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The Link Between Psoriasis and Arthritis

The Link Between Psoriasis and Arthritis

How the autoimmune response that causes psoriasis symptoms can also attack and damage the joints.

It’s estimated that up to 30 percent of people who have psoriasis also develop a type of arthritis called psoriatic arthritis (PsA). Like psoriasis, psoriatic arthritis is an autoimmune disease, caused by a misdirected immune response. With psoriasis, this can cause a number of different skin symptoms, the most common being the red, raised patches of scaled skin known as “plaque psoriasis.” With psoriatic arthritis, the misdirected immune response attacks the joints, causing inflammation, pain, tenderness and stiffness. Over time, this can cause the joints to become deformed and lose normal range of motion. However, early diagnosis and treatment can help prevent or delay this joint damage.

Overlap with psoriasis
The majority of patients with psoriatic arthritis experience psoriasis skin symptoms first. But a percentage of people with psoriatic arthritis have no skin symptoms or skin symptoms that went unnoticed. Other patients are diagnosed with both psoriasis and psoriatic arthritis at the same time.

There is also a correlation between psoriatic and nail psoriasis, and nail psoriasis is sometimes an early symptom of psoriatic arthritis. Nail psoriasis can affect the nails of the fingers and toes. Symptoms include nails that separate from the nail bed, become pitted (pits look like tiny dents), crumble, become discolored, are surrounded by dry skin, or have blood or buildup beneath the nail.

In addition to joints that are stiff, painful and tender, symptoms of psoriatic arthritis include swelling in the fingers and toes (called dactylitis), tendon pain in the feet and ankles, and fatigue.

Types of psoriatic arthritis
There are five main types of psoriatic arthritis. The two most common forms are symmetric and asymmetric arthritis. Symmetric arthritis mimics rheumatoid arthritis but is milder, affecting the same joint on different sides of the body (both knees or both ankles, for example). Asymmetric arthritis affects different joints on different sides of the body, and can affect a few joints or many.

Distal interphalangeal predominant arthritis involves the distal joints, the joints closest to the nails of the fingers and toes. Less common is spondylitis, which causes inflammation of the spinal column. Patients with spondylitis often feel stiffness in the neck and lower back.

Arthritis mutilans is the most a severe form of psoriatic arthritis. It causes bones and cartilage to be broken down and reabsorbed by the body, causing deformity and disability. It most often affects the hands and feet, and can cause the fingers and toes to become shorter. It only occurs in a small percentage of people who have psoriatic arthritis, but it also affects people who have rheumatoid arthritis.

Treatment
There is no cure for psoriatic arthritis, but there are ways to manage the condition, control symptoms and slow the progression of joint damage. Treatment will vary from patient to patient, depending on the severity of the disease, the symptoms and the type of psoriatic arthritis, but healthcare providers usually recommend a combination of lifestyle changes and medicines. Lifestyle changes can include losing weight, exercising more and working with a physical therapist. There are a variety of drugs that can be used to treat psoriatic arthritis, including nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (a type of steroid), disease-modifying antirheumatic drugs (DMARDs) and biologics.

Additionally, people with psoriatic arthritis should follow a healthy diet, reduce stress and avoid triggers that cause symptoms to flare.

Medically reviewed in February 2018.

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