If you’re living with psoriasis or psoriatic arthritis (PsA), you may also be more likely to develop Crohn’s disease or ulcerative colitis, which are types of inflammatory bowel disease (IBD).
“I’m new to psoriasis,” one MyPsoriasisTeam member wrote. “The problem is I also have Crohn’s, lupus, fibromyalgia, and neuropathy. They have listed five meds, but each one of them is not good for lupus or Crohn’s, so after two months, I’m still not taking anything, just using the cream.”
Read on to find out the link between these conditions and how they’re treated.
Crohn’s disease causes chronic inflammation in the lining and deeper layers of the digestive tract. Ulcerative colitis is characterized by inflammation and sores in the lining of the large intestine and rectum.
Psoriasis causes an overproduction of skin cells that leads to dryness, itching, and discolored patches of thick, scaly skin lesions (particularly with plaque psoriasis). According to the National Psoriasis Foundation, about 30 percent of people with psoriasis eventually develop PsA, with symptoms such as tendon pain, joint pain, swollen and stiff joints, and fatigue.
For people with psoriasis, the increased risk of ulcerative colitis is approximately 1.6 times greater than that of the general population. The risk of Crohn’s disease is about 2.5 times higher than average.
MyPsoriasisTeam members have shared their experiences with psoriasis, PsA, and Crohn’s disease. “I was diagnosed with Crohn’s last October, having been really sick all year,” said a member. “One good thing — if there is one — about having Crohn’s is that my psoriasis has gotten a lot better.”
“Does anyone else suffer from Crohn’s and psoriatic arthritis?” asked another member, adding that despite the apparently common link, “I don’t know anyone else with both conditions.”
Psoriasis and IBD are considered related inflammatory diseases because both the skin and the intestine are tissue barriers that connect the inside and outside of the body. Research indicates genetic correlations between both conditions, as well as related dysfunction in the immune system.
Both psoriasis and Crohn’s disease are associated with increased prevalence (commonness) among first-degree family members, which include parents, children, and siblings. Environmental factors for developing either Crohn’s or colitis, with or without psoriasis, include:
The primary risk factor for developing psoriasis is believed to be genetic. Numerous triggers can worsen the condition, including physical and mental stress, air pollution, infections, smoking, alcohol, and obesity.
People with Crohn’s disease are seven times more likely to develop psoriasis than the general population.
Biologic drugs target proinflammatory proteins, known as cytokines, in the immune system and can help treat psoriasis and IBD. Tumor necrosis factor (TNF)-alpha inhibitors (also called anti-TNF drugs), interleukin (IL)-23 inhibitors, and IL-17 inhibitors are used to treat psoriasis. Psoriasis and IBD share some immune pathways, so when these diseases occur together, biologic drugs can treat them simultaneously.
However, research has shown that treatment of psoriasis with IL-17 inhibitors may cause side effects that bring on or worsen IBD in some people. IL-17 inhibitors can aggravate inflammation in those with Crohn’s disease especially and also are a risk factor for developing Crohn’s. IL-17 inhibitors have been linked with a risk of moderate worsening of ulcerative colitis in some people.
IL-17 inhibitors used in the treatment of psoriasis include:
Talk to your dermatologist if you’re taking an IL-17 inhibitor for psoriasis and have questions about IBD. Be sure to also tell your health care team about any gastrointestinal symptoms you may be having. Biologic drugs that are effective for some people who have both psoriasis and Crohn’s include these TNF-alpha inhibitors and IL-23 inhibitors:
Managing psoriasis and IBD can be challenging. MyPsoriasisTeam members have commented on their experiences managing psoriasis, PsA, IBD, and sometimes other comorbidities at the same time. A comorbidity is when two or more disorders occur at the same time and may interact negatively.
“I have taken Humira for a while now for PsA, colitis, and psoriasis — works well, but I recently turned 65, and the Humira assistance plan stopped. Obviously, we all know how expensive it can be,” a member wrote.
“I have ulcerative colitis, and I have been on Remicade for that since 2009,” shared another member. “It does keep the worst of my PsA symptoms at bay for the most part. I also have osteoarthritis, so sometimes it is difficult to tell what is hurting.”
People with psoriasis and IBD are at a greater risk of additional conditions that are linked with inflammatory diseases, such as cardiovascular disease, anxiety and depression, cancer, and obesity. Having comorbidities like these can complicate treatment.
Along with topical and systemic medications for psoriasis and PsA, a range of treatment options might be used to manage IBD that’s also present. These drugs include anti-inflammatory medicine, antibiotics, corticosteroids, biologics, and immunomodulators. In acute cases, surgery may be necessary to remove damaged areas of the colon or rectum or make an internal ileal pouch.
Psoriasis is associated with many comorbidities, such as IBD, and can affect multiple organs. IBD is even one of the criteria for classifying psoriatic arthritis. People with psoriasis and PsA may find value from a multidisciplinary health care team if they also have Crohn’s or colitis. Specialists from different fields of medicine may be able to work together to improve your quality of life.
Studies have recommended that people with both psoriasis and IBD work with a team of doctors that includes at least a dermatologist, a gastroenterologist, and a rheumatologist. Some people with a group of these conditions may also benefit from receiving mental health care or seeing a general practitioner (such as a nurse practitioner) or — if eyes are affected — an ophthalmologist.
People with chronic inflammatory conditions like psoriatic disease, IBD, rheumatoid arthritis, or ankylosing spondylitis can improve their overall health by eating well, staying physically active, and avoiding unhealthy habits. You can improve your health and help reduce disease activity by making lifestyle changes such as:
Talk to your doctors about help for quitting smoking, and avoid using a nicotine patch before getting medical advice — it could make your psoriasis worse. Your health care providers can also give you referrals for dietitians, physical therapists, and occupational therapists.
On MyPsoriasisTeam, the social network for people with psoriasis and psoriatic arthritis, more than 125,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.
Are you living with Crohn’s disease or ulcerative colitis and psoriasis? Share your experience in the comments below, or start a conversation by posting on your Activities page.