The Connection Between Skin and Joint Pain

• It’s unclear why some people with psoriasis develop psoriatic arthritis, but most people who have the arthritic condition had the skin disease for 10 to 20 years first.
• Inflammation causes psoriatic arthritis. Identifying and managing conditions that increase inflammation, such as stress and obesity, can reduce the inflammation.
• Psoriatic arthritis doesn’t yet have a cure, but it can be treated with a variety of medications. Early treatment is key to preventing permanent joint damage.

If you have the symptoms of psoriasis, including scaly, itchy, inflamed skin, you may also be at risk for developing psoriatic arthritis (PsA). As many as 30 percent of people who have psoriasis eventually develop psoriatic arthritis as well. More than 13,000 MyPsoriasisTeam members report mild to severe joint pain, with or without active skin symptoms at the same time.

Researchers don’t fully understand why some people with psoriasis develop psoriatic arthritis. It may be due to a combination of genetics and environmental causes, like physical trauma or stress, or other factors.

Although not everyone who has psoriasis develops psoriatic arthritis, most people who have the joint condition also have the skin disease or are related to someone with psoriasis. About 70 percent of those who develop psoriatic arthritis show the skin condition symptoms first. In about 15 percent of people, the two conditions are diagnosed together. The remaining 15 percent show arthritis symptoms first. Both conditions are caused by an overactive immune system attacking the cells of the body, leading to painful inflammation in the skin and joints.

Understanding Inflammation

When your body produces white blood cells to heal a cut or fight a virus, that’s inflammation. Your immune system is triggered by illness or injury and responds with inflammation to drive the healing. But if your body never shuts that process down, those white blood cells may attack nearby organs and tissues that are actually healthy. This type of chronic inflammation is related to a number of conditions, including various types of arthritis, heart disease, Crohn’s disease, cancer, diabetes, and others.

Symptoms of Inflammation

For people with psoriasis, inflammation leads the body to produce skin cells faster than it can slough them off. That presents as the scaly patches of skin called plaque psoriasis. Those patches often appear near the joints, especially knees and elbows. They can also appear on the hands, face, scalp, and other parts of the body. The more severe the skin inflammation and the younger a person was diagnosed with psoriasis, the greater the risk that person will develop psoriatic arthritis. One study showed that developing psoriatic arthritis is related to the amount of the body’s surface featuring skin inflammation.

In psoriatic arthritis, inflammation causes symptoms including:

• Swollen, hot, painful joints
• Reduced movement in stiff joints
• Swollen fingers and toes (dactylitis)
• Tenderness and swelling of tendons

Almost any joint in the body can be involved, and sometimes the entheses (places where ligament or tendon connects to bone) can be affected as well. Because the inflammation causes swelling in the joints, it can damage the cartilage at the end of the bones and the bones themselves.

Risk Factors for Inflammation

Risk factors for the inflammation that leads to psoriatic diseases aren’t fully understood. One study showed an almost 50 times greater chance of developing psoriatic arthritis if you have a close family member who has had it. Genetics appears to play a role, but it’s unclear if family history alone is a good predictor of whether or not someone will develop the condition.

Other risk factors for the development of psoriatic arthritis may include age, environment, smoking, and obesity.

• Age — For most people, psoriatic arthritis begins between ages 30 and 50. It usually begins 10 to 20 years after the first diagnosis of psoriasis.
• Environmental factors — Stress, chronic illness, and some infections may assist the development of psoriatic arthritis.
• Smoking — The heavier a person smokes, the greater their risk of developing psoriatic arthritis. Past smokers are more likely to develop it than those who have never smoked.
• Obesity — People who have psoriasis and obesity are more likely to develop psoriatic arthritis.

It’s important to note that stress, chronic illness, smoking, and obesity worsen inflammation in the body in a general sense. Obesity and smoking trigger the release of inflammatory chemicals on their own. When combined with another source of inflammation, they may worsen it.

Although science hasn’t yet discovered how all these risk factors work together in causing psoriatic arthritis, greater levels of inflammation in the body make it more likely. It’s important to reduce inflammation overall when possible.

Reducing stress, stopping smoking, eating a balanced diet, exercising, and maintaining a healthy weight can all reduce inflammation in your body. Practicing good oral hygiene and keeping cholesterol under control can also reduce overall inflammation and increase good health outcomes. If you’re concerned about chronic inflammation, your doctor can perform simple blood tests that will show the levels of certain chemicals that indicate inflammation and its severity.

Treating Inflammation in Psoriatic Disease

Because the joint damage that psoriatic arthritis causes can be irreversible, identifying and treating it quickly is important. Early treatment can help slow the progression of the disease and prevent permanent joint damage. Today, both dermatologists and rheumatologists are better at identifying psoriatic arthritis, or a person’s potential for it, so it can be treated at the earliest opportunity.

The inflammation of psoriatic arthritis can be treated with corticosteroids, methotrexate, and biologic drugs. Nonsteroidal anti-inflammatory drugs (NSAIDs), ice packs, cold compresses, and heating pads may also soothe the inflammation of affected joints on a temporary basis.

In a perfect world, a single therapy would help both skin inflammation and arthritic conditions. It’s far more likely that your health care providers will use a number of treatment options over time to relieve symptoms and manage psoriatic arthritis. It’s important, if you do have both a dermatologist and a rheumatologist, to make sure they are aware of each other’s prescriptions for you.

Patience is important. Psoriatic arthritis usually doesn’t progress rapidly, and most medications that help the symptoms take a few months to fully take effect. Your health care providers will work with you to find the best combination of therapies to treat your condition.

You Are Not Alone: Learning More About the Connection Between Skin and Joint Pain

By joining MyPsoriasisTeam, the social network for people living with psoriasis and psoriatic arthritis, you’ll join a support group of more than 86,000 people. Having both skin and joint pain is just one topic members discuss.

How do skin and joint pain affect your life? Have you found ways to manage the symptoms? Share your tips and experiences in a comment below or on MyPsoriasisTeam. You'll be surprised how many other members have similar stories.