Is It Psoriatic Arthritis or Is It Gout?

If you experience joint issues, a timely, accurate diagnosis from a rheumatologist (a specialist in arthritis and musculoskeletal diseases) is essential. You want to be sure you receive proper treatment and prevent long-term damage or complications.

“We will use all the tools we have to get an accurate diagnosis,” says Zhanna Mikulik, MD, a rheumatologist at the Ohio State Wexner Medical Center in Columbus. “Your rheumatologist will look at what joints are affected, what the pattern is, and how it started.”

A comprehensive evaluation includes a physical exam, blood work to measure inflammation, imaging to determine the extent of joint damage, and an assessment of family history. (Many people with PsA have a family history of psoriasis or psoriatic arthritis.)

If you experience joint pain, here are a few tips from Dr. Mikulik to help you distinguish between signs of psoriatic arthritis, gout, and other diseases.

• If a single joint swells and becomes extremely painful quickly, you probably have gout. “Patients who have gout won’t let you touch the joint,” Mikulik explains. “The pain usually starts around 4 a.m., gets really severe, and then starts to subside. Patients can’t put on their shoe.”
• Compared with gout, psoriatic arthritis often has what doctors call a broader presentation. “You’ll see one or two larger joints affected in addition to small, distant joints, such as your fingers,” Mikulik says. Joint pain that’s worse in the morning or after inactivity is another sign of psoriatic arthritis, Mikulik says.
• If you have little or no joint swelling, but the joint hurts the most after you’re active, it’s probably osteoarthritis (OA).
• If the joints on both sides of your body hurt, you’ve likely developed rheumatoid arthritis (RA). “Rheumatoid arthritis usually starts in the small joints and is symmetrical,” Mikulik notes.

If you have joint pain or stiffness, it’s important to see a rheumatologist to ensure you get the right diagnosis, whether it’s psoriatic arthritis, gout, OA, RA, or something else.

“They are all different diseases, and while they may share symptoms and some pathophysiology, they are all separate diagnoses,” explains Jeffrey Weinberg, MD, a clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City.