Psoriatic Arthritis and Rheumatoid Arthritis

 

psoriasisWhat is Psoriatic Arthritis?

Psoriasis is an autoimmune disease which causes a red, itchy, scaly rash. Most frequently, the rash, called plaque, appears on elbows and knees. Some people with psoriasis also develop symptoms which are similar to Rheumatoid Arthritis. This is classified as a separate disease called Psoriatic Arthritis (PA).

According to the National Psoriasis Foundation, up to 30 percent of people with psoriasis develop Psoriatic Arthritis. I found several other sources which say it is as low as 5%. There are 5 distinct classifications of Psoriatic Arthritis based upon which joints are affected and type of joint destruction involved. Some types of PA cause severe deformity and disability.

Last month, we introduced you to Ankylosing Spondylitis, which is in a branch of the rheumatic disease family called seronegative spondarthropathies. If we call AS a cousin of RA, then Psoriatic Arthritis would be a sibling to Ankylosing Spondylitis. Genetic markers are used rather than apparent symptoms to determine how closely the conditions are related.

Is There a Typical Psoriatic Arthritis?

Eighty-percent of the time, psoriasis symptoms appear first. However, in some patients, the psoriasis is barely even perceptible. Or only the nail tissues may be affected.

Like RA, PA symptoms can vary greatly between patients. Psoriatic Arthritis may be symmetrical or asymmetrical. The spine and sacroiliac joints may or may not be involved. Fingers and toes may swell into a sausage-shaped deformity called dactylitis. A very destructive hand deformity called arthritis mutilans is caused by destruction of joint tissue. (Mutilans can also be caused by Rheumatoid Arthritis.)

How is Psoriatic Arthritis like Rheumatoid Arthritis?

  • Usually consists of a pattern of alternating flares and remissions
  • Runs in families, showing a probable genetic cause
  • Specific causes or triggers are unknown
  • Can result in joint destruction and severe disability
  • Can also be found in a kids’ size called Juvenile Psoriatic Arthritis / JPA
  • TNF plays a significant role in destruction of tissue
  • Treatments for PA include a traditional pyramid of medications consisting of NSAIDs, corticosteroids, DMARDs, and immunosuppressant drugs including the modern class of medications called Biologics

How is Psoriatic Arthritis different from Rheumatoid Arthritis?

  • Rheumatoid factor is negative 95% of the time with PA
  • Psoriatic Arthritis affects genders more equally than RA
  • Most RA patients eventually get rheumatoid nodules; Most PA patients get painful rashes and 80% of the time that includes nail damage
  • Rheumatoid Arthritis rarely affects the DIP joints close to the fingernail, but Psoriatic Arthritis does more frequently.

Fascinating facts about Psoriatic Arthritis

  • Smoking and drinking alcohol are believed to make psoriasis or Psoriatic Arthritis worse.
  • The arthritis symptoms and the psoriasis symptoms of PA frequently flare on separate schedules.
  • Juvenile Psoriatic Arthritis affects girls more than boys, although the adult version of PA is less discriminating.
  • DIP joints and spondarthropathy (spine-related) symptoms are more common in men with PA than women with PA.
  • Women are more likely to have symmetrical arthritis, similar to Rheumatoid Arthritis.

Postblog/PB:

Personal note: one of my first RA friends does not actually have Rheumatoid Arthritis, but Psoriatic Arthritis. Have you noticed that those of us who have an illness which is part of a family of autoimmune diseases often feel like we are connected to one another in a special way? It is not only the diseases which are similar; we have similar concerns and experiences. I have been ever more grateful for people who “get it”.

More psoriasis info:

Easy to read PA explanation for laymen: Mayo clinic PA article

Although psoriasis on the elbow and knee may be typical, I knew there are more severe cases. So I found a page with some photos, but be warned: they are a bit shocking. Shocking psoriasis images    

Related posts:

Another seronegative spondylarthropathy: Ankylosing Spondylitis and Rheumatoid Arthritis

Precautions for living on DMARDs: Preventative First Aid for Rheumatoid Arthritis

Modern view of treatment for autoimmune diseases Pyramid Approach to Rheumatoid Arthritis Trashed

Kelly Young

Kelly Young is an advocate providing ways for patients to be better informed and have a greater voice in their healthcare. She is the president of the Rheumatoid Patient Foundation. Kelly received national acknowledgement with the 2011 WebMD Health Hero award. Through her writing, speaking, and use of social media, she is building a more accurate awareness of Rheumatoid disease aka Rheumatoid Arthritis (RA) geared toward the public and medical community; creating ways to empower patients to advocate for improved diagnosis and treatment; and bringing recognition and visibility to the Rheumatoid patient journey. In 2009, Kelly created Rheumatoid Arthritis Warrior, a comprehensive website about RA of about 950 pages and writes periodically for other newsletters and websites. Kelly served on the Mayo Clinic Center for Social Media Advisory Board. There are over 42,000 connections of her highly interactive Facebook Fan page. She created the hashtag: #rheum. Kelly is the mother of five, a home-schooler, Bible teacher, NASA enthusiast, and NFL fan. You can also connect with Kelly by on Twitter or YouTube, or LinkedIn. She has lived over nine years with unrelenting Rheumatoid disease. See also http://www.rawarrior.com/kelly-young-press/

33 thoughts on “Psoriatic Arthritis and Rheumatoid Arthritis

  • October 8, 2009 at 11:14 pm
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    I also have a friend with Psoriasis, not with arthritis or at least not yet, thank G-d but it is so sad because of the visible signs of the disease how much they are discriminated against. It is devastating. Not only do these people have to deal with the symptoms of their disease but they have to deal with people staring at them, others wont hire them and even family members turning them away because they are “gross”. So sad 🙁

    Reply
    • January 23, 2011 at 9:42 am
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      People can be very unusual in their response to someone that has a psoriatic break out. I suffer from both Psoriasis, PA and RA, and your are so correct. Not only do we have to deal with the disease, our own emotional aspects but to have people treat you different, and they do, causes only more negative aspects. I for the most part am able to keep my head above, but sometimes it is hard.

      Reply
  • October 9, 2009 at 9:48 am
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    I cannot understand why the stigma of an illness. I know it is real, but it is just ridiculous to me that people react that way to illnesses. It’s akin to famous people hiding RA. It does not make sense to me.

    I’ll bet educating is the key to this problem also. We are so educated about certain issues that the stigma is almost gone – such as cancer and mental illness and even HIV. We will get there for autoimmune diseases.

    Reply
  • October 9, 2009 at 1:05 pm
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    Kelly, I think you are right. It is about education and awareness. People seem to me at least so stuck on awareness of their selves and what is directly around them that they don’t have time or desire to look around at the rest of the world.

    Reply
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  • May 5, 2010 at 10:50 am
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    Thank you so much for this article and this site. I look forward to reading your posts every day.

    Reply
  • August 6, 2010 at 9:05 am
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    I am asking each of my friends, family, RA Chicks, and RA Warriors to take less than five minutes of your time to send a letter to your States Congressman today! LeAnn Rimes is advocating on behalf of the Psoriasis and PsA (Psoriatic Arthritis) patients.

    Congress is meeting soon with the CDS (Center for Disease Control) to discuss whether to continue funding research. Without the funding a cure for my disease will not be found. Please, please do this for me and others who are suffering from this debilitating disease.
    It’s free and very easy using the link below. A letter has been created for you to send; it does have a place for you to personalize if you choose. If you do not have PsA please put my name within your letter so it personalizes it with a patient’s name. The research will also help RA patients since it PsA is an autoimmune arthritis disease.

    I want to thank each of you in advance for your help.
    To access the PsA site:.
    http://capwiz.com/psoriasis/issues/alert/?alertid=15226116

    Reply
  • October 27, 2010 at 12:13 pm
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    Kelly – I developed seronegative RA about a year ago. RA factor and sed rate are always normal. My rheumy has suggested that my symptoms point more towards PsA than RA, but we went with the RA diagnosis with a “time will eventually reveal” attitude. I had no discernable skin psoriasis and no family history of psoriasis, which presents somewhat of a diagnostic quandry.

    Well, last weekend, I found what I believe to be psoriasis on my back. I am having my derm take a look at it next week, but I’m quite certain at this point.

    In the end, it looks like I may have PsA rather than RA. Your site has been invaluable to me over the past year, and I really hope that I can continue to participate regularly despite the fact that I probably have PsA. I really admire your work and thank you wholeheartedly.

    I am currently on Enbrel (3rd shot in) and a Medrol dose pack due to a flare. I had to discontinue mtx due to massive hair loss.

    Reply
    • October 27, 2010 at 4:38 pm
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      :heart: Marie! I’m sorry about the PsA. I hope the doc can get your treatment so that it doesn’t bother you too badly. We have lots of readers / members /followers on the blog / Facebook/ Twitter who are PsA or JRA or other dx… We are like close cousins & I hope you find help & support here.

      Reply
      • October 27, 2010 at 6:05 pm
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        Thank you Kelly! You are a dear person, and this site is my internet “home”.

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        • October 27, 2010 at 8:36 pm
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          Honestly, we do need each other. We will get better results of support & a movement if we can all stick together too. Plus I like to hear from you. :heart:

          Reply
    • June 14, 2013 at 11:33 am
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      Marie,
      I’ve developed seronegative inflammatory arthritis . . . Started in 2009-10ish
      I’ve never had psoriasis, but the toenails on my right foot are looking more and more like psoriatic toenails.
      I just hurt my ankle and instead of seeing an orthopedic, I went to as podiatrist.
      He wants me to let those toenails grow out (I keep them as short as possible because they are so unsightly. My toenails used to always be painted and my feet pretty . . .) and then he will send samples to a pathologist with my history. He says they will be able to tell us if it is PsA or a fungal infection. I have been treating my feet with the strongest antifungal cream available by prescription for a year. The foot got better. The nails have only gotten worse.
      The podiatrist I saw last year said it was fungal and the cream would work.
      SSZ was helping, though we didn’t know it at the time. It kept my Sed Rate down and when I stopped it, I flared for about a week (after the first week off of it). . .
      Is it sad that I hope they find out that I have PsA? I have been on the pyramid approach to treatment and am so frustrated. I’m on Arava now and still don’t feel any better than I did on SSZ. I’d rather be on SSZ, fewer side effects.
      I’ve also been on MTX for a year an a half

      Reply
  • December 29, 2010 at 10:55 am
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    Goodmorning Kelly…Was checking out your slideshow and i loved it! You work so hard for us! Since i have RA and my daughter has PA i wanted to look at the Shocking Psoriosis Images…Guess what? It kept taking me to a web hosting page…Just wanted to share that with you…I have seen the psoriosis on my daughter…her head covered in it..her arms etc…it hurts a mother so much! My mother keeps saying she is sorry for giving me RA! As if she had a hand in it…But now i find myself saying that to my beautiful daughter! When u see your child covered in it it breaks my heart!..She goes on to say which joints hurt that day…And i look at her and wonder if its the truth!!! Since ive had RA since i was 8 i thought she couldnt be hurting…why do i do that when i want so badly for people to believe me! Well i have stopped denying her…i again went into a different subject! I do that alot!…Thanks again Kelly u really work so hard and im so gratefull for this ! Thank you :rotfl:

    Reply
    • January 4, 2011 at 10:42 pm
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      I’ll look Judi. If websites I link to change their address, it’s hard to track that down.
      Thank you for your kind comments. Please give my love to your daughter. We have to stick together like you say.

      Reply
  • January 23, 2011 at 9:36 am
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    I have just found your site and to be honest what a wealth of information I have found. I was diagnosed with PA many years ago and it has taken it’s progression and toll however over the past several years the PA has “morphed” into RA. I have tested positive for the RA markers and that form of arthritis is taking over. My hands have permanent joint damage and on any given day you don’t know which joint is going to become inflammed or hurt the worst. I am fortunate that I am able to work and function, however my activity levels are somewhat deminshed due to the pain and immobility. I typically maintain a very positive attitude but there are some days when I just don’t want to do it anymore. And having the knowledge that I will never have 100 % physical capacity is rather daunting at times.

    Having someone to discuss this with not necessarily from the medical standpoint but from the supportive. For someone that can understand what life is like to have this condition would I think be very liberating. Most people don’t get it.

    Reply
    • January 23, 2011 at 5:00 pm
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      Hi Mary. I’m glad you found the site. Yes, most people don’t get it, as you say. But I hope we can change that. 🙂

      Reply
  • January 31, 2011 at 8:18 am
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    Some of the links do not work. So the major differance between PsA and RA is skin involvement and nodules?

    Reply
    • January 31, 2011 at 9:39 pm
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      Lisaannamae,
      I think that they consider PsA and RA to be separate diseases because PsA is a spondarthropathy so it attacks the joints in a different way. The RA also tends to be aggressive on the heart and lungs and have a higher mortality rate. Sometimes, they can be hard to tell apart. I’ve met a few patients with a diagnosis of both, but I’ve also read that a patient has to have one or the other. I’ll check the links as soon as I can. Sometimes people change their addresses online & don’t forward them properly.

      Reply
  • February 9, 2011 at 8:50 am
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    I have both PsA and RA- diagnosed 2 yrs apart. My RA was finally diagnosed after I kept telling my GP that my Grandmother, aunts and father all had had RA. I had nodules on my fingers- which he decided were “cysts”. So he sent me to have hand surgery to remove the “cysts”. The hand specialist said he doubted that it was cysts- but he would go in and see what he could find. He met me after surgery and told me to have my doctor refer me to a rheumatologist ASAP- that I had RA.
    Two years later, my “rhummy” was looking over my hands and noticed my fingernails had these white marks and my finger tips were swollen and red. She asked if I had been breaking out in rashes anywhere and I told her I had been. After a trip to a dermatologist- I found I had PsA also. When visiting with him, I mentioned that my mom had had problems with what she called “hives”, that she always had several pain in her neck and back & also had had nail problems & her skin and joints close to the nail bed would swell and became very red and sore. So, I guess being the oldest of my siblings- I was “blessed” with both RA and PsA from my parents. 🙂
    I personally can tell if it is my RA or PsA flaring. My PsA attacks my neck and spine. I have a few bulging disks- the one in my neck swells enough to barely touch the spinal cord and shoots pains into my head and down my arms. With the RA my wrists, ankles, elbows and hands will flare & my lungs, eyes and heart have been effected with the RA.
    Honestly, I have been blessed with an awesome “rhummy” for a little over 7 yrs. She started me w/ MTX and Remicade for the first 2 yrs. and now I am on remicade only for both RA and PsA. I do not worry about side effects- my life is SO much more manageable than it was without the treatments. She recently said she might have to start me back onto MTX and truthfully I do not worry about that either.
    I truly was blessed to born at such a time as this! The treatments they have now compared to what my grandmother and family were on is like day and night. At end of my grandmother’s life- she could not walk and screamed and cried so hard that her neighbors in the apartments she lived in would call us- they were so sad for her.
    Thank you all for this website. When I first was diagnosed, the horror stories I read on the net about MTX and other treatments were frightening. Frankly, my co workers ask how I do it- working full time & raising our 10 yr old grandson. I tell them I am blessed to go to a clinic every 5 weeks and witness others who have pain and issues with their disease that are so much worse than me- it puts it all in perspective.
    Again- much thanks to you for this forum. 🙂

    Deb

    Reply
    • February 9, 2011 at 9:23 am
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      Thanks, Deb. I have heard from a few patients who say they have both and your symptoms sure seemed to make the diagnosis clear. Some places I read that it’s not possible to have both diseases – I’d sure like to know what the genes look like! Good luck with your treatment. 🙂

      Reply
  • February 25, 2012 at 7:52 am
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    I was tentatively diagnosed with RA this time last year, and after two not so great rheumatologists (one of whom fired me), I’ve finally found a good rheumatologist and a good dermatologist, both of whom are leaning towards a diagnosis of PsA.

    I was on Enbrel for 6 months (before rheumy #2 decided to take me off meds since I was seronegative, and therefore “didn’t have RA”), and it helped somewhat but I noticed the skin problems got worse right before I was due for my next injection. I had thought about asking for Enbrel again, in conjunction with MTX, but due to the potential shortage of injectable MTX, I may try Remicade or Humira instead. The dermatologist really seemed inclined towards Remicade, and I’m not certain why.

    I’m hoping that I will start meds soon; I really want off this roller coaster. I’ve come to terms with my life never going back to what it used to be, but I would like to think that it can get a little better than this. (Yes, I wrote a comment last summer, “Is this really as good as it gets?” I wrote that when I was on the Enbrel and feeling a little better but not great. I had no idea I would have to go off meds, and boy do I wish I could go back and appreciate the little amount of comfort I had back then).

    Reply
    • February 26, 2012 at 11:59 am
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      I’m glad you finally found a good rheumatologist Madison. The only benefit I know of Remicade is that they can adjust the dose and some doctors do. Yes being off meds or being like many others who do not respond to meds is terrible to feel the full brunt of RA. I hope you can get relief soon.

      Reply
  • March 10, 2012 at 12:32 am
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    I am 67 years old, and have never received a diagnosis of RA, but, my daughter has recently been diagnosed, and she noted thar we have some of the same sympyoms. Is that possible?

    Reply
  • March 30, 2012 at 6:52 pm
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    I found your website today and I’ve been clicking around in past posts (I even shared one on Facebook!) I just wanted to say something about PA and RA. I have been diagnosed with atypical RA in the past (took YEARS to get that diagnose), but PA has also been thrown around a lot by newer docs. I’ve been to a few Rheummys, and they can’t decide. I’m not sure if you were aware that, aside from the rash, the two diseases are incredibly similar. Unfortunately for me, I don’t have the major characteristics of either disease. Lots of painful joint swelling, but blood work doesn’t confirm, and joint are not inflaming in expected order. And, I don’t have actual plaque psoriasis or nail pitting… So, I’m just going to stick with the atypical RA for now! 😉

    Reply
  • April 16, 2012 at 3:18 pm
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    This post is particularly interesting to me. I’ve been on line for 10 months researching RA and PsA and have come to the conclusion that I don’t understand any of it lol! They seem to have so many things in common.

    I began suspecting PsA in June ’11 after I came down with a bad case of Iritis and Epislceritis. When I asked my ophthalmologist what it was he said “You have arthritis in your eye.” Say what??! I had been having joint pain/swelling and muscle pain for about 9 months by then as well as some other unexplained issues. My research into Iritis and Episcleritis showed that both are common in both RA and PsA.

    A month later I noticed a toenail was detaching and all of my toenails had horizontal ridging. Off to the dermatologist I went. He said it was either a fungus or psoriasis…those are the only two things that could cause a toenail to detach he said. (I have no pitting but I do have the lifting) So we did the fungal culture and it came back negative. He won’t diagnose psoriasis though until I show some skin lesions. Okay, I can be patient. I left his office thinking “This *has* to be PsA!”

    I finally decided to see a rheumatologist at the end of August. I explained everything to her and showed her my toenails. After 3 more visits with her, some x-rays and blood work and a favorable response to prednisone she diagnosed me with RA on April 2. I was absolutely stunned.

    I was diagnosed with seronegative RA despite all blood work being completely normal, perfect x-rays and funky toenails. I really questioned her about it, why RA and not PsA, and she explained that they are so closely similar that they can be really hard to tell apart. And the impression I took away from that visit is that the treatment is the same for each so the correct diagnosis isn’t quite as important as starting treatment is.

    Kelly I’ve been referring to your website for months now and have to say I find more consistency in what you write and what people have said in response to most anything else I’ve come across in my research. And what’s funny is that there is no consistency with RA but there sure is a lot of stuff out there that would convince most people that what the author says is written in stone and infallible. You make no claim to that and you are funny lol!, I like you. 🙂

    Reply
    • April 16, 2012 at 3:26 pm
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      Thanks, Jamielynn. I do try to let my funny side show when I can. And you hit on one of the main reasons this site was begun: lack of consistent information available to patients. about 650 pages here already and I feel I’ve just begun. I’ve found that listening to patients is the most consistent way to research & I hope that we’ll make patient voices heard in that capacity more and more.

      The “arthritis” in your eye idea is funny, but I also get tired of the illogic of it. If “arth” means joint, then we can’t have arthritis in our eyes and lungs, heart or veins. My point of course is that the correct word is “disease.” Good drs and researchers know this of course, but we need to bring the public up to speed.

      Good luck w/ your treatments!

      Reply
  • June 17, 2012 at 11:08 am
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    I have scalp psoriasis. I had it for two years. Initially diagnosed as dermatitis. Occassionally I would have strange rashes on my stomach. Eventually the full body joint swelling began, which made the psoriasis diagnosis more important. I finally recieved “it is probably psoriasis” from a dermatologist but the first Rheumatologist said “wait and see”.

    I couldn’t take the pain and fatigue and found another Rheumatologist who diagonsed me with RA. I am now treating with MXT and Enbrel. Remicade was my docs first choice because it is a direct infusion into the blood and doesn’t need to go through the subcutaneous tissues to get into the blood. He claims that in his patients the Remicade is 90% effective versus about 50% for the injectables, such as enbrel and humira. However, my insurance would not cover Remicade.

    My concern with distinguishing whether I have RA or PsA is the other effects related to each disease. For example, your recent post regarding heart disease risk for RAD. With PsA I believe there are different concerns and involvement of other organs.

    As a post script – the enbrel has completely cleared my scalp psoriasis, which by the way has cost me more than one hair stylist even though I did my best to explain that my condition was not contagious, etc. I am still waiting for complete joint relief. I also believe that I see some subtle nail effects; pitting and lifting. Hmmmm?

    Reply
    • June 23, 2012 at 10:16 pm
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      I’m glad you got to a rheum doc who was able to diagnose and treat. & it’s good to hear that you may be responding well to the Enbrel. In the future, I agree it would be important to know whether you’re watching for RA effects of PsA. But symptoms will probably make themselves clearer over time. Meanwhile, early response to treatment is such good news.

      Reply
  • January 6, 2014 at 6:03 pm
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    Hi Kelly, As a woman of 57 with PsA and 2 sisters, one with RA and the other with PsA, this site is a great find. We are doing OK with our rheumy’s but have a hard time explaining to family and friends the difference in our disease. Your efforts on this site will help us a lot. The 3 of us are very close and all have a great sense of humor. Very important for those with chronic disease. We all know there is some one out there that has it worse than us and appreciate our family that much more. We will comtinue to pray for our science to help us all!
    The Autoimmune Sisters: Sue,Sally, Sandy

    Reply
  • March 16, 2015 at 1:26 pm
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    I was diagnosed with RA 14 years ago. I have found the only treatment that seems to really help is Kombucha tea. I brew it myself. I have been off of my tea for about a year and am flaring in a big way. I’m using all organic herbal soaps and conditioners on my person and only spray perfume on my clothing. Since my early 20’s I have had extremely sensitive skin. I do not know if this symptom is related but I have been getting boils since I was a teenager and Drs just tell me to take anti-biotics. I do not feel that this is an effective answer. Do boils go along with PSA? My psoriasis started two years after the RA diagnosis. But may have started as early as childhood. I have always had extremely dry patches on elbows and black lines in my finger nails. My sed rate is 48 I do not know if this is good or bad but I am in a lot of pain. Can you let me know about the boils?

    Reply
  • April 22, 2015 at 4:52 pm
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    My mother lived with psoriasis from a young age and was told she had rheumatoid arthritis as a young adult following a knee injury. Although she was very active both of her knees ended up eventually losing range of motion almost completely and was a candidate for replacement surgery before age 40 but waited until after reaching 50 because she only wanted to have to go through with it once. After her replacement surgeries her psoriasis almost disappeared and at age 72 she had her RA factor tested and it was virtually non existent. She will be 75 this year.With all of the info we are now seeing regarding psoriatic arthritis, I am left wondering if she ever had rheumatoid arthritis.

    Reply
  • March 11, 2017 at 9:19 am
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    It is definitely possible to have both PA and RA. I was diagnosed this week with both. Glad to know there are others out there. Rheumatologist said it’s rare but it does happen. So whoever says it’s not possible, we are here to say otherwise!

    Reply

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