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What are Possible Complications of Progressive Disease with PsA?

Psoriatic arthritis (PsA) is a chronic inflammatory joint disease associated with psoriasis, a chronic inflammatory skin condition that causes painful, red, scaly patches. PsA generally develops after psoriasis, however a small percentage of patients develop the arthritis before psoriasis.1 PsA can cause progressive joint damage over time.2 The joint damage caused by PsA is irreversible and begins even before the disease is clinically noticeable. However, not all patients progress to joint damage. Early, aggressive treatment is critical for those patients whose disease may progress to prevent the irreversible joint damage.3

Other inflammatory diseases

In addition to joint damage, the inflammation of PsA is believed to put patients at an increased risk for other diseases that are associated with an inflammatory state, including:

Cardiovascular diseaseCardiovascular disease, which includes coronary artery disease, congestive heart failure, and vascular disease, can lead to death by heart attack or stroke. Several studies have shown an increased risk among PsA patients for cardiovascular disease.4-6

Eye disease – Several autoimmune diseases affecting the eyes have been observed in PsA patients, including uveitis, keratitis, blepharitis, conjunctivitis, episcleritis, and scleritis. The most common ophthalmic disease in PsA patients is uveitis.4,7

Hearing loss – A recent study has indicated that a greater percentage of people with PsA have hearing loss. PsA can cause damage to the inner ear or auditory nerve, which can result in hearing loss as well as balance problems.8,9

What is Arthritis mutilans?

The most severe form of PsA is arthritis mutilans, affecting approximately 5% of people with PsA. Arthritis mutilans is characterized by digital shortening of the fingers or toes associated with severe bone destruction. In arthritis mutilans, the bones in the fingers or toes degrade and begin telescoping into each other, sometimes referred to as a “pencil-in-cup” deformity, as the degradation resembles a pencil in a cup on radiographic images. It may also be called “opera glass finger.” Arthritis mutilans is often associated with polyarticular disease – that is, affecting many joints throughout the body – as well as symmetrical distribution (on both sides of the body), inflammation between the spine and the pelvis (sacroiliitis), and long disease duration. Arthritis mutilans causes severe deformity and loss of function for the patient.10

The impact of PsA on quality of life

The skin disease psoriasis reduces quality of life, impacting function and everyday activities. PsA increases the burden of disease and further diminishes quality of life, causing more work-related problems, more fatigue, more disease-related health care visits and more hospitalizations.2

Work can be particularly challenging for people with PsA. PsA is associated with a loss of work productivity, particularly in those with greater disease severity. 2 PsA is also associated with long-term work disability and absenteeism. The joint pain and stiffness caused by PsA can cause physical limitations, as well as emotional distress and discomfort. 1 Physical or occupational therapy can be beneficial for patients with PsA and may provide access to assistive devices for self-care, education on modifications, and possible vocational readjustments.11

Research on progressive join disease biomarkers

Much research has focused on identifying characteristics of those patients whose disease is likely to progress to irreversible and disabling joint damage. Aggressive treatment can potentially prevent the joint disease, however aggressive treatment has a high cost and potential side effects. Since only a small percentage of PsA patients will progress to severe joint disease, researchers have sought to find a measurable feature that can differentiate at-risk patients.3,12

No single biomarker (a medical sign that can be measured to indicate or predict disease) has been found as a reliable predictor, but there are studies that suggest possible association of progressive joint disease from PsA with the following:3

  • Calgranulin, a protein secreted by some white blood cells and are mediators of the inflammatory process in PsA3,13
  • Markers of angiogenesis, the process of building blood vessels that is pronounced in PsA3
  • Molecules that regulate bone turnover3

Additional research is needed to conclusively identify biomarkers and develop diagnostic tests.

Written by: Emily Downward | Last reviewed: October 2016.
  1. Mease PJ, Armstrong AW. Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis. Drugs. 2014 Mar;74(4):423-41.
  2. Boehncke WH, Menter A. Burden of disease: psoriasis and psoriatic arthritis. Am J Clin Dermatol. 2013 Oct;14(5):377-88.
  3. Mc Ardle A, Flatley B, Pennington SR, FitzGerald O. Early biomarkers of joint damage in rheumatoid and psoriatic arthritis. Arthritis Res Ther. 2015;17(1):141.
  4. Ogdie A, Schwartzman S, Eder L, Maharaj AB, Zisman D, Raychaudhuri SP, Reddy SM, Husni E. Comprehensive treatment of psoriatic arthritis: managing comorbidities and extraarticular manifestations. J Rheumatol. 2014 Nov;41(11):2315-22.
  5. Gelfand JM, Neimann AL, Shin DB, Wang X…Risk of myocardial infarction in patients with psoriasis. JAMA. 2006 Oct. 296(14):1735-1741.
  6. de Vlam K, Gottlieb AB, Mease PJ. Current concepts in psoriatic arthritis: pathogenesis and management. Acta Derm Venereol. 2014 Nov;94(6):627-34.
  7. National Psoriasis Foundation. Accessed online on 4/15/16 at https://www.psoriasis.org/about-psoriasis/related-conditions.
  8. Amor-Dorado JC, Barreira-Fernandez MP, Pina T, Vazquez-Rodriguez TR, Llorca J, Gonzalez-Gay MA. Investigations into audiovestibular manifestations in patients with psoriatic arthritis. J Rheumatol. 2014 Sep;41(10):2018-2026.
  9. Medline Plus, U.S. National Library of Medicine. Accessed online on 4/16/16 at https://www.nlm.nih.gov/medlineplus/.
  10. Haddad A, Chandran V. Arthritis mutilans. Curr Rheumatol Rep. 2013 Apr;15(4):321.
  11. Psoriatic arthritis. Medscape. Accessed online on 4/14/16 at http://emedicine.medscape.com/article/2196539-overview.
  12. Bogliolo L, Crepaldi G, Caporali R. Biomarkers and prognostic stratification in psoriatic arthritis. Reumatismo. 2012 Jun 5;64(2):88-98.
  13. Perera C, McNeil HP, Geczy CL. S100 Calgranulins in inflammatory arthritis. Immunol Cell Biol. 2010 Jan;88(1):41-9.