Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPrevention
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Prevention
Psoriatic arthritis(PsA) is a type ofinflammatory arthritisthat affects some people with the skin conditionpsoriasis. It frequently affects the joints and the entheses—the areas where tendons and ligaments meet bone.
PsA also causes joint pain, stiffness, and swelling, along with a skin rash that appears asskin plaques—raised red patches covered with a white buildup of dead skin cells called scales.
Verywell / Danie Drankwalter
Mixed connective tissue disease(MCTD) is defined as having a specific immune disease marker, symptoms, and organ involvement, plus selected features commonly seen with otherconnective tissue diseases,includingsystemic lupus erythematosus(SLE lupus),scleroderma, andmyositis.
People with MCTD might experience puffy and swollen fingers, numb fingertips, fatigue, malaise (a general unwell feeling), muscle and joint pain, and reddish patches on their knuckles.
In this article, we will discuss PsA versus MCTD, including symptoms, causes, treatment, and more.
Psoriatic Arthritis vs. Lupus: What Are the Differences?
Both PsA and MCTD areautoimmune diseaseswhere the immune system, which is generally responsible for fighting off harmful substances, mistakenly attacks healthy tissues.
In PsA, these attacks causeinflammationof the joints and overproduction of skin cells. In MCTD, the immune system attacks the fibers that give framework and support to the body.
Psoriatic ArthritisChronic fatiguePain, tenderness, and stiffness of multiple jointsAffected joints on one or both sides of the bodyReduced range of motion in affected jointsMorning stiffness of jointsLarge joint involvementNail pitting, crumbling, ridging, and nailbed separationSkin plaquesBack and neck painStiffness and pain with bending the backEnthesitisDactylitisRedness and pain of affected eyesMixed Connective Tissue DiseaseA general unwell feelingFatigueMild feverSwollen fingers or handsCold and numb fingers or toes in response to cold or stressJoint painMuscle painRashChest pain or breathing problemsGastrointestinal issues: Stomach inflammation, acid reflux, swallowing problemsHard or tight patches of skinHair lossPulmonary hypertensionInterstitial lung disease
Psoriatic ArthritisChronic fatiguePain, tenderness, and stiffness of multiple jointsAffected joints on one or both sides of the bodyReduced range of motion in affected jointsMorning stiffness of jointsLarge joint involvementNail pitting, crumbling, ridging, and nailbed separationSkin plaquesBack and neck painStiffness and pain with bending the backEnthesitisDactylitisRedness and pain of affected eyes
Chronic fatigue
Pain, tenderness, and stiffness of multiple joints
Affected joints on one or both sides of the body
Reduced range of motion in affected joints
Morning stiffness of joints
Large joint involvement
Nail pitting, crumbling, ridging, and nailbed separation
Skin plaques
Back and neck pain
Stiffness and pain with bending the back
Enthesitis
Dactylitis
Redness and pain of affected eyes
Mixed Connective Tissue DiseaseA general unwell feelingFatigueMild feverSwollen fingers or handsCold and numb fingers or toes in response to cold or stressJoint painMuscle painRashChest pain or breathing problemsGastrointestinal issues: Stomach inflammation, acid reflux, swallowing problemsHard or tight patches of skinHair lossPulmonary hypertensionInterstitial lung disease
A general unwell feeling
Fatigue
Mild fever
Swollen fingers or hands
Cold and numb fingers or toes in response to cold or stress
Joint pain
Muscle pain
Rash
Chest pain or breathing problems
Gastrointestinal issues: Stomach inflammation, acid reflux, swallowing problems
Hard or tight patches of skin
Hair loss
Pulmonary hypertension
Interstitial lung disease
Psoriatic Arthritis
According to the National Psoriasis Foundation, PsA affects 30% of people with psoriasis.For many people, PsA starts around 10 years after they develop psoriasis, but it is possible to have PsA without ever developing or noticing psoriasis.
PsA can develop slowly with mild symptoms, or it can develop quickly and become severe. Symptoms of the condition can include:
Mixed Connective Tissue Disease
Common symptoms of MTCD include:
Some people with MTCD might experience:
As with all autoimmune diseases, the causes of PsA and MTCD are unknown. One theory about autoimmune diseases is that some types of bacteria or viruses, or medications can trigger changes that confuse the immune system.This can occur in people who have genes that make them vulnerable to autoimmune diseases.
Researchers have identified genes that might influence the development of PsA. Of these, the most studied and well-known genes belong to a family of genes called thehuman leukocyte antigen(HLA) complex.
But having certain genes isn’t enough to cause the development of PsA. Both genes and environmental factors can play a role. Environmental triggers linked to PsA include infections, skin and other physical trauma, chronic stress, and obesity.
Certain risk factors can increase the risk for PsA, including:
MCTD occurs when the immune system attacks the connective tissues that provide the framework for the body. Some people with MCTD have a family history, but researchers have not established a clear genetic link.
Some studies have found a link between HLA genes and the development of MCTD.That research also confirmed that MTCD is a separate disease from other connective tissue conditions, including SLE lupus, scleroderma, and myositis.
Known risk factors for MCTD are:
There is no specific test to diagnose PsA, and diagnosis is often based on symptom history and a physical examination. In addition, MCTD can be difficult to diagnose because it resembles other conditions and has dominant features of other connective tissue diseases.
A diagnosis of PsA starts with a physical examination of joints, entheses, skin, and nails:
Additional testing to help aid in a PsA diagnosis includes imaging and laboratory testing:
A diagnosis of MCTD is based on symptoms, a physical exam, lab testing, imaging studies, and sometimes, a muscle biopsy. Since symptoms of MCTD can resemble those of other connective tissue diseases, it can sometimes take months or even years to get a correct diagnosis.
A positive anti-RNP antibody test can help confirm a diagnosis of MCTD.Anti-RNP autoimmunity is also seen in people with SLE lupus. In people with MCTD, anti-RNP autoantibodies generally mean a favorable prognosis.
According to the Cleveland Clinic, four features point to MCTD rather than another connective tissue disorder.These are:
Additional testing for MTCD includes:
Both PsA and MCTD are lifelong conditions that require long-term measures. Your doctor can recommend the best treatment options for each condition and their treatments can sometimes overlap.
There are many different treatment options available for treating PsA. Your doctor will prescribe treatments based onPsA typeand disease severity.
Medicines used to treat PsA include:
Additional therapies for managing PsA include:
Surgery can be recommended in cases where there is severe joint damage. Repairing joint damage can relieve pain and improve mobility.
The goals of MCTD treatment are to control symptoms, maintain function, and reduce the risk for disease complications. Your doctor will tailor treatment to your specific needs and how severe your disease is. Some people with MTCD might only need treatment for managing flare-ups, while others need long-term measures.
Medications prescribed to treat MCTD include:
Autoimmune diseases like PsA and MTCD are generally not preventable. If you have a family history of either condition or another autoimmune disease, ask your doctor about identifying risk factors for these conditions.
Doctors do not know of any ways to prevent PsA, and no treatment can guarantee that someone with psoriasis won’t go on to develop PsA. Doctors don’t fully understand how psoriasis progresses into PsA or who might be at risk for PsA.
One day, research might bring about answers, but for now, doctors focus on managing psoriasis to help reduce the risk for PsA and reducing the severity of psoriasis and PsA. If you have concerns about your risk for PsA, talk to your doctor about all of your risk factors for the condition.
Little is known about what causes MCTD and the risk factors for the condition. This means that doctors don’t know if the condition can be prevented.
Summary
Psoriatic arthritis and mixed connective tissue disease are autoimmune diseases, conditions where the immune system mistakenly attacks healthy tissues. With PsA, the attacks lead to inflammation of joints and overproduction of skin cells, and with MTCD, the immune system attacks fibers that give framework and support to the body.
Both PsA and MCTD are lifelong conditions, which means they will need long-term treatment. Your doctor can recommend a treatment plan for your condition, and treatments for these two conditions can sometimes overlap.
A Word From Verywell
If you are diagnosed with psoriatic arthritis or mixed connective tissue disease, make sure you regularly see your doctor. Both PsA and MCTD are progressive conditions and may get worse with time.
They also need strong medications to reduce the risk for serious complications. These conditions can affect your organs, so be sure to discuss any risk factors for other conditions, including symptoms and preventive measures.
You should work with arheumatologist(a doctor specializing in rheumatic conditions) and other specialists to best manage these conditions. Keeping your condition well-managed improves your outlook and your quality of life.
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Tanaka Y, Kuwana M, Fujii T, et al.2019 Diagnostic criteria for mixed connective tissue disease (MCTD): from the Japan research committee of the ministry of health, labor, and welfare for systemic autoimmune diseases.Mod Rheumatol. 2021;31(1):29-33. doi:10.1080/14397595.2019.1709944National Psoriasis Foundation.About psoriatic arthritis.National Organization for Rare Disorders.Mixed connective tissue disease.MedlinePlus.Autoimmune disorders.MedlinePlus.Psoriatic arthritis.National Psoriasis Foundation.Are you at risk for psoriatic arthritis?Flåm ST, Gunnarsson R, Garen T, Norwegian MCTD Study Group, Lie BA, Molberg Ø.The HLA profiles of mixed connective tissue disease differ distinctly from the profiles of clinically related connective tissue diseases.Rheumatology(Oxford). 2015;54(3):528-35. doi:10.1093/rheumatology/keu310Ungprasert P, Crowson CS, Chowdhary VR, et al.Epidemiology of mixed connective tissue disease, 1985-2014: A population-based study.Arthritis Care Res (Hoboken). 2016;68(12):1843-1848. doi:10.1002/acr.22872Arthritis Foundation.Enthesitis and PsA.Mease PJ.Measures of psoriatic arthritis: tender and swollen joint assessment, psoriasis area and severity index (PASI), nail psoriasis severity index (NAPSI), modified nail psoriasis severity index (mNAPSI), Mander/Newcastle enthesitis index (MEI), Leeds enthesit.Arthritis Care Res(Hoboken). 2011;63(Suppl 11):S64-S85. doi:10.1002/acr.20577National Psoriasis Foundation.Psoriatic arthritis screening test.Cleveland Clinic.Mixed connective tissue disease.Carpintero MF, Martinez L, Fernandez I, et al.Diagnosis and risk stratification in patients with anti-RNP autoimmunity.Lupus. 2015;24(10):1057-1066. doi:10.1177/0961203315575586Reiseter S, Gunnarsson R, Corander J, et al.Disease evolution in mixed connective tissue disease: results from a long-term nationwide prospective cohort study.Arthritis Res Ther. 2017;19(1):284. doi:10.1186/s13075-017-1494-7Rirash F, Tingey PC, Harding SE, et al.Calcium channel blockers for primary and secondary Raynaud’s phenomenon.Cochrane Database Syst Rev. 2017;12(12):CD000467. doi:10.1002/14651858.CD000467.pub2
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Tanaka Y, Kuwana M, Fujii T, et al.2019 Diagnostic criteria for mixed connective tissue disease (MCTD): from the Japan research committee of the ministry of health, labor, and welfare for systemic autoimmune diseases.Mod Rheumatol. 2021;31(1):29-33. doi:10.1080/14397595.2019.1709944National Psoriasis Foundation.About psoriatic arthritis.National Organization for Rare Disorders.Mixed connective tissue disease.MedlinePlus.Autoimmune disorders.MedlinePlus.Psoriatic arthritis.National Psoriasis Foundation.Are you at risk for psoriatic arthritis?Flåm ST, Gunnarsson R, Garen T, Norwegian MCTD Study Group, Lie BA, Molberg Ø.The HLA profiles of mixed connective tissue disease differ distinctly from the profiles of clinically related connective tissue diseases.Rheumatology(Oxford). 2015;54(3):528-35. doi:10.1093/rheumatology/keu310Ungprasert P, Crowson CS, Chowdhary VR, et al.Epidemiology of mixed connective tissue disease, 1985-2014: A population-based study.Arthritis Care Res (Hoboken). 2016;68(12):1843-1848. doi:10.1002/acr.22872Arthritis Foundation.Enthesitis and PsA.Mease PJ.Measures of psoriatic arthritis: tender and swollen joint assessment, psoriasis area and severity index (PASI), nail psoriasis severity index (NAPSI), modified nail psoriasis severity index (mNAPSI), Mander/Newcastle enthesitis index (MEI), Leeds enthesit.Arthritis Care Res(Hoboken). 2011;63(Suppl 11):S64-S85. doi:10.1002/acr.20577National Psoriasis Foundation.Psoriatic arthritis screening test.Cleveland Clinic.Mixed connective tissue disease.Carpintero MF, Martinez L, Fernandez I, et al.Diagnosis and risk stratification in patients with anti-RNP autoimmunity.Lupus. 2015;24(10):1057-1066. doi:10.1177/0961203315575586Reiseter S, Gunnarsson R, Corander J, et al.Disease evolution in mixed connective tissue disease: results from a long-term nationwide prospective cohort study.Arthritis Res Ther. 2017;19(1):284. doi:10.1186/s13075-017-1494-7Rirash F, Tingey PC, Harding SE, et al.Calcium channel blockers for primary and secondary Raynaud’s phenomenon.Cochrane Database Syst Rev. 2017;12(12):CD000467. doi:10.1002/14651858.CD000467.pub2
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Tanaka Y, Kuwana M, Fujii T, et al.2019 Diagnostic criteria for mixed connective tissue disease (MCTD): from the Japan research committee of the ministry of health, labor, and welfare for systemic autoimmune diseases.Mod Rheumatol. 2021;31(1):29-33. doi:10.1080/14397595.2019.1709944National Psoriasis Foundation.About psoriatic arthritis.National Organization for Rare Disorders.Mixed connective tissue disease.MedlinePlus.Autoimmune disorders.MedlinePlus.Psoriatic arthritis.National Psoriasis Foundation.Are you at risk for psoriatic arthritis?Flåm ST, Gunnarsson R, Garen T, Norwegian MCTD Study Group, Lie BA, Molberg Ø.The HLA profiles of mixed connective tissue disease differ distinctly from the profiles of clinically related connective tissue diseases.Rheumatology(Oxford). 2015;54(3):528-35. doi:10.1093/rheumatology/keu310Ungprasert P, Crowson CS, Chowdhary VR, et al.Epidemiology of mixed connective tissue disease, 1985-2014: A population-based study.Arthritis Care Res (Hoboken). 2016;68(12):1843-1848. doi:10.1002/acr.22872Arthritis Foundation.Enthesitis and PsA.Mease PJ.Measures of psoriatic arthritis: tender and swollen joint assessment, psoriasis area and severity index (PASI), nail psoriasis severity index (NAPSI), modified nail psoriasis severity index (mNAPSI), Mander/Newcastle enthesitis index (MEI), Leeds enthesit.Arthritis Care Res(Hoboken). 2011;63(Suppl 11):S64-S85. doi:10.1002/acr.20577National Psoriasis Foundation.Psoriatic arthritis screening test.Cleveland Clinic.Mixed connective tissue disease.Carpintero MF, Martinez L, Fernandez I, et al.Diagnosis and risk stratification in patients with anti-RNP autoimmunity.Lupus. 2015;24(10):1057-1066. doi:10.1177/0961203315575586Reiseter S, Gunnarsson R, Corander J, et al.Disease evolution in mixed connective tissue disease: results from a long-term nationwide prospective cohort study.Arthritis Res Ther. 2017;19(1):284. doi:10.1186/s13075-017-1494-7Rirash F, Tingey PC, Harding SE, et al.Calcium channel blockers for primary and secondary Raynaud’s phenomenon.Cochrane Database Syst Rev. 2017;12(12):CD000467. doi:10.1002/14651858.CD000467.pub2
Tanaka Y, Kuwana M, Fujii T, et al.2019 Diagnostic criteria for mixed connective tissue disease (MCTD): from the Japan research committee of the ministry of health, labor, and welfare for systemic autoimmune diseases.Mod Rheumatol. 2021;31(1):29-33. doi:10.1080/14397595.2019.1709944
National Psoriasis Foundation.About psoriatic arthritis.
National Organization for Rare Disorders.Mixed connective tissue disease.
MedlinePlus.Autoimmune disorders.
MedlinePlus.Psoriatic arthritis.
National Psoriasis Foundation.Are you at risk for psoriatic arthritis?
Flåm ST, Gunnarsson R, Garen T, Norwegian MCTD Study Group, Lie BA, Molberg Ø.The HLA profiles of mixed connective tissue disease differ distinctly from the profiles of clinically related connective tissue diseases.Rheumatology(Oxford). 2015;54(3):528-35. doi:10.1093/rheumatology/keu310
Ungprasert P, Crowson CS, Chowdhary VR, et al.Epidemiology of mixed connective tissue disease, 1985-2014: A population-based study.Arthritis Care Res (Hoboken). 2016;68(12):1843-1848. doi:10.1002/acr.22872
Arthritis Foundation.Enthesitis and PsA.
Mease PJ.Measures of psoriatic arthritis: tender and swollen joint assessment, psoriasis area and severity index (PASI), nail psoriasis severity index (NAPSI), modified nail psoriasis severity index (mNAPSI), Mander/Newcastle enthesitis index (MEI), Leeds enthesit.Arthritis Care Res(Hoboken). 2011;63(Suppl 11):S64-S85. doi:10.1002/acr.20577
National Psoriasis Foundation.Psoriatic arthritis screening test.
Cleveland Clinic.Mixed connective tissue disease.
Carpintero MF, Martinez L, Fernandez I, et al.Diagnosis and risk stratification in patients with anti-RNP autoimmunity.Lupus. 2015;24(10):1057-1066. doi:10.1177/0961203315575586
Reiseter S, Gunnarsson R, Corander J, et al.Disease evolution in mixed connective tissue disease: results from a long-term nationwide prospective cohort study.Arthritis Res Ther. 2017;19(1):284. doi:10.1186/s13075-017-1494-7
Rirash F, Tingey PC, Harding SE, et al.Calcium channel blockers for primary and secondary Raynaud’s phenomenon.Cochrane Database Syst Rev. 2017;12(12):CD000467. doi:10.1002/14651858.CD000467.pub2
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