How Psoriatic Arthritis Is Linked to Psoriasis

What you need to know about the relationship between psoriasis and psoriatic arthritis — and why treating both conditions can improve skin and joint symptoms, as well as your overall health.

P soriatic arthritis is an autoimmune condition where the body’s immune system mistakenly attacks joints and connective tissue. This leads to a cascade of inflammation that causes painful symptoms, such as joint pain, stiffness, and swelling.

Most people who develop psoriatic arthritis will have psoriasis first — sometimes for years before pain starts in their joints, says Jonathan Greer, MD, a rheumatologist at Arthritis & Rheumatology Associates of Palm Beach in Florida. In fact, it’s rare to have psoriatic arthritis without first having at least some symptoms of psoriasis, even if they’re mild.

“I sometimes have people who present with psoriatic arthritis but who have never had a diagnosis of psoriasis, but that doesn’t mean they don’t have it,” says Dr. Greer. “Or the psoriasis could be in a place where it’s gone unnoticed, such as the scalp, belly button, or behind the ears.”

Although psoriasis and psoriatic arthritis affect different parts of the body, both of them are triggered by changes in the immune system. With plaque psoriasis, the most common kind of psoriasis, the immune system mistakenly attacks the skin cells, causing the body to make new skin cells more often. The extra cells pile up on the surface of the skin and form thick, dry, discolored patches called plaques, according to the American Academy of Dermatology Association (AAD).

Underlying Causes of Both Psoriatic Arthritis and Psoriasis

Inflammation triggered by an overactive immune system is one possible cause of psoriasis and psoriatic arthritis, but there are others.

Genetics, for example, appear to be at play. “People with psoriasis often have a family history of psoriasis or psoriatic arthritis,” says Shilpi Khetarpal, MD, a dermatologist at Cleveland Clinic’s main campus in Ohio. A report published in 2019 estimates that this applies to around 40 percent of people diagnosed with either condition.

People with psoriasis often have a family history of psoriasis or psoriatic arthritis.
—?Shilpi Khetarpal, MD
Some people who develop psoriasis don’t have the genes associated with an increased risk, though, and some people who do carry the genes never develop psoriasis, according to the AAD.

Environmental triggers also play a role in both conditions. In the case of psoriasis, research shows those triggers can include stress, infection, poor diet, smoking, drug use, and alcohol consumption. For psoriatic arthritis, studies point to triggers such as certain infections, physical trauma, and obesity.

How to Treat Both Psoriatic Arthritis and Psoriasis — and Why It’s So Important

Your treatment plan will depend on:

  • Which condition(s) you’re diagnosed with
  • How much of your body is affected — and which areas
  • The severity of your symptoms
  • Which medications you’ve responded to best
  • Your personal preference

Finding the right treatment, or combination of treatments, often takes some trial and error.

Treatment options may include:

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“Many of the newer treatments can treat both psoriasis and psoriatic arthritis,” says Greer. That includes immunomodulators, disease-modifying antirheumatic drugs (DMARDs), biologics, and Janus kinase (JAK) inhibitors, all of which change how the immune system works, decreasing the inflammation that leads to psoriasis and psoriatic arthritis.

“If you have skin disease first and you’re on one of these treatments, it can actually prevent or delay arthritic changes,” he says.

Treatment Can Also Improve Your Overall Health

Treating psoriasis and psoriatic arthritis not only improves your symptoms, but can also reduce the risk of other health conditions.

“[Having both] psoriasis and psoriatic arthritis [causes] inflammation of the entire body,” says Greer. For example, psoriasis and psoriatic arthritis can accelerate hardening of the arteries and put people at much higher risk for heart attack and stroke. By managing both inflammatory conditions, that risk is reduced, he says.

Lifestyle Tips May Also Help You Manage Psoriasis and Psoriatic Arthritis

Complementary and alternative therapies are sometimes used with pharmaceutical treatments to manage psoriasis and psoriatic arthritis, but check with your doctor before making changes to your diet or activity level.
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6 Lifestyle Habits for Managing Psoriatic Disease

  1. Eat a healthy diet. For his patients, Greer recommends a Mediterranean diet, which is full of anti-inflammatory fruits, vegetables, legumes, grains, and healthy fats.
  2. Take daily baths.?Soaking in a bath with soothing ingredients, such as colloidal oatmeal, can help inflamed skin, according to the National Psoriasis Foundation. Just stay away from hot temperatures and harsh soaps, which can worsen your symptoms.
  3. Moisturize regularly. Products that contain aloe vera, jojoba, urea, zinc pyrithione, or capsaicin may help alleviate skin symptoms, according to the National Psoriasis Foundation.
  4. Practice mindfulness. There is evidence that regularly practicing mindfulness meditation may be a useful tool for managing psoriasis and improving quality of life, according to a systematic review published in September 2022 in Dermatology and Therapy.
  5. Stay active. Exercising regularly and maintaining a healthy weight can help improve the disease and ease joint pain, says Greer.
  6. Try herbs and supplements. There’s evidence that some supplements, including turmeric and krill oil (a type of omega-3 fatty acid), can help reduce inflammation, but you should check with your doctor before adding any to your diet, says Greer.
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