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Psoriatic arthritis (PsA) is an autoimmune disease. With PsA, your immune system turns on you by mistake, causing inflammation in your skin and joints. But it also affects other parts of your body. Several conditions are related to PsA, and the common link is inflammation.
This skin condition is closely linked to psoriatic arthritis.
That’s the percentage of people with psoriasis who also have PsA.
The link: PsA and psoriasis are both types of psoriatic disease, where inflammation damages your body from the inside out. People with both psoriatic diseases often have certain genes, including HLA-B27 and HLA-C06.
Psoriasis can start developing before you’re an adult, but it might not appear until you’re older. You may have psoriasis for years and get joint pain and swelling of psoriatic arthritis afterward. But it’s also possible to have PsA first and then psoriasis.
Different kinds of psoriasis show different symptoms. These are some common types:
Common Types of Psoriasis
The most common form, it causes patches of thick red, scaly, sometimes itchy rashes. You can get it on your scalp, back of the elbows, knees, or lower back.
This type appears on your scalp or neck. The skin appears hardened, or thickened with red areas of flaky skin.
This type is more common in children and young adults. It tends to appear suddenly and causes small red dots, usually around the middle of your body.
This type affects folds of your skin like the armpits, groin, or under your breasts. The patches appear shiny and bright red. They don’t typically have silver scales. It may appear to be a fungal infection.
When you have an active psoriasis rash, it’s called a flare. You may have several plaques over your body, or just one or two in certain areas. Your psoriasis can be mild, moderate, or severe, depending on how much of your body is affected, your physical symptoms, and how it impacts your life.
Psoriasis treatment: Once you get psoriasis, you’ll always have it. It doesn’t go away, but treatment can help manage it.
For mild to moderate psoriasis, you may use topical steroids, coal tar, retinoid, vitamin D, or anthralin creams.
For more moderate to severe or widespread psoriasis, you may need light therapy called PUVA, oral drugs like methotrexate or cyclosporine, or biologics to calm your overactive immune system.
Heart disease is one of the most serious conditions related to PsA.
That’s how much higher your heart disease risk is if you have PsA.
Active inflammation can make your body resistant to insulin, a hormone that helps control your blood sugar. Chronic inflammation can result in atherosclerosis, or hardened, narrowed arteries, and that may lead to heart attacks or strokes. Controlling your PsA activity with medications helps lower your risk of a heart attack or stroke.
Heart disease symptoms: Early signs include pain or tightness in your chest (also called angina), shortness of breath, or pain or numbness in your legs or arms.
Your doctor should pay special attention to the health of your heart and blood vessels if you have PsA. Expect regular screenings to check your blood pressure and cholesterol. They may also measure the thickness of your carotid arteries in your neck, a possible warning sign of heart disease in people with PsA.
Heart disease treatment: Your medical treatment for heart disease will depend on what you have. Medications can help lower blood pressure and cholesterol. So can lifestyle changes.
Metabolic Syndrome, Obesity, and Diabetes
When you have PsA, you’re at a higher risk of these three related conditions.
of people with PSA are likely to also have metabolic syndrome
The link: Metabolic syndrome is a combination of health conditions that, together, increase your risk of heart disease and diabetes. Those conditions are high blood pressure, high triglycerides or low HDL, a wide
waistline, and high blood sugar.
Obesity often comes with metabolic syndrome, and it makes you more likely to have PsA. Excess fat tissue makes inflammation-causing proteins called cytokines. Inflammation increases your risk of getting metabolic syndrome.
PsA and metabolic syndrome may be linked to the same genes too.
Medications to treat PsA may put you at risk for metabolic syndrome, including:
Steroids raise blood sugar, lead to high cholesterol, and cause weight gain.
Nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain can raise your blood pressure and heart disease risk.
Retinoids to treat psoriasis can affect your cholesterol levels.
Being obese can make PsA treatments less effective. You’re less likely to get relief from biologics called TNF blockers. Extra body fat boosts inflammation and makes it harder for these drugs to work.
PsA also makes it more likely for you to get type 2 diabetes. People with diabetes have high levels of inflammatory proteins in their blood. Metabolic syndrome can make you resistant to insulin, which can lead to diabetes.
Also, chronic inflammation from PsA makes your body more resistant to insulin. This hormone takes glucose from your blood and uses it to nourish your muscles and organs. Your pancreas will try to rev up insulin production, but if it
can’t make enough, you’ll end up with diabetes.
Your doctor can give you blood tests to find out if you have diabetes. You can take medications to boost your insulin production, improve how your body uses insulin, and decrease how much sugar your body makes and absorbs.
Lifestyle Changes: Lower Your Risks
If you have PsA, taking control of your lifestyle can help lower your risk of heart disease, obesity, metabolic syndrome, and diabetes.
Inflammatory Bowel Disease (IBD)
Inflammatory bowel disease (IBD) includes two conditions: Crohn’s disease and ulcerative colitis. In IBD, chronic inflammation attacks and damages your intestinal tract and bowels.
The link: Both IBD and PsA involve chronic inflammation, but both diseases may be linked to the same genes, too.
Medications for your PsA could also trigger IBD. Some biologics could cause some people with PsA to have IBD symptoms. Brodalumab (Siliq), ixekizumab (Taltz), and secukinumab (Cosentyx) are used to treat PsA, but some think they may cause some people to develop IBD, especially Crohn’s. Not all experts agree.
Another factor may be your microbiota -- the mix of bacteria that naturally live in your gut. The wrong balance of bacteria in your gut can trigger inflammation, IBD, and, possibly, psoriatic disease.
You may have IBD first, then develop joint pain. Or you may have PsA and just have low levels of bowel inflammation.
IBD symptoms: Watch for symptoms including belly pain or cramps, diarrhea, and blood in your poop.
IBD treatment: Many medications treat IBD:
Anti-inflammatory drugs like aminosalicylates or steroids for short-term flare-ups
Disease-modifying drugs to calm down your overactive immune system and lower inflammation: methotrexate, azathioprine, cyclosporine, and 6-mercaptopurine
Biologics to target specific proteins linked to IBD inflammation
Diet changes and probiotics
PsA raises your risk of kidney disease and kidney damage.
of people with PsA may be diagnosed with some type of kidney disease.
The link: Chronic inflammation can damage your kidneys. You may also have high uric acid in your blood if you have PsA. This can damage tubes in your kidneys. Your risk of PsA-related kidney disease may increase with age.
Kidney disease symptoms: Kidney disease symptoms may come on slowly and get worse over time. Signs to look for include changes in how much or often you pee, swollen feet or ankles, and high blood pressure.
If you’ve been diagnosed with PsA, the doctor may want to screen you for kidney damage. Blood tests to check for high creatinine, urea, or uric acid, or a urine test can show early signs of trouble.
Kidney disease treatment: Medications can treat kidney disease symptoms to make you more comfortable. Your doctor may suggest a low-protein diet to ease the strain on your damaged kidneys. In later stages of kidney disease, you may need regular dialysis treatments or a kidney transplant.
Non-Alcoholic Fatty Liver Disease
Non-alcoholic fatty liver disease (NAFLD) is liver damage not caused by drinking alcohol. NAFLD can lead to cirrhosis or liver cancer. In NAFLD, you store too much fat in your liver.
Chronic inflammation can damage your liver, causing you to develop NAFLD. If you also have metabolic syndrome conditions like high cholesterol, high triglycerides, and obesity, and your psoriatic disease activity is high, you’re at a much higher risk for NAFLD. Medications to treat PsA may cause liver damage too.
NAFLD symptoms: You may not have any symptoms. Or you might feel fatigued or notice pain or discomfort in your upper right abdomen where your liver is located.
The doctor can test your liver enzymes to see if they’re too high.
NAFLD treatment: A biologic medication that’s been shown to lower liver enzymes and inflammation in people with psoriasis may also help people with PsA.
Lifestyle changes, including losing extra weight and limiting how much alcohol you drink, can also help you treat or prevent NAFLD.
Autoimmune Ophthalmic Disease
If you have PsA, you’re at a much higher risk for autoimmune ophthalmic diseases, or eye inflammation. These include uveitis, keratitis, conjunctivitis, and blepharitis. Uveitis is the most common.
The link: Your immune system attacking your healthy tissues can cause eye pain, redness, and vision problems.
Usually, you develop autoimmune ophthalmic disease before PsA. Your eye inflammation can stick around and get worse even if you treat PsA and get it under control. Eye diseases like uveitis often keep coming back in people with PsA, too.
Eye inflammation symptoms: Autoimmune ophthalmic disease may cause dry or red eyes, the feeling of a foreign object in your eye, itchy eyes, pain, sensitivity to light, changes in vision, or loss of vision.
Eye inflammation treatment: Managing your overall inflammation may treat eye flare-ups too. NSAIDs and steroids can control inflammation flares, but they can cause severe side effects. Biologic TNF blockers such as adalimumab, golimumab, and infliximab may be more effective.
Eye inflammation prevention: Prevent vision loss with regular eye exams from an eye doctor. If you need a more specialized diagnosis or treatment, they may refer you to an ophthalmologist, an eye specialist.
Depression is common in people with PsA.
of people with PsA may also have chronic depression.
The link: High inflammation is seen in both PsA and depression. If your disease activity is high, and you have more inflamed joints, pain, and fatigue, you’re more likely to develop depression. Also, life with a chronic condition, like PsA, can take an emotional toll.
If you already have depression and psoriasis, both linked to all-over inflammation, you may be at a high risk to get PsA later on.
Depression symptoms: With chronic depression, you may often feel sad or hopeless, angry and frustrated, and have a loss in interest in activities you used to enjoy.
Depression treatment: Disease-modifying antirheumatic drugs (DMARDs) lower your PsA inflammation and seem to improve sleep and mood, possibly because they ease pain. Antidepressants may also improve your symptoms.
Finding support: Check out support groups to connect with other people who have depression or PsA. Share experiences, feelings, and coping tips. Staying connected to family and friends may improve your mood and quality of life, too.
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