If you have the symptoms of the skin condition psoriasis, including scaly, itchy, inflamed skin, you may also be at risk for developing psoriatic arthritis. PsA is a form of arthritis related to psoriasis that affects the joints, along with the connections between the tendons and ligaments. As many as 30 percent of people who have psoriasis eventually develop PsA 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 what causes psoriatic arthritis in people living with psoriasis. It may be due to a combination of genetics, environmental causes — such as physical trauma or stress — and/or other factors.
Although not everyone who has psoriasis develops PsA, 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 skin 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.
Inflammation is a process by which the body’s immune system may cause swelling, discoloration, heat, or pain, in reaction to injury or infection.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, your 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 inflammatory arthritis, heart disease, Crohn’s disease, cancer, diabetes, and others.
For people with psoriasis, inflammation causes the body to produce skin cells faster than it can slough them off, leading to scaly patches of skin called plaque psoriasis. These skin lesions often appear near the joints, especially the knees and elbows. Plaques can also show up on the hands, face, scalp, and other parts of the body.
Researchers have established some connections between psoriasis and arthritis. For example, they’ve found that people who are younger and who have more severe skin inflammation when diagnosed with psoriasis have a greater risk of developing psoriatic arthritis. One 2010 study showed that developing PsA is related to how much of the body’s surface is affected by skin inflammation.
In PsA, inflammation causes symptoms including:
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, inflammation can damage the cartilage at the ends of the bones and the bones themselves.
Risk factors for the inflammation that leads to psoriatic diseases aren’t fully understood. According to the American College of Rheumatology, around 40 percent of people living with PsA have a family member with psoriasis or arthritis. Genetics appear to play a role, but it’s unclear if family history alone is a good predictor of whether someone will develop PsA.
Other risk factors for the development of psoriatic arthritis may include age, environment, smoking, and obesity.
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 compound.
Although researchers haven’t yet discovered how all these risk factors work together in causing psoriatic arthritis, greater levels of inflammation in the body increase a person’s likelihood of developing the condition.
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 may 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 chemicals that indicate inflammation and its severity.
The joint damage that psoriatic arthritis causes can be irreversible, so identifying and treating PsA 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 so it can be treated at the earliest opportunity.
The inflammation of psoriatic arthritis can be treated with corticosteroids and disease-modifying antirheumatic drugs (DMARDs) like methotrexate, biologic drugs, or Janus kinase (JAK) inhibitors. Nonsteroidal anti-inflammatory drugs (NSAIDs), ice packs, cold compresses, and heating pads may also soothe psoriatic arthritis pain 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. If you have both a dermatologist and a rheumatologist, make sure they’re aware of each other’s prescriptions for you.
Patience is important. Some medications that help relieve the symptoms of PsA take a few months to take full effect. Your health care providers will work with you to find the best combination of therapies to treat your condition.
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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.