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Crohn’s Disease, Psoriasis, and Psoriatic Arthritis: What’s the Connection?

Posted on January 21, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Joan Grossman

Psoriasis and psoriatic arthritis (PsA) are linked to Crohn’s disease (CD) and ulcerative colitis (UC), and either condition may be a comorbidity for some people with psoriasis. A comorbidity is when two or more disorders occur in the same person and cause adverse interactions.

CD and UC are forms of inflammatory bowel disease (IBD). CD causes chronic inflammation in the lining and deeper layers of the digestive tract. UC is characterized by inflammation and sores in the lining of the large intestine and rectum.

Psoriasis causes an overproduction of skin cells that become dry, itchy, and discolored patches of thick, scaly skin lesions (particularly with plaque psoriasis), which can become infected during flares. Approximately 30 percent of people with psoriasis develop PsA with symptoms such as tendon pain, joint pain, swollen and stiff joints, fatigue, and eye redness and pain (uveitis).

For people with psoriasis, the increased risk for UC is approximately 1.6 times greater than the general population. The risk for CD is about 2.5 times higher than average.

MyPsoriasisTeam members have shared their experiences with psoriasis, PsA, and CD. “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,” she added.

“Does anyone else suffer from Crohn’s and psoriatic arthritis (apparently it is quite common), but I don’t know anyone else with both conditions,” wrote another member.

Causes and Risk Factors

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 has indicated genetic correlations between both conditions, as well as related dysfunction in the immune system.

Risk Factors for Developing IBD

Both psoriasis and CD are associated with an increased prevalence of these conditions among first-degree family members, which include parents, children, and siblings. Some of the environmental factors for developing either type of IBD, with or without psoriasis, include:

  • Birth by cesarean section
  • Lack of breastfeeding
  • Smoking
  • A diet high in animal fat, animal proteins, and food additives
  • Sedentary work conditions
  • City air pollution
  • Dysbiosis (imbalance in gut bacteria)

Oral contraceptives, antibiotics, and nonsteroidal anti-inflammatory drugs other than aspirin are also associated with a higher incidence of developing IBD.

Risk Factors for Developing Psoriasis

The primary risk factor for developing psoriasis is believed to be genetic. Numerous triggers can exacerbate the condition, including physical and mental stress, air pollution, infection, smoking, alcohol, and obesity.

People with CD are seven times more likely to develop psoriasis than the general population.

Psoriasis Treatment and IBD

Biologic drugs target proinflammatory proteins, known as cytokines, in the immune system and are used to treat psoriasis and IBD. Tumor necrosis factor (TNF)-α inhibitors (also called anti-TNF drugs), interleukin (IL)-23 inhibitors, and IL-17 inhibitors are therapies used to treat psoriasis. Because psoriasis and IBD share some of the same immune pathways, the diseases may be treated concurrently with biologic drugs when they occur at the same time.

However, research has shown that treatment of psoriasis with IL-17 inhibitors may cause side effects that induce or exacerbate IBD in some people. IL-17 inhibitors can aggravate inflammation in those with CD especially and are a risk factor for developing CD. IL-17 inhibitors have been associated with a risk of moderate exacerbation of UC in some people.

IL-17 inhibitors used in the treatment of psoriasis include:

  • Cosentyx (secukinumab)
  • Taltz (ixekizumab)
  • Siliq (brodalumab)

Talk to your dermatologist if you are taking an IL-17 inhibitor for psoriasis and have questions about IBD. Be sure to discuss any gastrointestinal symptoms you may be having with your health care team. Biologic drugs that are effective for some people who have both psoriasis and CD include:

  • Remicade (infliximab)
  • Humira (adalimumab)
  • Cimzia (certolizumab)
  • Stelara (ustekinumab)

Living With Psoriasis and IBD

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.

“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.

One member discussed her condition. “I have ulcerative colitis and I have been on Remicade for that since 2009. 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.”

“I'm new to psoriasis,” another 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.”

People with psoriasis and IBD are at a greater risk for additional comorbidities that are associated with inflammatory diseases, such as cardiovascular disease, anxiety and depression, cancer, and obesity, which can complicate treatment.

Along with topical and systemic treatment options for psoriasis and PsA, when IBD is also present, the condition may be managed with a range of treatment options. Drugs such as anti-inflammatory medicine, antibiotics, corticosteroids, biologics, or immunomodulators may be used. In acute cases, surgery may be necessary to remove damaged areas in the colon or rectum or to create an internal ileal pouch.

Multidisciplinary Health Care

Psoriasis is associated with many comorbidities, such as IBD, and can affect multiple organs. People with psoriasis and PsA may find value from a multidisciplinary health care team if they also have CD or UC. 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 a dermatologist, gastroenterologist, and rheumatologist at the minimum. Some people with a constellation of these conditions may also benefit from mental health care, general practitioners (such as a nurse practitioner), or an ophthalmologist, if the eye is affected.

Maintain a Healthy Lifestyle

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. Some lifestyle changes you can make to improve your health and help reduce disease activity include:

  • Quitting smoking, which increases your susceptibility for heart disease and aggravates inflammatory conditions
  • Reducing alcohol intake, which can interfere with medication, increase the chances for flare-ups, and increase your risk for complications, such as liver disease
  • Eating a well-balanced diet that can help you maintain a healthy weight
  • Performing exercise and physical activity for strengthening, flexibility, and stress reduction

Talk to your doctors about help for quitting smoking and avoid a nicotine patch before getting medical advice, in case it may exacerbate your psoriasis. Your health care providers can also give you referrals for dietitians, physical therapists, and occupational therapists.

Talk With Others Who Understand

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

Are you living with psoriasis and have questions about Crohn’s disease or ulcerative colitis? Share your experience in the comments below, or start a conversation by posting on your Activities page.

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.
Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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