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Does Psoriasis Lead To Psoriatic Arthritis

What Is Psoriatic Arthritis

Psoriasis, Psoriatic Arthritis and Weight

Psoriatic arthritis is a type of arthritis linked with psoriasis, a chronic skin andnail disease. Psoriasis causes red, scaly rashes and thick, pitted fingernails.Psoriatic arthritis is similar to rheumatoid arthritis in symptoms and jointswelling . But it tends to affect fewer joints than RA. And it does notmake the typical RA antibodies. The arthritis of psoriatic arthritis comes in 5forms:

  • Arthritis that affects the small joints in the fingers, toes, or both
  • Asymmetrical arthritis of the joints in the hands and feet
  • Symmetrical polyarthritis, which is similar to RA
  • Arthritis mutilans, a rare type of arthritis that destroys and deforms joints
  • Psoriatic spondylitis, arthritis of the lower back and the spine

Psoriasis and Psoriasis Arthritis FAQ

Psoriatic Arthritis And Heart Arrhythmia

Up to 30 percent of people with psoriasis will eventually develop psoriatic arthritis. One study linked psoriasis to increased risks of heart arrhythmia. This is an indication of heart problems. The study concluded that psoriatic arthritis carries a higher risk of arrhythmia.

People who have severe forms of the skin disease and are under age 60 are more likely to develop heart disease, according to findings published in the American Journal of Cardiology.

Psoriasis can mean an increased risk of heart problems. But you can strengthen your heart through diet, exercise, and stress reduction.

Lifestyle Changes Can Help Too

Eating a healthy diet that includes limiting alcohol consumption, quitting smoking, getting regular exercise, maintaining or reaching a normal weight, and managing stress with yoga, meditation or other mindbody practices may also help reduce inflammation and your risk of psoriatic disease comorbidities.

âMany of these comorbid conditions can be reversed by treating psoriasis and making the right lifestyle changes,â says Dr. Mehta, who emphasizes that taking small steps each day can lead to better heath.

âI tell my patients, âEach day, please do one thing for your psoriasis, one thing for your mind and one thing for your body,ââ he says.


1. Elmets CA, Leonardi CL, Davis DMR, Wu JJ, Hariharan V, Menter A, et al. Joint AAD-NPF Guidelines of Care for the Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities. Published February 13, 2019. J Am Acad Dermatol.

2. Takeshita J, Grewal S, Langan SM, Mehta NN, Ogdie A, Van Voorhees A, Gelfand JM. Psoriasis and Comorbid Disease Part I. Epidemiology. March 2017. J Am Acad Dermatol.

3. Mathew AJ, Chandran V. Depression in Psoriatic Arthritis: Dimensional Aspects and Link with Systemic Inflammation. Published April 22, 2020. Rheumatology and Therapy.

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Occurrence In The United States

According to the National Psoriasis Foundation, psoriatic arthritis affects about 1 million people in the United States, or about 30% of all persons with psoriasis. However, prevalence rates vary widely among studies. In one population-based study, less than 10% of patients with psoriasis developed clinically recognized psoriatic arthritis during a 30-year period. A random telephone survey of 27,220 US residents found a 0.25% prevalence rate for psoriatic arthritis in the general population and an 11% prevalence rate in patients with psoriasis. However, the exact frequency of the disorder in patients with psoriasis remains uncertain, with the estimated rate ranging from 5-30%.

Moreover, since the late 20th century, the incidence of psoriatic arthritis appears to have been rising in both men and women. Reasons for the increase are unknown it may be related to a true change in incidence or to a greater overall awareness of the diagnosis by physicians.

How Bad Can Psoriatic Arthritis Get

Does Psoriasis Lead to Psoriatic Arthritis?

Severe symptoms of PsA can affect your daily life. Untreated or severe PsA can cause permanent joint damage. Extended periods of inflammation can cause affected bones to erode, and the joint space may begin to narrow. All of these things will make it harder for you to move.

PsA is also associated with many different comorbid conditions that are indicators of disease progression.Comorbid conditions associated with PsA include cardiovascular disease, obesity, diabetes, and gastrointestinal inflammation. PsA can also shorten life expectancy and lead to a decreased quality of life.

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How Does Psoriatic Disease Affect The Immune System

Psoriatic disease is an immune-mediated disease that includes psoriasis, along with other comorbidities such as psoriatic arthritis and related systemic inflammation. In people living with psoriasis and/or PsA, the immune system is triggered and activated, acting as though there are harmful pathogens attacking the body.

This inflammation can present with noticeable signs such as discoloration of the skin or swelling around joints. However, the overactive immune system may also lead to inflammation a person cannot see. It can affect in the body, organs and systems and lead to other health conditions associated with psoriatic disease. Comorbidities of psoriatic disease include cardiovascular disease, metabolic syndrome, obesity, hypertension , type 2 diabetes, anxiety and depression, and more.

Researchers who study psoriatic disease are still working to identify the substances inside the body that trigger this immune response. One possibility could be certain kinds of bacteria acting as antigens . For example, sometimes streptococcal infection can trigger a case of guttate psoriasis. Another possible antigen could be antimicrobial peptides, molecules made by the body that are a part of the immune system and that work as antibiotics. *

What Psoriatic Arthritis Looks Like

PsA is characterized by the symptoms it causes. This includes swelling and stiffness of joints, low back pain, foot pain, eye symptoms, skin changes, and nail symptoms. It is important to recognize the signs and symptoms so your doctor can properly diagnose you and start treatment as early as possible.

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How To Prevent Psoriasis And Psa Flare

The symptoms of psoriatic disease cant be completely stopped, but they can usually be controlled with treatment.

Identifying what triggers your psoriasis and PsA flares is key to treating the condition. Because PsA is a result of psoriasis, both conditions may be triggered by the same environmental factors.

For some people, stress can be a major trigger for a psoriasis flare. Learning breathing exercises, practicing yoga, and using other coping mechanisms for stress may help stop stressful situations from making your psoriasis symptoms worse.

The biggest lifestyle change that might ease the symptoms of psoriatic disease is diet. Looking at your diet to identify things that trigger your psoriasis symptoms could mean removing some foods as a form of treatment.

Obesity is known to contribute to psoriasis symptoms. Maintaining a healthy diet is essential to being in a healthy weight range. If you can avoid carrying extra pounds, studies indicate that your symptoms will be less severe.

Drinking alcohol and smoking can also trigger flares, so limiting or eliminating these factors entirely can be beneficial.

Treatments For Psoriasis And Psoriatic Arthritis

Living With Psoriatic Arthritis and Psoriasis

Many medications can help treat both the skin and joints, but there are definitely medications that work better for one than the other, explains Dr. Haberman. When treating PsA, we focus on both domains. We may start with one medication if your skin is worse that is better on the skin, but it should still have effects on the joints, she says.

According to the clinical treatment guidelines by the American College of Rheumatology and the National Psoriasis Foundation , your personal treatment plan should depend on how PsA is impacting your body as well as the severity of your symptoms.

Since patients with psoriatic arthritis may have different degrees of involvement of skin, joint pain, finger and toe swelling , and pain where tendons and ligaments attach to bone , its important to identify the most problematic areas and choose treatment options that are best suited for them, says Dr. Husni.

For example, if you have little joint pain and a lot of skin involvement, your rheumatologist might try newer biologics called IL-17 inhibitors, like secukinumab and ixekizumab , notes Dr. Haberman.

While we have a lot of medication options for PsA, sometimes it is more of trial and error to see which medication the patient will respond to, she says. Sometimes we need to try more than one medication to find the one that is right for that patient.

Medications use to treat both psoriasis and PsA include:

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How Do Psoriasis And Psa Overlap

For every 10 patients who walk in the door with psoriasis, about three or four of them will eventually get PsA, says Elaine Husni, MD, MPH, vice chair of the department of rheumatic & immunologic diseases at the Cleveland Clinic in Ohio. Most cases almost always start with the skin condition and then within seven to 10 years later, joint pain symptoms start to develop.

However, skin and joint symptoms can develop at the same time and, more rarely, joint symptoms can appear before skin involvement, says Dr. Haberman. While estimates vary, one study showed that up to 3 percent of patients developed joint disease before skin disease, she notes.

In some cases, there may have been skin involvement that went unnoticed or undiagnosed. For example, psoriasis can be sneaky and show up in hidden or private areas like the scalp, intergluteal cleft , belly button, and inside the ear, explains Dr. Husni. Since people dont really examine their scalp or buttocks very often, small psoriasis patches can get missed and delay diagnosis, she says.

Adds Dr. Haberman: You might have a small fleck in your scalp that you just think of as dandruff that is actually psoriasis.

Whats more, people with psoriasis in some of these hidden areas may actually be more prone to PsA. Studies have shown that you may be at higher risk of developing PsA if you have scalp, nail, or inverse psoriasis, says Dr. Haberman.

Symptoms Of Psoriatic Arthritis

The severity of the condition can vary considerably from person to person. Some people may have severe problems affecting many joints, whereas others may only notice mild symptoms in 1 or 2 joints.

There may be times when your symptoms improve and periods when they get worse .

Relapses can be very difficult to predict, but can often be managed with medicine when they do occur.

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Effects On The Immune System

PsA is an autoimmune condition, which means that it influences the way that the immune system works. The immune system fights pathogens, such as bacteria and viruses. In someone with an autoimmune condition, it mistakenly attacks healthy cells.

In a person with PsA, the immune system attacks the joints, tendons, and the insertion points of tendons and ligaments. If a person also has psoriasis, it also affects the skin.

Researchers do not fully understand why this happens. They think that some bacterial infections, including strep throat, may trigger PsA. In addition, if a person has a genetic susceptibility, they may develop PsA as a result of severe stress, a physical injury, or an event that causes the immune system to react strongly.

720% of people with psoriasis develop uveitis, and it is more common in people who have PsA than in those who have psoriasis alone.

Uveitis is a group of diseases related to eye inflammation. Without treatment, it can lead to vision loss. People with PsA should have regular eye exams for this reason.

Dealing With Dual Diseases

OMG! Do You Have Psoriatic Arthritis? â Page 4 â Life

There are no cures for either psoriasis or psoriatic arthritis, but the conditions are treatable, says Dr. Davis. Typically, youll start with drugs that target the inflammatory process affecting your skin and joints. Once psoriasis and psoriatic arthritis are considered moderate to severe, a patient can try medications like injectable biologicals or infusible biologicals, says Dr. Orbai. There are psoriatic disease-specific biologicals like the interleukin-17 inhibitors and interleukin-23 inhibitors, and also biologicals known as TNF inhibitors approved by the FDA for both psoriasis and psoriatic arthritis. Because the Interleukin-17 and Interleukin-23 inhibitors are specific to PsA, they probably wont work if you have another form of arthritis, like rheumatoid, so proper diagnosis is key.

The good news: Drugs for these conditions keep getting better and better. These diseases have a wide spectrum, Dr. Davis says. However, with todays treatments and medications, there is increasing hope that we will be able to prevent permanent complications or joint damage if you are vigilant about taking medications and making lifestyle modifications.

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Key Points About Psoriatic Arthritis

  • Psoriatic arthritis is a form of arthritis with a skin rash.
  • Psoriasis is a chronic skin and nail disease. It causes red, scaly rashes and thick, pitted fingernails. The rash may come before or after the arthritis symptoms.
  • Psoriatic arthritis causes inflamed, swollen, and painful joints. It happens most often in the fingers and toes. It can lead to deformed joints.
  • Treatment may include medicines, heat and cold, splints, exercise, physical therapy, and surgery.

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Faq Frequently Asked Questions

Author: Jonathan Meddings BMedLabSc First answered: 26 Nov 2014Last reviewed: 19 May 2018Rating: 4.3 out of 5Votes: 811 Category: Rheumatoid arthritis

All Health& ‘s health information is accredited by international standards and approved by our world-class Health& Medical Advisory Board.

Always ask your doctor or healthcare provider any questions you may have regarding a medical condition. In case of emergency, call your doctor or dial 911 , or dial 112 , or dial 000 immediately.

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Lifestyle Changes Can Help

If you have PsO, there are things you can do to try to lower your chances of developing PsA, too. One modifiable risk factor is being overweight or obese, says Dr. Orbai. A possible explanation is that there might be more wear and tear on joints when someone is carrying more weight, which leads to inflammation. It could also be because inflammation is amplified by the fatty cells in the tissue.

Regular exercise and smart food choices based on the Mediterranean diet can help you reach a healthy weight and lower inflammation in your body.

Other ways to reduce your chances of developing PsA? If you smoke, quit. Moderate your alcohol intake, avoid cold weather , and find ways to boost your mood: A 2017 Canadian study found that psoriasis patients who reported depression were at a 37% greater risk of developing psoriatic arthritis.

How Is Psoriatic Arthritis Diagnosed In A Child

Psoriatic Arthritis: Types, Symptoms, Diagnosis & Treatment – Dr. Chaithanya K S | Doctors’ Circle

Psoriatic arthritis is easier to confirm if your child already has psoriasis. If the skin symptoms have not yet occurred, diagnosis is more difficult. Your childs healthcare provider will take your childs medical history and do a physical exam. The provider will ask about your child’s symptoms. Your child may have blood tests such as:

  • Erythrocyte sedimentation rate . This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood’s proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.

  • Uric acid. High blood uric acid levels are linked to psoriatic arthritis.

  • Complete blood count . This test checks for low counts of red blood cells , white blood cells, and platelets.

  • Antibody blood tests. These tests are done to look for certain kinds of proteins, called antibodies, in your blood. These tests can be positive for many kinds of rheumatic diseases. Younger children are more likely to have a positive antinuclear antibody test.

Other tests may include:

  • X-rays. This test uses a small amount of radiation to create images of organs, bones, and other tissues.

  • Eye exam. This is done by a pediatric eye doctor . The exam looks for uveitis, a swelling of the middle layer of the eye.

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What Is Psoriatic Arthritis In Children

Psoriatic arthritis is a rare form of arthritis or joint inflammation that affects both skin and joints. Psoriasis is an ongoing condition that causes a red, scaly, itchy rash. It also causes nails to become thick and pitted with tiny holes.

Psoriatic arthritis causes painful joint pain and swelling, along with skin rashes. It most often affects finger and toe joints. But it can also affect wrists, knees, ankles, and the lower back.

This condition is most common in adults ages 30 to 50. But it can start in childhood. In many cases, the skin disease starts before the arthritis.

Early diagnosis and treatment helps to ease pain and prevent joint damage from getting worse.

The Bodys Defenses Gone Rogue

Researcher Nehal N. Mehta, M.D., MSCE, is a senior investigator in the Section of Inflammation and Cardiometabolic Diseases at the National Heart, Lung, and Blood Institute in Bethesda, Maryland. For the past six years, he and other scientists in his NHLBI lab have followed a group of 350 people with plaque psoriasis, looking into how chronic inflammation affects their risk of heart disease and metabolic conditions such as diabetes.

âInflammation is simply a collection of immune cells trying to put out a fire, and that fire is usually an infection or some sort of virus,â says Dr. Mehta, a cardiologist and internist.

Setting off this inflammatory response, infiltration of immune cells and release of factors, is what the immune system evolved to do. In psoriatic disease, however, this primal defense has gone awry.

âIn psoriasis, immune cells attack places they shouldnât,â Dr. Mehta says. âThey go to the skin and cause psoriatic plaques, but they can also go to the joints and cause psoriatic arthritis. When they infiltrate blood vessels of the heart, they inflame the cells that line blood vessels. These fill with immune cells that donât belong there and cause inflammation. Thatâs the beginning of cardiovascular disease.â

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