Untangling the nuances between these two conditions can be a bit complicated. That’s why we spoke with experts about the important things you should know about psoriatic arthritis and psoriasis, including how the two are linked.
Psoriatic arthritis and psoriasis are both autoimmune conditions.
Both conditions happen when your autoimmune system mistakenly attacks healthy cells in your body, causing inflammation. With psoriasis, new skin cells grow too quickly and build up, resulting in thick, scaly rashes that can make it painful to move, according to the Cleveland Clinic. People with psoriatic arthritis also have inflammation, but their symptoms generally result in stiff, painful joints, and swollen skin surrounding the joints, according to the Mayo Clinic.
The exact causes of autoimmune diseases are not clear. Some experts theorize that injuries might trigger psoriatic arthritis and that infections could trigger psoriasis, according to John Hopkins University. Doctors commonly suspect that genetics may determine whether someone is susceptible to autoimmune disorders, but the specifics explaining how or why are up in the air.
Both conditions are lifelong diseases that can alternate between periods of remission where you have very few symptoms and flares in which your symptoms are worse.
There are various forms of psoriasis and psoriatic arthritis.
There are five types of psoriatic arthritis, and the disease can trigger symptoms in different areas of your body depending on the type you have, according to NYU Langone Health. They are:
- Asymmetric oligoarthritis can cause pain and stiffness in up to five joints on either side of your body.
- Symmetric arthritis is characterized by painful, swollen joints on just one side of your body.
- Spondylitic arthritis When you experience arthritis symptoms in your spine, or you might have neck pain and difficulty moving your head.
- Distal interphalangeal predominant psoriatic arthritis involves inflammation in your fingernails and toenails.
- Arthritis mutilans is a rare but severe form of psoriatic arthritis that causes damage in the bones of your toes and fingers, according to NYU Langone.
The Mayo Clinic explains there are six types of psoriasis, and your symptoms may vary depending on the type you have.
- Plaque psoriasis is the most common form of the disease and is marked by dry, raised skin lesions. The plaques can be itchy, and tender, and generally appear on your elbows, knees, back, and scalp.
- Nail psoriasis causes pitting, breaking, and discoloration in your fingernails and toenails.
- Guttate psoriasis usually appears after someone has a bacterial infection such as strep throat. This form leaves small lesions on your arms, trunk, or legs.
- Inverse psoriasis lesions appear in spots like your groins, buttocks, and breasts. The lesions get worse when there’s friction or sweat in the area.
- Pustular psoriasis is rare and characterized by pus-filled lesions.
- Erythrodermic psoriasis, the least common type of psoriasis, involves a peeling rash that itches, burns, and covers your entire body.
The majority of people with psoriasis won’t develop psoriatic arthritis.
About 7 million Americans have psoriasis, and only a fraction of them will ever develop psoriatic arthritis, according to the Cleveland Clinic. Estimates vary depending on the source, but the Centres for Disease Control and Prevention (CDC) says that roughly 10% to 20% of people with psoriasis go on to develop psoriatic arthritis.
In contrast, the Cleveland Clinic estimates that up to 30% of people with psoriasis will develop psoriatic arthritis. That said, “having psoriasis is the single most significant risk factor for developing psoriatic arthritis,” Naomi Schlesinger, M.D., chief of the Division of Rheumatology at Rutgers Robert Wood Johnson Medical School, tells SELF.
If you have psoriasis, it’s extremely important to watch for any joint symptoms, such as swelling, pain, or stiffness—the most common signs of psoriatic arthritis—and report them to your physician, says David Giangreco, M.D., a rheumatologist at Northwestern Medicine Delnor Hospital. Psoriatic arthritis is a progressive disease, meaning it can get worse over time. And if you happen to get diagnosed with psoriatic arthritis in its early stages, then your doctor can prescribe treatments that slow the disease’s progression and help preserve your joints.
You can develop psoriatic arthritis anytime before or after your psoriasis diagnosis.
Medical experts used to believe that people with psoriasis could only develop psoriatic arthritis within 10 years of their initial psoriasis diagnosis, according to the Cleveland Clinic. However, studies have shown that this isn’t true. In fact, up to 15% of people with both diseases actually experienced their psoriatic arthritis symptoms first, according to the Cleveland Clinic. Some people may develop psoriatic arthritis before psoriasis, and others may have had psoriasis for years without realizing it, according to Dr. Giangreco. “Psoriasis can remain hidden from patients on the back of the scalp or buttock area and go unnoticed for long periods of time,” Dr. Giangreco tells SELF. If you have psoriatic arthritis and suddenly notice changes in your skin and nails, then you don’t want to rule out the possibility of psoriasis. Rarely do people have psoriatic arthritis without getting psoriasis, too, according to the U.S. National Library of Medicine.
Experts aren’t sure why psoriasis and psoriatic arthritis are linked.
Psoriasis and psoriatic arthritis are clearly connected, but experts don’t know why some people develop both conditions. However, genetics appears to be involved. Researchers have pinpointed a family of genes called the human leukocyte antigen (HLA) complex as a possible contributor to psoriasis and psoriatic arthritis, according to the U.S. National Library of Medicine. (The HLA complex helps your immune system recognize your body’s proteins compared to proteins from foreign pathogens such as viruses and bacteria, the organization explains.) People with psoriasis or psoriatic arthritis have HLA genes that are different from people who don’t have either condition, according to a May 2021 paper published in The Journal of Rheumatology. And people with psoriasis who have a specific HLA gene mutation are more likely to develop psoriatic arthritis, according to the same paper.
Medical experts also believe that psoriatic arthritis may be inherited. About 40% of people with psoriatic arthritis have a family member with either psoriasis or psoriatic arthritis, according to the U.S. National Library of Medicine.
Psoriasis and psoriatic arthritis can severely affect your quality of life.
People with either condition frequently say that their health informs their decision-making, from the clothes they buy to their careers. That’s because both conditions can drastically change your life, making it difficult to sleep, work, and do the things you love, like playing with your children or baking. For example, when you have a psoriasis flare, even rolling over in bed or wearing tight clothing can be extremely painful. Some people with psoriasis choose clothing that hides their flares to avoid getting comments about their skin’s appearance. Similarly, joint pain from psoriatic arthritis can make it really hard to sit on the floor with your kids, get out of bed for work, or follow through on plans. This can all become overwhelming, and understandably make some people feel self-conscious about their health conditions.
Psoriasis and psoriatic arthritis treatments can make it easier to live a full life with these conditions.
There are no cures for either disease, but an effective treatment plan can minimize symptoms for both psoriasis and psoriatic arthritis. With psoriasis, doctors generally prescribe treatments that prevent your skin cells from growing too quickly, according to the Mayo Clinic. There are many treatment options for this, including creams, light therapy, or oral or injected medications, the Mayo Clinic explains.
As for psoriatic arthritis, treatments generally focus on controlling inflammation to minimize your joint pain and damage. Your doctor might suggest pharmacological options that target your immune system to lower inflammation, along with exercise or other lifestyle modifications, according to the Mayo Clinic. With each condition, the best treatment depends on your particular situation.
Bottom line: Talk to your doctor if you have psoriasis or psoriatic arthritis symptoms.
Both conditions can cause a lot of physical and emotional pain—but you can find some relief with the right treatment plan. If you think you have psoriasis or psoriatic arthritis (or both), talk to your doctor about how you can live more comfortably.
https://www.self.com/story/connection-psoriatic-arthritis-psoriasis
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