Skin and Joint Pain With Psoriatic Arthritis

• Most people who have psoriatic arthritis (PsA) had psoriasis for five to 10 years first.
• Inflammation contributes to both psoriasis and psoriatic arthritis.
• Psoriatic arthritis doesn’t have a cure, but it can be treated with a variety of medications.

If you have the symptoms of psoriasis, including scaly, itchy, inflamed skin, you may also be at risk for developing psoriatic arthritis. 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 why some people with psoriasis develop psoriatic arthritis. 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 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 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.

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, leading to scaly patches of skin called plaque psoriasis. Those patches often appear near the joints, especially the knees and elbows. Plaques 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 when 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 affected by 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, inflammation 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 the condition. Genetics appear to play a role, but it’s unclear if family history alone is a good predictor of whether or not someone will develop PsA.

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 five to 10 years after the first diagnosis of psoriasis.
• Environmental factors — Stress, chronic illness, and some infections may contribute to the development of psoriatic arthritis.
• Smoking — The more heavily a person smokes, the greater their risk of developing psoriatic arthritis. People who have smoked in the past are more likely to develop PsA 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 compound.

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 PsA more likely.

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.

Treating Inflammation in Psoriatic Disease

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, 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. 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.

You Are Not Alone

By joining MyPsoriasisTeam, the social network for people living with psoriasis and psoriatic arthritis, you’ll join a support group of more than 103,000 people.

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.