What Exactly Is the Connection Between Psoriatic Arthritis and the Immune System?

From yahoo.com

Dealing with the itchy, scaly patches that come with psoriasis is difficult enough. But having psoriasis puts you at risk of developing psoriatic arthritis, an inflammatory condition that impacts the joints. In fact, research suggests that up to 30% of people with psoriasis will eventually develop psoriatic arthritis.

The exact cause of psoriatic arthritis isn’t known, but the immune system plays a major role in its development. In general, a person will develop psoriatic arthritis when they have a genetic predisposition and are exposed to environmental triggers like infections, physical injury, emotional stress, or lifestyle factors like obesity and smoking, says Paras Karmacharya, MD, director of the Vanderbilt Psoriatic Arthritis and Spondyloarthritis Center. “This is often described as a ‘two-hit’ process,” he says.

Together, these factors can spark an immune system reaction that leads to psoriatic arthritis. Of course, the process of developing psoriatic arthritis, having flares, and getting effective treatment is more complicated than that. Here’s what doctors who treat psoriatic arthritis want people to keep in mind about the immune system’s role in the condition—and in getting proper treatment.

What is psoriatic arthritis?

Psoriatic arthritis is an inflammatory condition that impacts the joints, which can happen in combination with the chronic inflammatory skin disorder psoriasis, according to the U.S. National Library of Medicine. While psoriasis causes symptoms like red, irritated skin, psoriatic arthritis is usually linked with signs like stiff, painful joints and swelling around the joints.

People typically have psoriasis before they develop psoriatic arthritis, although that’s not always the case, says Zhanna Mikulik, MD, a rheumatologist at The Ohio State University Wexner Medical Center. “Usually, psoriatic arthritis patients have psoriasis for 10 or 12 years and then develop psoriatic arthritis,” she says. While rare, some people develop psoriatic arthritis without any obvious skin changes, Mikulik says.

OK, but how does the immune system influence psoriatic arthritis?

The immune system is a major player in psoriatic arthritis. “Psoriatic arthritis is the result of your immune system reacting abnormally because of both your genes and something in your environment that flips the switch,” says Karmacharya. “In people with psoriatic arthritis, the immune system, which normally protects the body from infections, mistakenly targets the joints, skin, and entheses—the sites where tendons and ligaments attach to bone.”

With psoriatic arthritis, “something is stimulating the immune system and it’s hyperactive in the wrong way,” Mikulik says. That causes inflammation in different areas of the body, especially around the joints, she says. Over time, that chronic inflammation leads to pain, stiffness, swelling, and eventually joint and tissue damage if it’s left unchecked, Karmacharya says.

Beyond that, the relationship between the immune system’s overreaction and psoriatic arthritis isn’t well understood, says Vivien Hsu, MD, acting chief of the division of rheumatology at Rutgers Robert Wood Johnson Medical School. However, she points out that people who have psoriasis and psoriatic arthritis share similar “abnormal” immune system reactions. Those include the over-expression of certain inflammatory cytokines, which are small proteins secreted by the immune system, she says.

But the link between the immune system and psoriatic arthritis also means that being stressed or having infections like the common cold or flu can cause a flare or worsen joint issues, Hsu says. “That’s because infections activate the immune system broadly,” Karmacharya explains. “In someone with psoriatic arthritis whose immune system is already overactive and misdirected, this can unintentionally escalate inflammation in the joints and skin.”

How do psoriatic arthritis treatments influence the immune system?

Many medications used to treat psoriatic arthritis are immunosuppressants, meaning they weaken the immune system. However, these medications are usually focused on certain cytokines. “Most treatments are selected to target the cytokines that are overly expressed in psoriatic arthritis,” Hsu says. As a result, Karmacharya stresses that they don’t shut the immune system down. “They fine-tune it to stop it from attacking the body while still allowing it to defend against real threats,” he says.

Having medications that work on the immune system is important because psoriatic arthritis is more than a joint problem, Karmacharya explains. “It’s a systemic immune-mediated disease,” he continues. “Understanding this helps explain why treatments that target the immune system directly, like biologics, are so effective.”

Still, these treatments aren’t perfect. “Because these medications suppress parts of the immune system, they can also slightly increase the risk of infections. You do have the army to fight against viruses and bacteria, but you just have less of an army,” Karmacharya says. “That’s why monitoring and infection prevention, like staying current on vaccines, are important parts of treatment planning.”

How to support your immune system while living with psoriatic arthritis

If you have psoriatic arthritis, doctors stress the importance of working with a healthcare provider to come up with a treatment plan that works for you. But beyond taking any recommended medications as prescribed, there are certain lifestyle moves you can make to support your immune system.

Consistent, high-quality sleep is crucial. “Poor or insufficient sleep increases inflammation and can make symptoms feel worse,” Karmacharya says. He recommends that most people aim to get seven to nine hours of sleep a night.

Stress management is also important to support a healthy immune system, Mikulik says. “Chronic stress can disrupt immune regulation and trigger flares,” Karmacharya explains. “Techniques like deep breathing, yoga, or mindfulness can help bring things back into balance.”

Regular exercise can help keep joints mobile, too, Mikulik says. Your diet is also important, with Karmacharya recommending a nutrient-rich, anti-inflammatory diet, like the Mediterranean diet. “Foods like fatty fish, leafy greens, colorful fruits, whole grains, and healthy fats like olive oil can help calm inflammation,” he explains. “At the same time, it’s important to limit processed foods, added sugars, and unhealthy fats, which can fuel inflammation.”

That doesn’t mean that lifestyle treatments alone will get rid of psoriatic arthritis symptoms—but doctors say they can help you to feel more comfortable. “While these steps won’t replace treatment, they can make a real difference in how well the immune system functions and how the disease behaves day to day,” Karmacharya says.

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