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Conditions Related to Psoriatic Arthritis

Posted on January 03, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Emily Wagner, M.S.

Certain underlying health conditions are more common in people with psoriatic arthritis (PsA) than in the general population. Some people may have these conditions before their PsA diagnosis, while other people may develop them as a result of the disease or its treatment.

PsA is a chronic autoimmune condition that affects the joints and where the tendons and ligaments connect to bone. This causes joint pain, tenderness, and swelling, along with swollen fingers and morning stiffness that is similar to rheumatoid arthritis.

Comorbidities and Complications

When a person has more than one health condition at the same time, the health conditions are known as comorbidities. On the other hand, complications refer to other medical problems that make treating an existing disease more difficult.

Psoriatic arthritis: causes, risk factors, and diagnosis

Age is an important factor that affects whether a person develops any comorbid conditions. Generally, the longer a person lives, the more likely they are to have illnesses. The National Psoriasis Foundation suggests visiting your primary care provider regularly to make sure you are healthy and to screen for any underlying conditions.

According to the Arthritis Foundation, more than half of people living with PsA have at least one comorbid condition, and 40 percent have at least three comorbidities. In light of this, it is important to manage your PsA with proper treatment. Doing so can lower your risk of developing other related conditions and help improve your health.

Triggers of Comorbidities and Complications in PsA

Certain triggers can lead to the development of other related conditions and complications in PsA. The lifestyle choices you make and medications you take all have impacts on your PsA and the potential conditions that can develop later on.

Lifestyle

Lifestyle choices can have a major impact on managing PsA and preventing complications. Diet and exercise can help you lose weight and keep it off, which helps lower levels of inflammation in the body. While it can be difficult to motivate yourself to exercise and eat healthy during a flare-up, these choices can help prevent more trouble in the future.

Medications

While medications are useful in managing your PsA or psoriasis, certain drugs may also affect underlying conditions. For example, nonsteroidal anti-inflammatory drugs can be used to help control inflammation. However, they can also increase your blood pressure, putting you at risk for cardiovascular complications in the long term.

Taken over long periods of time, oral or injected corticosteroids (such as prednisone, prednisolone, and methylprednisolone) prescribed for treating PsA or psoriasis can cause you to gain weight and affect blood sugar levels. Retinoids and corticosteroids can also affect your cholesterol levels, which all contribute to your risk of developing metabolic syndrome. Antirheumatic drugs like leflunomide and methotrexate have also been found to affect liver function, which may already be impaired due to PsA.

Every medication can cause side effects. Your doctor is the best person to help you understand your individual risk versus the potential benefits of each treatment option.

Cardiovascular Disease

People with PsA are more likely to develop cardiovascular disease. Research shows that people with PsA are 43 percent more likely to develop heart disease than those living without the condition. In addition, those with PsA have a 22 percent increased risk of developing cerebrovascular disease, which can limit blood flow to the brain.

This is because the immune system is dysregulated in autoimmune diseases, which can result in inflammation throughout the entire body. The inflammation can affect the lining of blood vessels (endothelium), which can cause the buildup of fatty plaques known as atherosclerosis. In turn, atherosclerosis can block blood flow through the vessels and arteries, leading to a heart attack or other cardiovascular complications, such as:

  • Ischemic heart disease (inadequate blood supply to the heart)
  • Peripheral vascular disease (problems in the arteries throughout the body)
  • Stroke
  • High blood pressure in the lungs (pulmonary hypertension)
  • Irregular heartbeat (arrhythmia)

Metabolic Syndrome

Metabolic syndrome refers to a set of conditions relating to the body’s metabolism of energy. Metabolic syndrome increases the risk of stroke, heart disease, and type 2 diabetes mellitus. The set of conditions includes:

  • High blood pressure (hypertension)
  • Obesity (characterized by high body mass index, or BMI)
  • Insulin resistance caused by chronically high blood sugar levels
  • Abnormal cholesterol levels (dyslipidemia)

Studies have found that around 45 percent of people with PsA are obese, which can contribute to the development of metabolic syndrome. People with PsA and metabolic syndrome also tend to have more severe symptoms.

The low-grade systemic inflammation in PsA can also increase the risk of type 2 diabetes. One study found that people with PsA were 43 percent more likely to develop diabetes than those without PsA.

Inflammatory Bowel Disease

Inflammatory bowel disease is caused by chronic inflammation in the stomach, intestines, and colon. The two main types of IBD are ulcerative colitis and Crohn’s disease, which can cause:

  • Vomiting
  • Diarrhea
  • Loss of appetite
  • Weight loss
  • Abdominal pain
  • Damage to the intestines or other parts of the gastrointestinal tract

Many types of inflammatory arthritis — including PsA, reactive arthritis, and ankylosing spondylitis — have been linked to IBD. Research shows that people with PsA, psoriasis, and spondyloarthritis have as much as a four-fold increased risk of developing IBD compared to those without the conditions. The more severe your PsA, the higher your risk for developing IBD.

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a lung disease caused by inflammation in the lungs and airways. Symptoms include difficulty breathing, coughing, and wheezing. While the most common cause of COPD is smoking, inflammation from rheumatic diseases may also trigger it.

Research shows that people with PsA are at a higher risk for developing COPD compared to the general population. Researchers found that 11.5 percent of people with early PsA and 9.4 percent of people who have had PsA for more than two years had COPD.

Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is a term used for a number of liver conditions that are not caused by drinking alcohol. In NAFLD, fat collects in the liver cells and, if left unaddressed, can lead to scarring and liver cancer. According to the National Institute of Diabetes and Digestive and Kidney Diseases, around 24 percent of adults in the United States have the condition.

NAFLD can develop in people with PsA and rheumatic diseases, most likely due to increased levels of inflammation in the body. Obesity and type 2 diabetes, two other comorbidities common in those with PsA, also increase the risk of NAFLD.

One study found that 28 percent of people with PsA have fatty liver disease. This condition also complicates treatment, and it can make it difficult to achieve minimal disease activity (improvement in PsA symptoms).

Uveitis

Uveitis is a type of inflammation found in the eye that affects the middle layer of tissue, known as the uvea. Symptoms of uveitis can develop suddenly and quickly get worse; if you develop any of these symptoms, contact a health care professional immediately:

  • Eye pain and redness
  • Blurred or decreased vision
  • Sensitivity to light
  • Floaters, or dark, floating spots in your vision

If left untreated, uveitis can lead to permanent vision loss or other serious eye complications.

Around 25 percent of people with PsA develop uveitis, especially in Western and Asian populations.

Anxiety and Depression

Depression and anxiety have long been linked to PsA, due to the impact that PsA has on the personal and social lives of those living with it. Research shows about 20 percent of people with PsA are living with depression, with inflammation linking the two conditions together. Many people with PsA also have other comorbidities and complications, which can negatively affect quality of life.

Symptoms of depression can include:

  • Irritability
  • Tiredness
  • Feelings of sadness, hopelessness, or emptiness
  • Changes in sleeping and eating patterns
  • Reduced interest in things you once liked
  • Suicidal thoughts
  • Trouble focusing or sitting still
  • Feelings of worthlessness or guilt
  • Difficulty making decisions

If you are experiencing any of these symptoms, talk to your doctor about treatment options. It is important to take care of yourself both mentally and physically. Options can include:

  • Medication, such as antidepressants
  • Therapy or counseling
  • Support groups or group therapy
  • Getting regular physical activity

The Impact of Comorbidities

Some comorbidities can affect your health and quality of life with PsA more than others. If you do have any of these underlying health conditions, it is important to speak with your doctor about how to manage and treat them. Addressing these conditions can help you lead a healthier, more comfortable life.

Find Your Team

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis. On MyPsoriasisTeam, more than 101,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis and psoriatic arthritis.

Do you have other conditions in addition to psoriatic arthritis? Share your experience and tips in the comments below or by posting on MyPsoriasisTeam.

References
  1. About Psoriatic Arthritis — National Psoriasis Foundation
  2. Comorbidity — Cambridge Dictionary
  3. Complication — Cambridge Dictionary
  4. Ageing and the Epidemiology of Multimorbidity — European Respiratory Journal
  5. Related Conditions of Psoriatic Arthritis — National Psoriasis Foundation
  6. Metabolic Comorbidities of Psoriatic Arthritis — Arthritis Foundation
  7. Psoriatic Arthritis and Your Heart — Arthritis Foundation
  8. Atherosclerosis in Psoriatic Disease: Latest Evidence and Clinical Implications — Therapeutic Advances in Musculoskeletal Disease
  9. Metabolic Syndrome: Symptoms and Causes — Mayo Clinic
  10. The Risk of Developing Diabetes Mellitus in Patients With Psoriatic Arthritis: A Cohort Study — The Journal of Rheumatology
  11. Inflammatory Bowel Disease (IBD): Symptoms and Causes — Mayo Clinic
  12. Inflammatory Bowel Disease — Arthritis Foundation
  13. Managing Psoriatic Arthritis With Inflammatory Bowel Disease and/or Uveitis — Frontiers in Medicine Rheumatology
  14. COPD: Symptoms and Causes — Mayo Clinic
  15. Chronic Obstructive Pulmonary Disease and Rheumatic Diseases: A Systematic Review on a Neglected Comorbidity — Journal of Comorbidity
  16. Nonalcoholic Fatty Liver Disease: Symptoms and Causes — Mayo Clinic
  17. Definition and Facts of NAFLD and NASH — National Institute of Diabetes and Digestive and Kidney Diseases
  18. Hepatic Steatosis, Carotid Plaques, and Achieving MDA in Psoriatic Arthritis Patients Starting TNF-α Blockers Treatment: A Prospective Study — Arthritis Research and Therapy
  19. Defining Minimal Disease Activity in Psoriatic Arthritis: A Proposed Objective Target for Treatment — Annals of the Rheumatic Diseases
  20. Uveitis: Symptoms and Causes — Mayo Clinic
  21. Depression in Psoriatic Arthritis: Dimensional Aspects and Link With Systemic Inflammation — Rheumatology and Therapy
  22. Depression — National Institute of Mental Health
All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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