, there is no single test that will reveal psoriatic arthritis, and your doctor may not be able to offer a final diagnosis. Instead, expect a referral to a rheumatologist, who is better equipped to differentiate arthritic conditions.
Could It Be Something Else?
Psoriatic arthritis can mimic osteoarthritis (the most common type of arthritis), gout or rheumatoid arthritis, but each of these forms of arthritis calls for a different plan of action.
There are some helpful diagnostic criteria to rule out other conditions. For instance, if the inflammation comes on suddenly and severely affects a single joint, gout may be to blame.
On the other hand, if the joint in painful but there is hardly any swelling, it’s more likely that the problem is osteoarthritis. The bottom line is that it can take some time, and several diagnostic approaches, to find the right diagnosis. Work with a doctor you trust, and communicate openly and honestly to help move the process along.
