The four faces of arthritis

| Chris Paoli

Knowing the difference between psoriatic arthritis, osteoarthritis, gout and rheumatoid arthritis can get hairy, especially when so many symptoms and causes overlap. Here, Arthur Mandelin, M.D., Ph.D., an NPF medical board member and a rheumatologist at Northwestern University Feinberg School of Medicine in Chicago, helps clear up any confusion.

Psoriatic arthritis

Doctor’s notes: In simplest terms, psoriatic arthritis (PsA) is a disease in which the body’s immune system attacks healthy cells, specifically in the joints. About a third of people with psoriasis also develop PsA sometime in their lifetime. While PsA shares similarities with rheumatoid arthritis, osteoarthritis and gout, it is dissimilar, especially in the case of gout and osteoarthritis.

“Psoriatic arthritis is a disease,” says Mandelin. “Something is going on in the body that shouldn’t be going on, making the person ill and driving the arthritic process.”

Rheumatoid arthritis and PsA share many similarities, as they are both caused by issues in the immune system. However, one of the ways in which PsA differs from rheumatoid arthritis is that it can affect the spine, where RA rarely strikes, Mandelin explains.

One major similarity between PsA and rheumatoid arthritis is how they are handled. For the most part, the two have similar treatment options (biologics, oral treatments, non-steroidal anti-inflammatory drugs, etc.) and the trial-and-error process to find what works best for each individual.

Symptoms

  • Swelling and pain in the joints
  • Limited range of motionTenderness and pain in the tendons (fibrous tissue that attaches muscle to bone)
  • Morning stiffness and general fatigue
  • Pain in the eyes and redness of the cornea

Treatment options

  • Biologics and biosimilars
  • Oral treatments
  • Non-steroidal anti-inflammatory drugs
  • Disease-modifying anti-rheumatic drugs

 

Rheumatoid arthritis

Doctor’s notes: Of all the joint diseases, rheumatoid arthritis is the most similar to PsA and operates in the same fashion – the body’s immune system attacks healthy tissue. The biggest distinction between PsA and rheumatoid arthritis is that, while PsA is usually accompanied by psoriasis, there is no visible skin condition associated with rheumatoid arthritis.

Symptoms

  • Swelling and pain in the joints
  • Limited range of motion
  • Tenderness and pain in the tendons
  • Morning stiffness and general fatigue

Treatment options

  • Biologics and biosimilars
  • Oral treatments
  • Non-steroidal anti-inflammatory drugs
  • Disease-modifying anti-rheumatic drugs

 

Gout

Doctor’s notes: While gout shares some similarities with PsA, the way in which the disease functions is quite different. “For gout, there is a very clear trigger," Mandelin says. "There is a biochemical overabundance of uric acid, which is very irritating and inflammatory.” Gout is part of the crystalline family of arthritis (and the best known, according to Mandelin), which is easy to remember because the disease is caused by deposits of crystallized acid. (Gout’s lesser known cousin is calcium pyrophosphate deposition disease.)

The initial onset of gout has the unique distinction of being tied directly to diet – a characteristic not shared with rheumatoid arthritis, PsA or osteoarthritis. While the disease can occur from joint injury or chemotherapy, most cases arise from diets high in purines (commonly found in shellfish and red meat), excessive alcohol consumption and crash diets.

Symptoms

  • Swelling and pain in the joints
  • Limited range of motion
  • Tenderness and pain in the tendons

Treatment options

  • Steroids
  • Prescription medication to block uric acid production and pain relievers
  • Non-steroidal anti-inflammatory drugs
  • Improvements to diet

 

Osteoarthritis

Doctor’s notes: “OA is more classically wear and tear, related to aging or overuse,” says Mandelin. While he classifies osteoarthritis as degenerative, he is quick to stress that over time the medical community has come to understand that osteoarthritis is more complicated than simple overuse of the joint. Ongoing research is needed to understand the full picture of what causes degeneration.

Unlike PsA, rheumatoid arthritis and gout, osteoarthritis affects older adults more than any other age group. The majority of people over 60 typically have some form of osteoarthritis, ranging from mild to severe. Common causes of osteoarthritis at a younger age include physical joint injury or overuse of a specific joint. Professional athletes, for instance, are at a high risk for developing osteoarthritis in their 30s and 40s.

Symptoms 

  • Swelling and pain in the joints
  • Limited range of motion
  • Tenderness and pain in the tendons
  • Morning stiffness
  • Bone spurs formed at the affected joint

Treatment options

  • Physical therapy and exercise
  • Weight loss for overweight patients
  • Non-steroidal anti-inflammatory drugs and pain relievers
  • Steroid injection into the affected joint

Listen for more on this topic 

Arthur Mandelin, M.D., keeps the arthritis conversation going in a special episode of Psound bytes, an original podcast from NPF. 

Illustration by Charles Mertens


Driving discovery, creating community

For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.

Recent Advance Posts

Dr. Ronald Prussick
A chance meeting with an inspiring mentor channels a promising young man into...
Kumar Family
The Kumar family from southern California discover that they are not alone and...
doctor facing patient across desk
The Corrona Psoriasis Registry will give health care providers the data needed...
Charlotte Community
Researcher Charlotte Hurabielle-Claverie, M.D., finds joy in unraveling the...
hand with arthritis on mouse beside keyboard
We take many common movements and activities for granted – until they become...
Shujahn family
Derek Schujahn turns helplessness into motivation and raises money for NPF in...
Psoriasis sunscreen tips
Just in time for summer, expert tips to help you stay safe in the sun.
Stephen Katz
Six longtime members of our community remember Stephen I. Katz, M.D., Ph.D., a...
Patients are looking to 2020 for utilization management reform in the Golden...