Arthritis Comparison Overview

OA vs. RA: OA onset

usually begins at age 40

OA vs. RA: RA onset

initially develops between ages 25-50

OA vs. RA: OA incidence

12% of adults; 21 million people

OA vs. RA: RA incidence

- 1%-2% of US adults; 600k men and 1.5 mil women

- estimated prevalence rate of juvenile RA in children younger than 16 is 30k-50k

OA vs. RA: OA gender

- men before age 45

- women after age 45

OA vs. RA: RA gender

affect women 3 times as often compared with men, but more disabling and severe when in men

OA vs. RA: OA etiology

unknown; immunologic reaction with massive inflammatory response; possible genetic and environmental triggers

OA vs. RA: RA etiology

multifactorial; local biomechanical factors; biochemistry, previous injury, inherited predisposition

OA vs. RA: OA manifestations

- usually begins in joints on one side of the body

- primarily affects hips, knees, spine, hands, feet

- inflammation with redness, warmth, and swelling in 10% of cases

- brief morning stiffness that is decreased by physical activity movement

OA vs. RA: RA manifestations

- symmetric simultaneous joint distribution

- can affect any joint (large or small) predilection for UE

OA vs. RA: OA associated signs and symptoms

no systemic symptoms, possible associated trigger points

OA vs. RA: RA associated signs and symptoms

systemic presentation with constitutional symptoms (fatigue, malaise, weight loss, and fever)

OA vs. RA: OA lab values

- effusions infrequently, synovial fluid has low WBC and high viscosity

- ESR may be mildly to moderately increase

- Rheumatoid Factor RF absent

- new biomarkers under investigations

OA vs. RA: RA lab values

- synovial fluid has high WBC, and low viscosity

- ESR increased in the presence of inflammatory process but not specifically diagnostic for RA

- RF is usually present but is not specific or diagnostic for RA (can be elevated C-Reactive protein)

- C-Reactive protein, a true indicator of systemic inflammation, strong predictor of disease outcome

Psoriatic Arthritis vs. RA: Psoriatic Arthritis clinical anatomical presentation

- DIP joint and axial arthritis

- often asymmetrical

- Enthesitis common

Psoriatic Arthritis vs. RA: RA clinical anatomical presentation

- MCP and wrist joints

- Predominantly symmetrical

Psoriatic Arthritis vs. RA: Psoriatic Arthritis Genetics

- HLA Cw6 and B27

- IL23 receptor

Psoriatic Arthritis vs. RA: RA genetics

- HLA DRB1

Psoriatic Arthritis vs. RA: Psoriatic Arthritis Pathogenesis

- absence of circulation autoantibodies

- distinct vascular pathology

- T-lymphocyte Predominance

- Early expression of vascular growth factors

Psoriatic Arthritis vs. RA: RA Pathogenesis

- circulating autoantibodies RF/ACPA

- T-Lymphocyte and B-Lymphocyte infiltration

- late expression of vascular growth factors

Psoriatic Arthritis vs. RA: Psoriatic Arthritis Response to Therapy

- DMARDS, methotrexate

- TNF inhibitors

- Abatacept

- Ustekinumab

- Secukinumab

Psoriatic Arthritis vs. RA: RA Response to Therapy

- DMARDS, methotrexate

- TNF inhibitors

- Abatacept

- Rituximab

- Tocilizumab

Psoriatic Arthritis peripheral disease

asymmetric

RA peripheral disease

symmetric

OA peripheral disease

Asymmetric

Psoriatic Arthritis Sacroiliitis

Asymmetric

Ankylosing Spondylitis Sacroiliitis

Symmetric

Psoriatic Arthritis AND RA stiffness

in the morning and/or with immobility

OA stiffness

with activity

Psoriatic Arthritis Female : Male Ratio

1:1

RA Female : Male Ratio

3:1

OA Female : Male Ratio

Hand/Foot more common in female patients

Ankylosing Spondylitis Female : Male Ratio

1:3

What arthritis features Enthesitis

Psoriatic Arthritis

what arthritis features High-titer RF

RA

Psoriatic Arthritis, HLA association

- CW6

- B27

RA, HLA association

DR4

Ankylosing Spondylitis, HLA association

B27

what arthritis features nail lesions

Psoriatic Arthritis