Psoriatic arthritis: What to expect
Around 30% of people with psoriasis will experience PsA.
PsA and psoriasis are aspects of psoriatic disease, which can result in changes throughout the body. In psoriasis, these changes affect the skin as the overgrowth of skin cells causes red, scaly patches to form on it. PsA involves pain, swelling, and deformation in the joints.
The symptoms of psoriatic disease come and go, worsening during flares and improving or disappearing during periods of remission. The symptoms can sometimes worsen over time.
In this article, we look at the outlook for people with PsA, its effect on their quality of life, and the solutions available.
Symptoms include pain and swelling in the joints.
How PsA progresses will depend on various factors, including the type of PsA, its stage at diagnosis, the treatment a person receives, and how they respond to it.
- In the early stages, there may be few or no symptoms. Tissue damage might be present, but bone damage may not show on an X-ray.
- When symptoms appear, they include inflammation of the joints, which causes pain, swelling, redness, and warmth in the surrounding tissues.
- In time, the spaces between the joints narrow, and bone erosion occurs. Osteoporosis may develop in some areas.
- Bone erosion can affect the joints on one or both sides of the body, and it can vary in severity from causing mild pain to resulting in changes that make it difficult to continue with daily activities.
- In time, erosions worsen, and bone spurs develop, as in other types of arthritis. The bones can become deformed.
Will symptoms worsen over time?
For some people with mild symptoms, these symptoms may not worsen over time.
Symptoms that follow a cycle of flares and remissions can sometimes get worse over time, but an effective treatment plan can usually prevent progressive damage from occurring.
If symptoms are severe, however, or the person does not receive effective treatment, symptoms can get progressively worse, and this can affect an individual's ability to carry out their daily tasks.
In the early stages, it can be difficult to predict the course of the disease.
Progression of psoriasis and PsA
Most people who develop PSA will already have had psoriasis for around 10 years, but this is not always the case.
In 2016, researchers noted that among people who have both PsA and psoriasis, 70% experience skin changes before the symptoms of PsA appear, while 15% develop skin changes after having symptoms of PsA for about 2 years. The other 15% develop both at the same time.
Early diagnosis and treatment can help a person manage their symptoms and reduce the risk of flares and future complications.
Learn more about what symptoms to expect with PsA.
PsA does not usually affect life expectancy, but it can increase the risk of other conditions that do, such as cardiovascular disease.
Regular screening can help reduce the risk of other conditions developing.
Comorbidities are conditions that can occur alongside another primary condition.
Comorbidities for PsA include conditions relating to metabolic syndrome:
Other conditions that may arise include:
Guidelines from 2018 recommend that people with PsA take the following actions to minimize the risk of disease progression:
- reaching or maintaining a healthy body weight
- participating in suitable physical activity
- quitting smoking or avoiding secondhand smoke where possible
They also recommend screening for heart disease, diabetes, and other conditions that may occur with PsA and pose additional challenges.
There is some evidence that people with psoriatic disease have a higher risk of certain types of cancer, but it is unclear whether it is the psoriasis or a combination of other factors, such as smoking, that increases the risk.
In 2015, researchers presented their findings regarding the effect of some biologic medications that doctors often prescribe for PsA and psoriasis.
They looked at:
The team did not find any evidence to suggest that these drugs significantly increase the risk of cancer.
Tips for reducing the risk
People with psoriasis, PsA, or both can reduce their risk of complications by:
- maintaining a healthy weight
- following a healthful diet that includes plenty of fresh fruit, vegetables, and fiber
- avoiding excessive alcohol consumption
- exercising regularly
- avoiding or quitting smoking
- using sunscreen and wearing protective clothing when in the sun
- seeking routine screening for cancer and other conditions
Prompt treatment of skin changes, high blood pressure, and other symptoms can help reduce the risk of further complications.
Quality of life
Two challenges for people with PsA are pain and mental well-being.
Water-based exercise can help people with PsA stay active.
PsA can cause pain, stiffness, and other symptoms. People who experience skin changes may find that these also lead to discomfort.
Severe symptoms can limit an individual's ability to perform everyday activities.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help with mild pain.
If these do not work, a person can try the following:
Talk to the doctor about pain: The doctor might be able to help the person find new options for pain relief.
Keep a pain journal: Doing this can help a person keep track of their daily pain levels, noting any activities that worsen pain and the measures that help relieve it. Sharing this journal with the doctor can help them put together a personal treatment plan.
Stay active: Physical activity can help alleviate stiff joints and prevent muscle weakness. Light exercise, such as yoga, swimming, and gentle stretching, may be suitable for people with painful or swollen joints. A doctor can recommend specific exercises for people with limited mobility.
Physical and occupational therapy: These therapies can help in various ways, which may include improving strength and flexibility and helping a person find new ways to do things when pain and stiffness make daily activities difficult to carry out.
The physical symptoms of psoriatic disease can have a negative effect on personal, social, and work relationships.
People with psoriatic disease may have a higher risk of various mental health conditions, including anxiety and depression. These conditions can, in turn, worsen symptoms.
Anyone who is experiencing depression, anxiety, or other mental health symptoms should speak to their doctor, as treatment may be available.
A doctor might suggest:
- cognitive behavioral therapy
- joining a local support group
Other tips that might help include:
- Doing regular exercise and following a healthful diet to improve the overall sense of well-being.
- Learning as much as possible about psoriatic disease and the treatment options, as this can make a person feel more in control of their condition.
- Joining a yoga, meditation, or tai chi group for mild exercise and relaxation.
What is the link between PsA and depression? Click here to find out more.
Various medications are available for people with PsA, depending on the severity of the symptoms and how they affect the individual.
When a person receives a diagnosis of PsA, a doctor may recommend using a type of drug called a tumor necrosis factor inhibitor. This biologic drug can slow the progression of the disease and reduce both the number of flares and the severity of symptoms.
These drugs can have adverse effects, however, and they may not be suitable for everyone.
Other options include:
Disease-modifying antirheumatic drugs (DMARDs): These drugs help slow the joint damage that PsA causes. Tofacitinib (Xeljanz), which is also an immunosuppressive drug, is one example.
Corticosteroids: These drugs can reduce pain and inflammation. They can have adverse effects and are not suitable for long-term use. A doctor can deliver this medication to one or more affected joints in the form of an injection.
A person should speak to their doctor about the best option for them.
Some people say that natural remedies help them manage their symptoms. Find out more.
Click here to get some tips for coping with PsA-related fatigue.
Living with a chronic inflammatory condition can be challenging. Psoriatic disease, including psoriasis and PsA, can have a profound effect on a person's physical and mental well-being.
Early diagnosis and treatment are key to staying mobile and continuing to enjoy a good quality of life.
As new treatment options become available, the outlook for people with PsA and other chronic conditions is improving.
I am 25, and I have just had a diagnosis of PsA. What is the chance I will lose my mobility?
With the current effective treatment options, it is very unlikely that PsA will significantly impair your mobility.
Doctors can now tailor treatment to match the type and severity of a person’s condition. By blocking inflammation, treatment can prevent the disease from progressing and leading to disability.Nancy Carteron, MD, FACR Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.