So, you’ve been living with psoriasis, sticking with your management program, and then your joints start to hurt. You wonder: Is this the start of psoriatic arthritis that I was warned about?
If you do experience joint pain or new symptoms, rheumatologists can help you look at what’s going on. Though they won’t be able to stop or prevent psoriatic arthritis from developing, they can help you access early treatment and improve your overall outlook.
The exact link between psoriasis (PsO) and psoriatic arthritis (PsA) is still being researched.
“At this point, we have no tools to predict who will develop psoriatic arthritis [of those] who have psoriasis,” says Dr. Stan Cohen, a board certified rheumatologist, clinical professor in the Department of Internal Medicine at UT Southwestern Medical Center, and co-director of the Division of Rheumatology at Presbyterian Hospital, Dallas.
“Studies are ongoing to try to determine if there are any genetic or underlying differences in the immune system in patients who have psoriasis or who have psoriatic arthritis and potentially may identify differences.”
Let’s take a closer look at how these conditions relate and get into risk factors, early signs, and prevention.
If you’re living with psoriasis, you’re definitely not alone! You make up one of an estimated 7.5 million to more than 8 million people living in America, and over 125 million people worldwide.
To be clear, that’s about 2 to 3 percent of the total world population living with psoriasis.
There are different types of psoriasis. The most common type, known as plaque psoriasis, affects nearly 80 percent of people living with psoriasis. This type is associated with red, itchy patches with white, silvery scales on lighter skin, and purple or dark brown patches with gray scales on darker skin.
If you’re one of the roughly 8 million with psoriasis, you have about a 1 in 3 chance of developing PsA. It involves inflammatory arthritis along with psoriasis on your skin.
Strictly speaking, anywhere from 18 to 42 percent of people with PsO go on to develop PsA.
Why such a large range? Well, the exact number depends on what study you look at. The Arthritis Foundation, which provided that general range, got its data from a 2013 study that looked at cases worldwide. In that study, the average worldwide was 30 percent, while the average in the United States was 36 percent.
Around 30 percent seems to be the number that most experts go with.
So, let’s talk about your chances of developing psoriatic arthritis. You already know one. Living with psoriasis increases your risk of developing psoriatic arthritis.
A 2021 study found that people with severe psoriasis were more likely to develop PsA than those with less severe psoriasis.
But as with other risk factors, living with psoriasis does not mean you’ll actually develop PsA. And to flip it, you can develop PsA with or without psoriasis.
Researchers are starting to understand more about the characteristics of psoriasis that may help predict your individual risk more accurately. This knowledge may help doctors provide better recommendations and treatments to help prevent or start early treatment for PsA.
A few more factors to consider include:
- Family history. About 40% of people with a close family member with at least one of the diseases develop PsA.
- Genes. Certain mutations, such as the HLA-B gene, may increase your risk of developing PsA.
- Smoking. Smoking or having been a smoker in the past increases a person’s chances of developing PsA.
- Alcohol. Drinking alcohol has been associated with a higher risk of PsA.
- Environmental factors. Experts believe that certain infections, living with HIV, stress, or stressful life events may increase your chances of developing PsA.
- Age. Though you can develop PsA at any age, most people develop it between the ages of 30 and 50.
- Body size. Up to 50% of people who develop PsA have obesity.
The key is to understand what factors you can influence, and which are beyond your control. To reduce your risk, a 2019 study found that weight loss can reduce the risk for people with obesity.
You don’t need to worry about every ache and pain. Pain may be due to things like overuse or wear and tear.
If you’re developing PsA, your symptoms may start off mild and slowly increase, or they may develop swiftly.
Here are some common symptoms of PsA to be aware of:
- stiffness and tiredness in the morning
- swelling, pain, and tenderness in the tendons
- swollen “sausage-like” fingers or toes
- changes in your nails, like pitting
- pain and redness in one or both eyes
- reduced range of motion in one or more joints
“It is best to catch PsA early before it can damage the joints,” says Dr. Erin Bauer, a board certified rheumatologist at Virginia Mason Medical Center. That means keeping up with regular dermatology appointments and alerting your dermatologist to any joint pain or swelling.
Researchers have not yet found a way to prevent PsA. There are no treatments for your psoriasis that will block or stop PsA from developing.
In a 2019 study, researchers noted that more research is needed to understand how psoriasis transitions to PsA. Once they understand the connection better, they may be able to recommend strategies to help prevent PsA.
Your doctor will likely suggest taking steps to help control your psoriasis symptoms. Though this may not prevent PsA, it can help you find relief from psoriasis and potentially help reduce the impact of PsA.
“The combination of a healthier lifestyle, proper management for skin disease, vigilance, and a prompt response to inflammatory joint symptoms are presently the best we can offer in terms of a risk mitigation strategy,” says Dr. Howard Blumstein, a board certified rheumatologist and clinical assistant professor of medicine at Stony Brook University Hospital.
It can take about 10 years from your initial diagnosis of psoriasis to develop PsA, which means you should talk with your doctor or treatment team about any concerns you may have about your joints.
Your doctor will likely check for signs and symptoms of PsA during checkups. Make sure you bring up any new symptoms with them so they can better help you.
Common treatments for both psoriasis and psoriatic arthritis include:
- topical preparations
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- nonbiologic disease-modifying anti-rheumatic drugs (DMARDs)
- biologic DMARDs
- lifestyle interventions
PsA is sometimes treated with immunosuppressants to reduce inflammation.
Living with psoriasis increases your risk of developing PsA, as do other lifestyle, genetic, and environmental factors. Doctors do not know exactly how the disease progresses, so they can’t predict if you’ll develop it or help you prevent it from occurring. They can help monitor for it and provide treatment should PsA develop.