Can you have psoriatic arthritis and ankylosing spondylitis

Sacroiliac joint involvement is more likely to be asymmetrical in axial PsA compared with AS. For additional clinical perspective, Rheumatology Advisor interviewed Dafna D. Dr Gladman: The question we face as rheumatologists when a patient with axial disease has psoriasis is whether they have AS with psoriasis or whether they have psoriatic arthritis.

This distinction is not very challenging if the patient responds to nonsteroidal anti-inflammatory medications. However, if they do not, do you treat them as a patient with AS? Until recently, we only had anti-[tumor necrosis factor] agents for AS, whereas for PsA there are a number of other agents.

Not all agents work for all conditions. Dr Gladman: We need more research comparing the patients who are clearly diagnosed with AS who happen to have psoriasis and those with axial PsA.

The research should include longitudinal observations, as assessments made at 1 point in time make it difficult to interpret the results. Both clinical and laboratory comparisons should be made, and genetic factors should be examined. Rheumatology Advisor: Please feel free to add anything else about this topic that may be of interest to rheumatologists. First, is it possible to have RA even when blood work indicates no? Second, are the medications used to treat PA the same as those used to treat RA?

Third, is it possible to have both PA and RA? Lastly, are there any new treatment options to reverse the damage and stop the pain? It would be highly unlikely to have all 3. There is always one entity which explains most of your symptoms. Up to 30 percent of people with psoriasis also develop psoriatic arthritis. In most cases though not always , the psoriasis will precede the arthritis, sometimes by many years. When arthritis symptoms occur with psoriasis, it is called psoriatic arthritis PsA.

In these cases, the joints at the end of the fingers are most commonly affected, causing inflammation and pain, but other joints like the wrists, knees, and ankles can also become involved. This is usually accompanied by symptoms in the fingernails and toenails, ranging from small pits in the nails to nearly complete destruction and crumbling as seen in reactive arthritis or fungal infections.

About 20 percent of patients with PsA will develop spinal involvement, which is called psoriatic spondylitis.

Inflammation of the spine can lead to complete fusion, as in ankylosing spondylitis AS , or affect only certain areas such as the lower back or neck. Patients who are HLA-B27 positive are more likely than others to have their disease progress to the spine. PsA and AS are considered genetically and clinically related because both are inflammatory rheumatic diseases linked to the HLA-B27 gene. HLA-B27 is a powerful predisposing gene associated with several rheumatic diseases. The gene itself does not cause disease, but can make people more susceptible.

The symptoms of PsA, which vary from person to person, can change in severity. Skin symptoms typically but not always appear before the joints become involved, sometimes up to 10 years before.

Without treatment, many of these symptoms can lead to progressive, permanent joint damage. Diagnosing psoriatic arthritis PsA can be tricky, primarily because it shares similar symptoms with other diseases such as osteoarthritis, rheumatoid arthritis, and gout. Because of this, misdiagnosis can often be a problem. Early diagnosis, however, is important because long-term joint damage can be warded off better in the first few months after symptoms arise.

The exact cause of psoriatic arthritis is not known, but it is known that heredity plays a large role. Up to 40 percent of people with PsA have a close relative with the disease. If an identical twin has PsA, there is a 75 percent chance that the other twin will have it as well.

Men and women are equally likely to develop psoriatic arthritis.