Rheumatoid Arthritis vs Psoriatic Arthritis
Rheumatoid Arthritis and Psoriatic Arthritis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Rheumatoid Arthritis vs Psoriatic Arthritis at a glance
- Rheumatoid Arthritis: Chronic symmetric inflammatory polyarthritis with autoantibodies and erosive joint damage.
- Psoriatic Arthritis: Seronegative inflammatory arthritis associated with psoriasis; classic features include dactylitis, enthesitis, and DIP involvement.
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Side-by-side comparison
| Feature | Rheumatoid Arthritis | Psoriatic Arthritis |
|---|---|---|
| At a glance | Chronic symmetric inflammatory polyarthritis with autoantibodies and erosive joint damage. | Seronegative inflammatory arthritis associated with psoriasis; classic features include dactylitis, enthesitis, and DIP involvement. |
| Classic presentation | Symmetric MCP/PIP/wrist swelling with positive MCP/MTP squeeze test, plus rheumatoid nodules in seropositive disease.; Insidious symmetric polyarthritis of… | Joint pain with morning stiffness >30 minutes, improving with activity; Asymmetric oligoarthritis (most common pattern), DIP-predominant, polyarticular… |
| Workup / key labs | 2010 ACR/EULAR classification: score ≥6 of 10 across (a) joint involvement, (b) serology (RF/anti-CCP), (c) acute-phase reactants, and (d) symptom duration ≥6… | CASPAR classification criteria: inflammatory articular disease (joint, spine, or entheseal) plus ≥3 points from psoriasis, nail changes, RF-negative,… |
| Imaging | Plain radiographs of hands and feet — periarticular osteopenia, symmetric joint-space narrowing, marginal erosions (MTPs often earliest); Ultrasound or MRI —… | Plain radiographs — 'pencil-in-cup' deformity at DIPs, periostitis, fluffy new bone formation, marginal erosions, ankylosis, asymmetric sacroiliitis,… |
| First-line treatment | Early DMARD therapy within 3 months of diagnosis — methotrexate is anchor drug; start 10-15 mg PO/SC weekly with folic acid 1 mg daily; Conventional DMARDs —… | Mild peripheral disease: NSAIDs — naproxen, ibuprofen, meloxicam — plus intra-articular steroid injections; Conventional DMARDs for peripheral arthritis:… |
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