Complications of psoriatic arthritis (PsA) range from mild to potentially life threatening and can include diabetes, depression, and issues with the eyes or heart. Treatment for PsA may help lower the risk of complications.

Most people who develop PsA already have psoriasis. However, it is possible to develop the condition without having psoriasis first.

PsA can lead to various complications, which may vary in severity. The most appropriate treatment will depend on the complication a person experiences.

This article details possible complications of PsA, including treatment options for each and how to prevent them.

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

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

If an individual does not receive the correct treatment, PsA can lead to the following 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 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 with a PsA diagnosis should also undergo screening for type 2 diabetes, especially if they experience symptoms such as:

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

Around 7% of people with PsA may develop uveitis, which is inflammation of the uvea — the middle layer of the eye between the retina and the sclera. Symptoms of uveitis include:

Some individuals also develop eye infections, such as conjunctivitis or pink eye. These infections usually resolve on their own. However, a person may sometimes require topical corticosteroids or antibiotics.

According to a 2018 review, PsA may be an independent risk factor for cardiovascular diseases.

The following steps may also help to lower the risk of heart complications:

Severe joint pain is a common symptom of PsA. Joint pain can affect mobility and the ability to perform daily tasks, such as typing, caring for children, or cooking. It can also affect a person’s mental health.

A 2020 scoping review highlights depression and anxiety as comorbidities of PsA, with a significantly higher prevalence than in the general population.

The review suggests that around 20% of people with PsA experience depression.

A person should contact a doctor if they experience symptoms of depression lasting at least 2 weeks, including:

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

Certain treatments for PsA, such as biologic disease-modifying antirheumatic drugs (DMARDs), may increase the risk of 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, which can make it more difficult to breathe.

Interstitial pneumonia is a potentially life threatening complication of ILD. A 2018 analysis found 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 progression.

People with PsA may be 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:

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

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

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 feel more tired than usual.

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

Alcohol can cause damage to the liver, so a doctor may recommend reducing intake if a person drinks it.

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

Spondylitis affects the joints and ligaments of the spine. Symptoms can include:

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

According to a 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 condition’s progression.

Obesity is more common in people with PsA. 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 and swelling in the joints.

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 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 PsA medications, including some types of DMARDs, and a greater risk of nonmelanoma skin cancer.

However, further research is necessary, and people should always speak with a doctor before stopping their medication if they have concerns about complications.

Individuals can help 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 2–21% 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 tissue damage.

To help prevent PsA complications, a person with psoriasis should work with a healthcare professional.

A 2019 study notes that targeting specific inflammatory markers may improve psoriasis outcomes. However, further evidence is necessary to understand if 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 medications that reduce inflammation

Some lifestyle strategies may also reduce the risk of serious complications. For example:

  • exercising regularly
  • eating a nutritious diet
  • reaching or maintaining a moderate body weight

Below are some common questions about PsA and its complications.

How bad can psoriatic arthritis get?

Psoriatic arthritis can vary from mild to severe, and symptom progression can vary from person to person. Experts classify arthritis mutilans as the most severe form of psoriatic arthritis.

What are the neurological complications of PsA?

PsA may cause neuropathy, a condition that causes 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.

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.

Complications of PsA include obesity, type 2 diabetes, depression, and more.

Comprehensive medical care can significantly reduce the risk of severe complications and make it easier to manage symptoms. Most people with PsA need to work with a rheumatologist to get the best possible care.