When psoriasis turns into psoriatic arthritis: what you need to know
So you live with psoriasis, you stick to your management program, and then your joints start hurting. You wonder: is this the beginning of the psoriatic arthritis that I was warned about?
If you experience joint pain or new symptoms, rheumatologists can help you see what’s going on. Although they cannot stop or prevent the development of psoriatic arthritis, they can help you access early treatment and improve your overall outlook.
The exact link between psoriasis (PsO) and psoriatic arthritis (PsA) is still being researched.
“At this point, we have no tools to predict who will develop psoriatic arthritis. [of those] who have psoriasis,” says Dr Stan Cohenboard-certified rheumatologist, clinical professor in the department of internal medicine at UT Southwestern Medical Center, and co-director of the division of rheumatology at Dallas Presbyterian Hospital.
“Studies are ongoing to try to determine if there are genetic or underlying differences in the immune system in patients with psoriasis or psoriatic arthritis and could potentially identify differences.”
Let’s take a closer look at how these conditions are linked and discuss risk factors, early signs, and prevention.
To be clear, this represents approximately 2-3% of the total world population living with psoriasis.
There are different types of psoriasis. The most common type, known as plaque psoriasis, affects almost 80 percent people with psoriasis. This type is associated with itchy red patches with white and silver scales on lighter skin, and purple or dark brown patches with gray scales on darker skin.
If you’re one of the approximately 8 million people with psoriasis, you have about a 1 in 3 chance of developing PsA. It is inflammatory arthritis and psoriasis on the skin.
Strictly speaking, anywhere from 18 to 42 percent people with PsO go on to develop PsA.
Why such a wide range? Well, the exact number depends on the study you are looking at. the Arthritis Foundation, which provided this general range, got its data from a 2013 study that looked at cases around the world. In this study, the global average was 30%, while the US average was 36%.
Approximately 30 percent seems to be the number most experts use.
So let’s talk about your chances of developing psoriatic arthritis. You already know one. Living with psoriasis increases your risk of developing psoriatic arthritis.
A study 2021 found that people with severe psoriasis were more likely to develop PSA than those with less severe psoriasis.
But like other risk factors, living with psoriasis doesn’t mean you’ll actually develop PsA. And to reverse it, you can develop PsA with or without psoriasis.
Researchers begin to learn more about the characteristics of psoriasis that can help predict your individual risk more accurately. This knowledge can help doctors provide better recommendations and treatments to help prevent or start early treatment for PSA.
Some additional factors to consider include:
- Family history. About 40% of people who have a close family member with at least one of these conditions develop PsA.
- Genoa. Some mutations, such as HLA-B gene, may increase your risk of developing PsA.
- Smoking. Smoking or having smoked in the past increases the risk of developing PsA.
- Alcohol. Alcohol consumption has been associated with a higher risk of PsA.
- Environmental factors. Experts believe that certain infections, living with HIV, stress, or stressful life events can increase your chances of developing PsA.
- Age. Although you can develop PA at any age, most people develop it between their 30s and 50s.
- Body size. Up to 50% of people who develop PSA are obese.
The key is to understand which factors you can influence and which are out of your control. To reduce your risk, a study 2019 found that weight loss can reduce risk for obese people.
You don’t have to worry about every pain. The pain can be due to things like overuse or wear and tear.
If you develop PsA, your symptoms can start mild and slowly increasing, or they may develop rapidly.
Here are some common symptoms of PsA to be aware of:
- stiffness and fatigue in the morning
- swelling, pain and tenderness in the tendons
- Swollen “sausage-like” fingers or toes
- changes in your nails, such as pitting
- pain and redness in one or both eyes
- reduced range of motion in one or more joints
“It’s best to catch PsA early before it can damage the joints,” says Dr. Erin Bauer, board-certified rheumatologist at Virginia Mason Medical Center. This means keeping regular dermatology appointments and alerting your dermatologist to any joint pain or swelling.
Researchers have yet to find a way to prevent PA. There is no treatment for your psoriasis that will block or prevent the development of PSA.
In a study 2019, the researchers noted that more research is needed to understand how psoriasis turns into PsA. Once they better understand the link, they may be able to recommend strategies to help prevent PA.
Your doctor will likely suggest that you take steps to help control your psoriasis symptoms. Although it may not prevent PA, it can help you find relief from psoriasis and potentially help reduce the impact of PA.
“The combination of a healthier lifestyle, good management of skin diseases, vigilance and rapid response to inflammatory joint symptoms is currently the best we can offer in terms of a treatment strategy. ‘risk mitigation’, says Dr. Howard Blumsteinboard-certified rheumatologist and Clinical Assistant Professor of Medicine at Stony Brook University Hospital.
It may take approx. 10 years from your initial diagnosis of psoriasis to developing PSA, which means you should speak with your doctor or treatment team about any concerns you may have about your joints.
Your doctor will likely check for signs and symptoms of PA during exams. Be sure to report any new symptoms with them so they can help you better.
Common treatments for psoriasis and psoriatic arthritis include:
- topical preparations
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- non-biologic disease-modifying anti-rheumatic drugs (DMARDs)
- biological ARMM
- lifestyle interventions
PSA is sometimes treated with immunosuppressants to reduce inflammation.
Living with psoriasis increases your risk of developing PsA, as do other lifestyle, genetic, and environmental factors. Doctors don’t know exactly how the disease progresses, so they can’t predict whether you’ll get it or help prevent it. They can help monitor it and provide treatment if PA develops.