Psoriatic arthritis (PsA) is a type of arthritis that is more likely to affect individuals with psoriasis. People with PsA have joint pain and chronic inflammation. The condition can also cause complications that range from mild to potentially life threatening.

While most people who develop PsA already have psoriasis, it is possible to develop it without having psoriasis first.

The estimated prevalence of PsA among people with psoriasis varies from 6 to 41%, depending on the definition that health experts use.

This article briefly discusses PsA and details possible complications of the condition.

Happy, thoughtful senior woman reading book on park bench, looking up thinking about  psoriatic arthritis complications Share on Pinterest
Hero Images Inc/Getty Images

Psoriasis is an autoimmune condition that affects the skin. PsA primarily affects joints, tendons, and ligaments. The immune system overreacts, causing inflammation and pain.

While there is no cure for PsA, it is possible to manage its symptoms with treatment. In addition to the impact on joints, the symptoms of PsA can include:

If an individual does not receive proper treatment, PsA can lead to complications.

A 2018 study suggests that PsA increases a person’s risk of type 2 diabetes. The researchers compared people with PsA with those with psoriasis and with the general population.

The risk of type 2 diabetes in those with PsA was about 40% higher than in the general population and more than 50% higher compared with individuals with psoriasis.

Although the connection between type 2 diabetes and PsA is not entirely clear, there is a link between both conditions and increased levels of chronic inflammation.

People who have received a PsA diagnosis should also undergo screening for type 2 diabetes, especially if they experience symptoms such as:

Monitoring blood sugar levels regularly, taking medications as prescribed, and making changes to one’s diet and lifestyle can help prevent complications resulting from type 2 diabetes.

According to estimates, around 7% of people with PsA develop uveitis, which is inflammation of the uvea — the middle layer of the eye between the retina and the sclera.

Uveitis causes redness, pain, and blurred vision and could even threaten a person’s sight. PsA may also affect the skin around the eyes.

Steroids can help reduce inflammation and protect the eyes, but they also have side effects. It is important to discuss the risks and benefits of steroid treatment with a doctor.

Some individuals also develop eye infections, such as conjunctivitis, which people often call pink eye. These infections usually resolve on their own, but in some cases, they may require topical corticosteroids or antibiotics.

Psoriasis causes chronic inflammation. Over time, this inflammation can damage blood vessels, increasing the risk of heart disease, stroke, and heart attack.

People with PsA have a still higher risk of heart disease than those with psoriasis alone, according to the authors of a 2018 review.

A healthy lifestyle may help reduce the risk of heart conditions. A heart-healthy lifestyle includes:

If a person has high cholesterol, high blood pressure, or type 2 diabetes, taking medications as prescribed can also help reduce the risk of heart disease.

Severe joint pain is a common symptom of PsA. For some people, joint pain can affect mobility and the ability to carry out daily tasks, such as typing, tending to children, or cooking. It can also affect a person’s mental health.

Some individuals with chronic pain develop depression or anxiety. Pain-induced depression may be more resistant to treatment than typical depression, according to a 2017 analysis.

Another 2017 study, which involved 186,552 people with PsA, estimates that the prevalence of depression was 21.2%.

A person should contact a doctor if they experience:

  • feelings of hopelessness
  • loss of interest in pleasurable hobbies or activities
  • difficulty concentrating
  • irritability
  • fatigue

Treatment for depression may involve medications, psychotherapy, or a combination of both.

Chronic inflammation can harm the lungs, which can lead to a condition called interstitial lung disease (ILD).

ILD refers to a group of lung conditions that cause scarring of the lungs. Over time, this scarring leads to stiffness in these organs, which can make it more difficult to breathe.

Interstitial pneumonia is a potentially life threatening complication of ILD. A 2018 analysis found that 2% of 392 people with psoriasis had interstitial pneumonia. However, only one-fifth of the participants also had PsA.

Lung damage resulting from ILD is irreversible and often worsens over time. It may cause symptoms such as:

Treatment for ILD focuses on relieving symptoms and slowing the progression of the condition.

Although treatment options may vary depending on the specific condition and severity, doctors often recommend the following:

Chronic inflammation can have a negative impact on digestion, causing health issues, such as diarrhea and constipation.

People with PsA are also more vulnerable to IBD, a condition that involves inflammation in the digestive tract.

A 2021 study found an association between both psoriasis and PsA and a higher risk of Crohn’s disease and ulcerative colitis.

Symptoms of these conditions include the following:

  • diarrhea
  • stomach pain
  • rectal bleeding
  • low energy levels
  • unintentional weight loss

Doctors treat IBD with medications that reduce inflammation and regulate a person’s immune response. These medications include:

  • corticosteroids
  • aminosalicylates
  • immunomodulators
  • biologics

PsA increases the risk of kidney disease and non-alcohol-related fatty liver disease.

The risk of liver disease may be higher in individuals with other liver disease risk factors, such as obesity and metabolic syndrome.

Non-alcohol-related fatty liver disease typically does not cause any symptoms. However, if a person does experience symptoms, they may feel discomfort in the upper right side of the stomach, or they might feel more tired than usual.

Chronic kidney disease also causes symptoms as it progresses, including:

Drinking alcohol can cause damage to the liver, and therefore, a doctor may recommend reducing alcohol intake, if a person consumes alcohol.

Reaching or maintaining a moderate body weight and managing blood sugar, cholesterol, and blood pressure levels may also help prevent both liver and kidney disease.

Spondylitis is a condition that affects the joints and ligaments of the spine.

Symptoms include:

Over time, spondylitis can also cause damage to the bones and joints of the spine, neck, and pelvis.

According to one 2022 review, 35–75% of people with PsA experience cervical spondylitis, which affects the neck.

Although there is no cure for spondylitis, treatment can help improve posture, reduce pain, and slow the progression of the condition.

Treatment may involve:

Obesity is more common in people with PsA. Moreover, a 2020 review reports that those with PsA are more likely to have obesity than individuals with psoriasis alone.

Additionally, there may be a link between excess body weight and PsA severity. Excess body weight may also reduce the effectiveness of certain medications, such as biologics.

According to the Arthritis Foundation, the relationship between obesity and PsA may be due to the increased number of fat cells, which play a role in the production of certain proteins that regulate inflammation.

Reaching a moderate body weight can ease symptoms and reduce the severity of PsA.

People with PsA are at a higher risk of developing gout, a type of arthritis that causes severe pain swelling in the joints. The ankle, feet, and toes can appear red, deep red, and purple depending on skin tone.

This is because psoriasis and PsA may increase blood levels of uric acid, a byproduct of inflammation and high skin cell turnover, which can build up in the joints and cause gout.

A doctor can recommend nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain during a flare of gout.

A person can also help prevent future flares by:

  • reaching or maintaining a moderate body weight
  • reducing alcohol intake, if they consume it
  • limiting consumption of purine-rich foods, such as red meat and organ meats, if they include them in their diet

Many people with PsA also have psoriasis, which researchers link to a higher risk of developing nonmelanoma skin cancer.

There may also be an association between certain medications that help treat PsA and decrease the activity of the immune system, including some types of disease-modifying antirheumatic drugs (DMARDs), and a greater risk of nonmelanoma skin cancer.

However, research has turned up mixed results, and the benefits of these medications likely outweigh any potential risks.

Individuals can minimize their risk of skin cancer by:

  • limiting sun exposure
  • using sunscreen
  • avoiding indoor tanning

It is also advisable to get regular checkups with a dermatologist, especially if a person has a history of skin cancer or notices any unusual moles or skin changes.

Arthritis mutilans is a rare form of PsA that usually involves the fingers and toes.

According to estimates, it affects approximately 4% of people with PsA and causes gradual loss of bone tissue in the affected joints.

Arthritis mutilans can cause changes in the shape or appearance of the fingers and toes. It can also lead to a loss of function in the joints, which may worsen over time.

Early treatment is important and may involve physical therapy and medications to reduce inflammation, such as NSAIDs or corticosteroids.

In severe cases, a doctor may also recommend surgery to repair damage to the tissues.

To prevent PsA complications, a person with psoriasis should work with a doctor who specializes in the condition they have.

Psoriasis is a complicated condition. Many people with psoriasis notice that environmental factors, such as specific foods, seasonal changes, or infections, trigger symptoms. Managing these factors may reduce the risk of psoriasis flares and minimize PsA symptoms.

Comprehensive treatment of psoriasis, including the use of psoriasis medications, may help. The authors of a 2019 study note that targeting specific inflammatory markers may improve psoriasis outcomes. However, there is no evidence that this strategy reduces the overall risk of PsA.

It is not always possible to prevent PsA or its complications. For people who develop joint pain despite prevention strategies, treatment can minimize the risk of severe joint damage and other complications.

A doctor may recommend:

  • anti-inflammatory medications
  • corticosteroids
  • light therapy
  • DMARDs
  • biologic medicines that reduce inflammation

Some lifestyle strategies, such as exercising regularly, eating a nutritious diet, and reaching or maintaining a moderate body weight, may reduce the risk of serious complications.

Individuals who develop complications may need to adopt additional strategies to prevent those complications from causing serious health issues.

For instance, a person with diabetes may need to eat a low glycemic diet or use insulin to manage their blood sugar. Someone with heart disease may need to take blood pressure medication.

Below, we answer some questions about PsA.

What are the types of PsA?

Health experts categorize PsA based on the parts of the body it affects and the severity of inflammation.

There are five types of PsA:

  • distal interphalangeal predominant PsA
  • asymmetric oligoarticular PsA
  • spondylitis
  • symmetric polyarthritis
  • arthritis mutilans

What are neurological complications of PsA?

PsA may cause neuropathy, a condition whose symptoms include weakness, numbness, and pain due to nerve damage.

Certain conditions that health experts associate with PsA, such as type 2 diabetes, can also increase the likelihood of neurological complications, including peripheral neuropathy.

Does PsA cause permanent damage?

PsA can cause permanent damage to the joints if a person does not receive treatment.

It may also increase the risk of several other conditions that could have long-term effects on health, including liver, lung, and heart problems.

What happens when PsA goes untreated?

Untreated PsA can lead to severe joint damage and deformities over time. It may also increase the risk of many other conditions, such as:

  • heart disease
  • liver and kidney disease
  • gout
  • type 2 diabetes

How does PsA affect the skin and the eyes?

PsA can cause itchy, red patches of skin, which may develop anywhere on the body. In darker skin tones, the patches may appear deep red or purple.

Additionally, it can cause inflammation of the eye, or uveitis, which could lead to vision loss if a person does not receive treatment.

PsA is a type of arthritis and a serious autoimmune condition that causes the body’s immune system to mistakenly attack healthy tissue of the joints.

Comprehensive medical care can significantly reduce the risk of serious complications and make it easier to manage symptoms.

Most people with PsA need to work with a rheumatologist to get the best possible care.