8 Surprising Ways Psoriatic Arthritis Can Affect Your Health

Psoriatic arthritis is an autoimmune disorder which causes joint pain and stiffness. But the disease can involve many parts of the body, and its symptoms vary widely.

The skin inflammation of psoriasis can affect many people with PsA, as can “fingernail and toenail changes, inflammation of the locations where tendons and ligaments attach to bone (called enthesitis), and swelling of the soft tissues and other structures of a finger or toe (dactylitis),” explains Norman Madsen, MD, a rheumatologist at the University of Rochester in New York. Some patients may also develop eye inflammation (uveitis) and there is association with inflammatory bowel disease (Crohn’s disease or ulcerative colitis), Dr. Madsen adds.

Here are eight surprising ways psoriatic arthritis can affect your body:

According to a meta-analysis in the journal Arthritis Care and Research, people with psoriatic arthritis were 43 percent more likely to have or develop heart disease compared with the general population. They also had a 31 percent higher risk of heart failure.

Having psoriatic arthritis ups your risk of uveitis — a condition that causes inflammation of the uvea, or the middle layer of the eye, located under the white of the eye.

According to the National Psoriasis Foundation (NPF), about 7 percent of people with psoriatic arthritis will develop uveitis. If it’s not treated, uveitis can lead to vision loss.

The reasons for this higher risk are uncertain, but it’s likely the inflammation that causes joints to flare also can affect some of the tissues in the eye.

Genetics may also be involved. Research has shown that psoriatic arthritis patients with the gene for the human leukocyte antigen (HLA) B27 have a higher risk for uveitis.

Other eye problems, such as glaucoma and cataracts, are also more common in people with psoriatic arthritis, especially if they have taken steroid medications for any length of time. Additionally, people with psoriatic disease may be more likely to develop conjunctivitis, commonly known as pink eye.

Studies have shown that people with psoriatic disease are at an increased risk for anxiety and depression .

One survey found that more than 36 percent of people with psoriatic arthritis had anxiety and about 22 percent had depression.

These numbers were much higher than what people with only psoriasis reported.

Other research has found depression to be prevalent among PsA patients and closely correlated with disease activity, suggesting that achieving low disease activity and maintaining physical function may ease the psychological burden.

Madsen says that depression is common in people with PsA and a large part of that has to do with the very visible nature of psoriatic disease. It can take a toll on your emotional health.

There is also growing evidence that the inflammation that causes psoriatic disease can affect the brain. A review of research notes that “there is a striking similarity between the inflammatory pattern in psoriatic disease and neuroinflammation that leads to depression.”

“As our understanding of depression and other mental health disorders improves, it is not unexpected that the resident immune cells in the brain may be implicated in some way,” says Madsen.

Signaling proteins called cytokines are associated with psoriatic arthritis and also commonly found in people with depression. Cytokines are used by cells to communicate with and between immune cells, Madsen explains. Cytokines tend to be specific to the type of inflammatory state (such as allergic disease, psoriatic disease, rheumatoid arthritis, or lupus), but many cytokines are shared between these conditions in either promoting or reducing the inflammation.

Research suggests that the risk of developing type 2 diabetes increases with elevated levels of psoriatic arthritis activity and that the prevalence of diabetes is higher in people with PsA compared with the general population.

A review published in Rheumatology and Therapy found that people with psoriatic arthritis have a higher prevalence of type 2 diabetes compared with the general population. Study authors suggest that elevated levels of adipokines, including TNF-a (proteins which cause inflammation), are linked to insulin resistance and could partly explain the association between PsA and diabetes. The authors also suggest that certain treatments for psoriatic arthritis may affect how the body maintains blood sugar.

There is a higher prevalence of fatty liver disease in people with psoriatic arthritis, notes Madsen.

Some research has found that up to 47 percent of psoriatic patients develop metabolic dysfunction-associated steatotic liver disease (MASLD) — a condition that causes fatty deposits to develop on the liver and can lead to permanent scarring or damage.

Other research puts that figure as high as 65 percent and notes that compared with patients with PsA alone, patients with MASLD tend to have more severe clinical symptoms, and MASLD is significantly correlated with psoriasis lesions and severity.

Some researchers believe the inflammation triggered by psoriatic arthritis underlies the development of MASLD, notes Creaky Joints.

Additionally, people with psoriatic arthritis are more likely to have obesity, diabetes, and metabolic syndrome, which are all MASLD risk factors.

Drugs used to treat psoriatic arthritis, including NSAIDs and methotrexate, can adversely affect your liver. If you’re taking these drugs, your doctor will want to monitor your liver function.

Madsen notes that methotrexate is becoming less commonly used in psoriatic disease since the development of biologic therapies, though it still has a role. It can cause elevations of liver enzymes and, in severe cases, cirrhosis due to chronic liver inflammation. “This is why it is so important that we monitor blood tests in patients on methotrexate and other higher risk medications, to ensure safe use and prevent severe side effects,” says Madsen.

Biologics tend to be safer for the liver, he notes, but there are occasional case reports of liver irritation. “TNF inhibitor biologics can increase the risk of hepatitis B reactivation in people who have previously been infected with it and this can also lead to liver damage and inflammation, without treatment.” All patients should be screened for hepatitis B prior to starting a biologic, especially if they have risk factors, he adds.

Psoriatic arthritis can affect any joint, including the temporomandibular joint (TMJ) that connects the jawbone to the skull. The TMJ is linked to the masseter — the strongest muscle in your body based on its weight. Because it works so hard, the TMJ is at risk for damage.

About 35 percent of people with psoriatic arthritis will have symptoms in their TMJ, according to the National Psoriasis Foundation.

Rheumatologists are encouraged to perform a “66/68 joint count,” which essentially measures swelling in 66 joints and tenderness and pain in 68 joints, including the TMJ. Still, doctors may miss signs of TMJ damage.

Treatment options, such as biologics and disease-modifying anti-rheumatic drugs (DMARDs), can help prevent or slow TMJ damage. Additionally, you should try to avoid chewing hard foods to reduce pressure on your jaw.

The inflammation that underlies psoriatic arthritis may also harm your lungs, notes the Arthritis Foundation, resulting in interstitial lung disease (ILD) — which causes shortness of breath and fatigue. ILD is more frequently seen in people with rheumatoid arthritis, but it can also affect those with PsA.

Pulmonary issues have also been linked to psoriasis. In a review of studies, researchers concluded that people with psoriasis are at an increased risk for COPD.

And in a meta-analysis which looked at the association between psoriasis and asthma in 66,772 people with psoriasis and 577,415 control patients, the risk of asthma was found to be greater in individuals with psoriasis, especially among older patients.

If you have psoriatic arthritis, you might want to avoid smoking, lung irritants, and dust, which could raise your chances of developing COPD.

Did you know there’s a link between psoriatic arthritis and gut health?

Research shows that people with psoriatic arthritis are at risk for having the following conditions:

Crohn’s disease, a chronic inflammatory bowel disease that affects the lining of the digestive tract
Ulcerative colitis, a chronic inflammatory bowel disease that causes inflammation in the digestive tract
Reflux esophagitis, a condition where inflammation damages the esophagus
Peptic ulcer disease, a condition that causes painful sores or ulcers in the lining of the stomach or small intestine

A study, published in JAMA Dermatology, revealed people with psoriasis were around 2 times more likely to develop Crohn’s and ulcerative colitis compared with the general population.

Another study found that more severe psoriasis was significantly associated with a higher likelihood of IBD.

Scientists believe that the same gene mutations that are associated with psoriasis may also be related to the gut disorders.

Psoriatic arthritis is an autoimmune disorder that causes stiff and painful joints. It is linked to the chronic skin condition psoriasis, but there are other surprising ways it can affect your health. These include an increased risk of heart disease, uveitis, anxiety, and depression. Studies have also linked psoriatic arthritis with a greater risk of developing type 2 diabetes and fatty liver disease. Psoriatic arthritis may also affect the lungs and digestive systems, leading to interstitial lung disease and several digestive disorders including Crohn’s disease and ulcerative colitis.

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