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Risk Factors for Psoriatic Arthritis in Those With Psoriasis

Posted on April 20, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Anastasia Climan

About 30 percent of people with psoriasis also suffer from a more severe progression of the disease called psoriatic arthritis (PsA). For most people, PsA occurs between the ages of 30 and 50, about 10 years after the first signs of skin psoriasis appear. However, PsA can happen at any time. It can sometimes affect children or even appear before skin symptoms are noticeable.

Fortunately, there are some ways to help stave off PsA, including using certain types of psoriasis treatments and maintaining a healthy lifestyle. Here are some science-backed tips to reduce your risk.

What Is Psoriatic Arthritis?

PsA occurs when chronic inflammation affects the joints and surrounding connective tissues. It can have an impact on any part of the body, including the spine, knees, and finger joints. The primary symptoms of PsA are similar to those of rheumatoid arthritis and osteoarthritis — joint pain, stiffness, and swelling. One-third of people with PsA will also develop enthesitis, which is inflammation where your bones connect to your tendons and ligaments. When untreated, severe PsA can lead to disability.

Just like with skin psoriasis, people with PsA experience flare-ups where their symptoms are worse, alternating with periods of remission or low disease activity. Unfortunately, there’s currently no cure for PsA. Treatment aims to control the symptoms and reduce the progression of joint damage. PsA can negatively impact your quality of life and make it difficult to work, exercise, or participate in activities you once enjoyed.

MyPsoriasisTeam members often discuss life with PsA. “I had psoriasis for years but didn’t know what psoriatic arthritis was until I was diagnosed with it after arthritic changes in my knee and a sausage finger,” one member wrote. Another said, “I am suffering from arthritis as well. It really limits my activity and changes my mood. I feel tired most of the time.”

Doctors can’t always predict who will end up with PsA. But there are some preventive measures that can help lower your risk of developing the condition.

Who Is Most Likely To Develop Psoriatic Arthritis?

If you have psoriasis that covers a large proportion of your skin, you may be more likely to develop PsA than someone with small patches of psoriasis. Specifically, having 10 percent or more of your body surface area affected by severe psoriasis is associated with a higher incidence of PsA.

Other health conditions, like obesity and depression, are also thought to be risk factors. Males with psoriasis have a higher risk of PsA than females, as do people with psoriasis that affects their nails.

More research is needed, but some studies have suggested that people who are diagnosed with psoriasis at an earlier age (those who have a longer history of psoriasis) and those with skin lesions on the scalp, perianal, or intergluteal areas are more likely to develop PsA.

It’s likely that family history, specific genetic variants, and environmental factors also affect the development of PsA. However, there’s no one definitive genetic link. Multiple genes are suspected to affect joint involvement in psoriasis. Rather than focusing on the characteristics you can’t change, it’s best to put your energy into PsA risk factors that you can control.

What Can You Do To Lower Your Risk?

Keeping skin psoriasis under control by using certain medications can help protect against PsA. For example, one study showed that people who take biologics have a lower chance of developing PsA compared to those using topical treatments. Your health care provider can help determine your risk of PsA and work with you to find your best treatment options.

Smoking, excessive alcohol consumption, and obesity are believed to contribute to higher systemic inflammation levels, which are associated with an increased risk of PsA. These factors can also raise the rate of common comorbidities (co-occurring health issues) for psoriasis, such as cardiovascular disease.

Carrying extra body weight puts added strain on weight-bearing joints, like the knees. This can result in joint damage that progresses faster for people with inflammatory arthritis. Working with your health care team to address these risk factors can help you live better, reduce your psoriasis severity, and mitigate additional health concerns.

If you have psoriasis and begin to notice any potential signs of PsA, such as back pain, foot problems, or stiffness or swelling in your fingers, talk to your dermatologist right away. You may benefit from meeting with a rheumatologist to further assess your condition. Early treatment of PsA is associated with better outcomes. It’s best to get help right away and stay ahead of joint inflammation and damage.

Talk With Others Who Understand

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

If you were diagnosed with PsA, what was your experience like? Share your insights in the comments below, or start a conversation by posting on MyPsoriasisTeam.

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.
Anastasia Climan is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here.

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