Psoriatic Arthritis: Prognosis Life Expectancy And Quality Of Life
The big questions
If you or a loved one has been diagnosed with psoriatic arthritis , youre likely wondering how this condition might impact your life, both now and in the future.
It may help to know that there are several treatment options for easing symptoms, and researchers are always searching for new ones.
PsA can be a serious chronic inflammatory condition that can cause significant pain and, in severe cases, disability. But its possible to manage your condition through medications and lifestyle changes.
In most cases, the joint pain and inflammation caused by PsA respond well to treatment.
PsA is a chronic condition, which means theres no cure. Medications can treat its symptoms, however, and PsA isnt life-threatening.
Some research suggests that people with PsA have a slightly shorter life expectancy than the general population. This is similar to other autoimmune conditions, like rheumatoid arthritis. It might be because people with PsA are also at an increased risk of developing heart disease.
If you have severe PsA, talk to your doctor about the best treatments to ease your symptoms and prevent chronic inflammation.
Its hard to predict exactly how PsA will affect your life because people experience symptoms differently. For some, the condition progresses quickly and causes more severe symptoms, while others may go quite some time without noticing a huge change.
PsA symptoms can include:
What Causes Psoriatic Arthritis
The cause of psoriatic arthritis is unknown. Researchers suspect that it develops from a combination of genetic and environmental factors. They also think that immune system problems, infection, obesity, and physical trauma play a role in determining who will develop the disease. Psoriasis itself is neither infectious nor contagious.
Recent research has shown that people with psoriatic arthritis have an increased level of tumor necrosis factor in their joints and affected skin areas. These increased levels can overwhelm the immune system, making it unable to control the inflammation associated with psoriatic arthritis.
What You Can Change
- Men and women should not drink more than 14 units a week on a regular basis
- Spread your drinking over 3 or more days if you regularly drink 14 units a week
- If you want to cut down, try to have several drink-free days each week
14 units is equivalent to 6 pints of average-strength beer or 10 small glasses of low-strength wine.
The following table will show you how many units are in different alcoholic drinks.
Type of drink
Large glass of red/white/rosé wine
Remember: for certain medications you will be advised to avoid alcohol , so do make sure your healthcare provider is aware of your alcohol consumption.Stress: Stress can increase your risk of heart disease, and it may also encourage your psoriasis to flare. It is important to learn how to reduce your stress in a healthy way rather than resorting to unhealthy strategies such as smoking, drinking and overeating. Exercise, yoga and relaxation techniques can be effective. Healthy stress release, such as listening to music, meeting with friends or pursuing a hobby is really good too. You may also wish to talk to your doctor about counselling or medication.
Recommended Reading: Ra Hand Pain Relief
Increased Risk Of Gout/high Uric Acid Levels
There is also a clear link between cardiovascular disease and gout, another type of arthritis. Gout causes an excessive amount of uric acid build up in your blood, which causes inflammation and joint pain. At the 2019 American College of Rheumatology annual meeting, researchers revealed that people with PsA have a prevalence of hyperuricemia that is three times greater than those without the condition. This prolonged exposure to high levels of uric acid in the blood can interfere with endothelial dysfunction as well as structural changes in the heart , which is associated with congestive heart failure.
Arthritis And Heart Disease
Learn how having arthritis can affect heart health and what you can do to protect yourself.
Youre probably all too aware of how arthritis affects your joints. But having arthritis osteoarthritis , but especially inflammatory conditions like rheumatoid arthritis , gout, lupus and psoriatic arthritis also puts you at increased risk for heart disease. That includes heart attack, stroke, atrial fibrillation , high blood pressure, heart failure, and atherosclerosis .
Those with gout are also at greater risk for a heart attack or of dying from cardiovascular and coronary heart disease. Gout was linked to a 15% higher risk for heart attack, stroke, or death from heart disease in a 2018 study published in the Journal of the American Heart Association.
People with OA face a 24% higher risk for cardiovascular disease, according to a meta-analysis of 15 studies that included nearly 360,000 people. The authors say shared heart disease risk factors such as high cholesterol and diabetes, along with inactivity and the use of nonsteroidal anti-inflammatory drugs , may be behind the increased risk. Another important contributor to heart disease is inflammation that can come with OA.
Chronic Inflammation and Your Heart
Inflammatory cells get into blood vessel walls where they make cytokines immune system proteins that promote inflammation. Inflammation also reshapes blood-vessel walls, making deposited plaques more prone to rupture. A rupture, in turn, can trigger a heart attack.
You May Like: Arthritis Skin Rash
Can Psoriatic Arthritis Affect The Esophagus
Psoriatic arthritis is an autoimmune condition that affects many parts of the body, such as the eyes and gastrointestinal tract, including the esophagus. Symptoms of PsA may include inflamed, itchy skin, swollen joints, and the possibility of infections.
The inability to swallow effectively is known as dysphagia. Studies have not yet found a clear link between PsA and dysphagia, but research is ongoing.
This article examines whether PsA affects the esophagus. It also explores potential esophageal-related problems PsA may cause and possible treatment options.
People who have dysphagia may experience symptoms such as:
- difficulty swallowing starchy foods, such as bread or potatoes
- feeling as though food is too big to swallow
- pain in the chest when food travels down the esophagus
- acid reflux after a meal or after eating particular foods
- gastroparesis, where the stomach muscles that push food through the intestines stop working or slow down
- weakness in the esophagus that can cause a pocket to form and trap food
- inflammatory bowel syndrome that has links to PsA through triggering chronic inflammation
- ulcerative colitis that relates to PsA and may cause mouth ulcers
Psoriatic Arthritis And Your Lungs
The inflammation associated with psoriatic arthritis can also harm your lungs and increase the risk of chronic obstructive pulmonary disease a group of lung conditions that cause breathing difficulties.
A Taiwanese study published in the Journal of the European Academy of Dermatology and Venereology showed the risk for COPD was even higher in men and those over age 50 with psoriasis.
If you have psoriatic arthritis, you might want to avoid smoking, lung irritants, and dust, which could raise your chances of developing COPD.
Read Also: Vicks Vapor Rub For Arthritis
Inflammation And Heart Disease
Inflammation can take many forms. These may include reddened patches of skin on your body and psoriatic arthritis. Symptoms can also include conjunctivitis, inflammation of the lining of your eyelids.
Psoriasis may also take different forms. Generally, people with any type of psoriasis have a risk of heart attack that is almost three times greater than in people without psoriasis.
Blood vessels can also become inflamed. This can cause the development of atherosclerosis. Atherosclerosis is the buildup of a fatty substance called plaque inside your artery walls. Plaque slows or interrupts the flow of blood to your heart. This heightens your risk of heart disease and heart attack.
Some psoriasis treatments can result in irregular cholesterol levels. This can harden the arteries and make a heart attack even more likely. People with psoriasis have also been found to have an increased risk of coronary heart disease, according to the
Hypertension And Diabetes Mellitus
The prevalence of hypertension has been reported higher in patients with PsA compared with that in the general population or with that in patients with psoriasis only . The prevalence of diabetes mellitus was also found increased in PsA in the majority of , but not in all of the previous studies. Tam et al. compared cardiovascular risk factors in 102 patients with PsA and 82 healthy controls . After adjusted for body mass index , patients with PsA were still more likely to have hypertension and diabetes mellitus. Insulin resistance, measured by the Homeostasis Model Assessment Index, was also significantly increased in patients with PsA compared with that in controls . The presence of hypertension and diabetes mellitus has been found significantly associated with abnormal IMT in univariate analysis, but the association became insignificant after adjusted for age and waist circumference . The presence of hypertension was also found independently associated with subclinical left ventricular dysfunction in patients with PsA .
Read Also: Rheumatoid Arthritis Leg Pain At Night
How Is Psoriatic Arthritis Diagnosed
There is no single test to diagnose psoriatic arthritis. Healthcare providers make the diagnosis based on a patient’s medical history, physical exam, blood tests, and X-rays of the affected joints. Magnetic resonance imaging is generally not needed except in unusual circumstances.
Laboratory tests that may be helpful in diagnosis or used to monitor disease activity include:
- Rheumatoid factor and anti-CCP – types of blood tests to help diagnose rheumatoid arthritis.
- HLA-B27 – blood test to help diagnose, may also be indicated with a family history of psoriasis or psoriatic arthritis.
- Sedimentation rate and C-reactive protein – may indicate inflammation.
X-rays are not usually helpful in making a diagnosis in the early stages of the disease. In the later stages, X-rays may show changes that are more commonly seen only in psoriatic arthritis. One such finding is called the “pencil-in-cup,” which describes the finding where the end of the bone gets whittled down to a sharp point. This finding indicates more severe inflammatory changes to joints, which may require more aggressive treatment.
Psoriatic Arthritis Linked To Increased Heart Disease Risk
Arthritis that accompanies the skin condition psoriasis may also come with a higher risk of heart problems, according to a Hong Kong study.
You Might Also Like
In particular, patients with psoriatic arthritis may have a three- to four-fold higher prevalence of coronary atherosclerosis.
Clinicians need to identify patients with high cardiovascular risk so they can provide lifestyle advice and preventive treatment to those individuals, said study author Lai-Shan Tam of the Chinese University of Hong Kong.
Psoriasis and psoriatic arthritis are related, but not everyone with psoriasis will develop the more severe psoriatic arthritis associated with joint swelling and pain.
According to the National Psoriasis Foundation, about 30 percent of those with psoriasis develop the inflammatory arthritis, which that can cause permanent damage to joints.
Compared to the general population, people with psoriatic arthritis had a 68 percent higher risk of heart attack and a 43 percent higher risk of death in previous studies, the authors of the new study point out in the Annals of the Rheumatic Diseases, online January 4. Although the increased risk and association are known, studies cant yet explain why.
Tam and colleagues evaluated coronary atherosclerosis using coronary CT angiography in 90 patients with psoriatic arthritis and 205 patients who didnt have this condition but who did have cardiovascular risk factors.
Read Also: Signs Of Arthritis In Legs
What Are The Symptoms Of Psoriasis
There are different types of psoriasis. The most common is chronic plaque psoriasis. This causes patches of red, raised skin, with white and silvery flakes.
It can occur anywhere on the skin, but most commonly at the elbows, knees, back, buttocks and scalp.
Psoriasis can cause small round dents in finger and toe nails, this is known as pitting. Nails can also change colour, become thicker and the nail may lift away from your finger.
How Can Your Doctor Help
Your doctor may measure your blood pressure or take some blood tests to check your blood glucose or cholesterol levels. Often these are performed in the morning after an overnight fast. You may be prescribed medication to help you reduce your risk of heart disease. Some medications, such as those which can help control cholesterol , have several additional health benefits. Other medications, such as beta-blockers, are helpful for blood pressure but can cause worsening of psoriasis. If a new medication seems to be affecting you in an adverse way, please consult your doctor immediately.Some medications for the treatment of psoriasis can cause high blood pressure or change the levels of triglycerides/cholesterol . If your dermatologist is considering these medications, he or she will check your blood pressure and take blood tests regularly.
Read Also: Bee Pollen For Arthritis
Ask About Medication To Control Your Cholesterol Blood Pressure And Blood Sugar
Depending on your risk factors and medical history, you may benefit from taking heart medications sooner than people without psoriatic arthritis. Talk to your doctor about what kind of medication you can take to keep your numbers in a heart-healthy range.
Statins, for example, work in the liver to lower cholesterol by blocking a liver enzyme that produces cholesterol. They also have strong anti-inflammatory properties. Yet the use of aspirin and statins among people with PsA is underutilized, according to a 2018 study published in the journal Arthritis & Rheumatology.
Bottom line: Talk to your doctor about what you can do to take care of your heart today. PsA doesnt go away. Its a chronic condition. Throughout your lifetime, make sure that youre on top of these other health factors. We can treat PsA, but that doesnt mean we shouldnt recognize the behind-the-scenes things that are happening, says Dr. Mankad.
Cardiovascular Morbidity In Psa
In summary, there is an increased prevalence of cardiovascular morbidity and their risk factors in patients with PsA when compared with general population. The prevalence of CVD in PsA was found to resemble that in RA in a cross-sectional study on 489 patients with PsA and 353 patients with RA . The age- and sex-adjusted odds risk of CVD showed no significant difference between patients with RA and those with PsA . In a recent cross-sectional study by Husted et al., prevalence of cardiovascular morbidities was compared between 611 patients with PsA and 449 patients with psoriasis only . Results indicated significantly increased prevalence of hypertension , obesity , hyperlipidemia , type 2 diabetes mellitus , and at least 1 cardiovascular event among patients with PsA compared with those with psoriasis only. The increased prevalence of hypertension remained significant after adjusted for demographics, psoriasis severity, and use of medication. Overall, these findings tentatively support the role of inflammatory arthritis in cardiovascular morbidity in patients with PsA.
You May Like: Arthritis Itchy Skin
Signs Of Heart Disease Psa Patients Need To Know
In general, someone with PsA who has heart disease would experience similar symptoms as someone in the general population, says Dr. Mankad. Its not just a chest-clutching heart attack to look out for, though. Not everyone has classic chest pain, she says. Symptoms of heart disease may include:
- Chest pressure, tightness, or discomfort
- Shortness of breath
- Excessive sweating
People may not always pay close attention to these symptoms, because they can be vague or people may assume theyre related to their psoriatic arthritis. The problem is that any symptoms get attributed to your PsA. Patients may think that a pain in the chest is related to the arthritis, says Dr. Mankad.
As such, patients may be more likely to delay seeking help, particularly if they are not aware of the link between PsA and heart disease.
Sometimes heart disease symptoms are silent or so subtle that people are not aware of them. Many people are tuned into a heart problem when they exercise or exert themselves in some way and are hit with chest tightness or pressure. If youre not exerting yourself as much because your joints hurt, you may not be doing enough to bring on these symptoms, Dr. Mankad says. You may not realize something is wrong until later.
Work And Psoriatic Arthritis
Having psoriatic arthritis may make some aspects of working life more challenging. But, if youre on the right treatment, its certainly possible to continue working.
Help and support is available, and you have rights and options.
The Government scheme Access to Work is a grant that can pay for equipment to help you with activities such as answering the phone, going to meetings, and getting to and from work.
The 2010 Equality Act, and the Disability Discrimination Act in Northern Ireland makes it unlawful for employers to treat anyone with a disability less favourably than anyone else. Psoriatic arthritis can be classed as a disability if its making every-day tasks difficult.
Your employer may need to make adjustments to your working environment, so you can do your job comfortably and safely.
You might be able to change some aspects of your job or working arrangements, or train for a different role.
In order to get the support youre entitled to, youll need to tell your employer about your condition. Your manager or HR department might be a good place to start.
Other available support might include:
- your workplace occupational health department, if there is one
- an occupational therapist. You could be referred to one by your GP or you could see one privately
- disability employment advisors, or other staff, at your local JobCentre Plus
- a Citizens Advice bureau particularly if you feel youre not getting the support youre entitled to.
You May Like: Stiff Neck Rheumatoid Arthritis
Recommendations For Cardiovascular Risk Management
The European League Against Rheumatism has developed recommendations for cardiovascular risk management in patients with RA and other inflammatory arthritis, including AS and PsA . The EULAR recommendations recognize the association between inflammation and atherosclerosis in patients with inflammatory arthritis and recommend that aggressive suppression of disease activity or inflammation is necessary to lower the cardiovascular risk. Annual assessment of cardiovascular risk using national guidelines is recommended for all patients with PsA. Any risk factors identified should be managed according to local guidelines. In the absence of local guidelines, cardiovascular risk management should follow the Systematic COronary Risk Evaluation model. Unlike the Framingham risk score, in which the pragmatic outcome bases on both cardiovascular mortality and morbidity , the SCORE model estimates the 10-year risk of developing cardiovascular death and includes the following risk factors: age, gender, smoking habit, systolic blood pressure, and either total cholesterol or the total cholesterol/HDL cholesterol ratio . Statins, angiotensin-converting enzyme inhibitors, and/or angiotensin II blockers are preferred treatment options due to their potential anti-inflammatory effects. Prescribing COX2 inhibitors and most NSAIDs in patients with a documented CVD or in the presence of cardiovascular risk factors should be cautious due to their potential cardiovascular risk.