Health Conditions Linked to PsA

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Psoriatic arthritis (PsA) is an inflammatory joint condition that can lead to decreased health-related quality of life and possibly permanent joint damage. The inflammatory response seen in PsA is believed to put individuals at an increased risk for other diseases associated with an inflammatory state.1,2

Psoriasis

Psoriatic arthritis is most often associated with the disease psoriasis, an inflammatory skin disease that frequently precedes the onset of the joint disease. Psoriasis occurs in several forms, with 90% of patients having plaque psoriasis. Plaque psoriasis causes round or oval red patches on the skin that are scaly, itchy, and painful. The lesions of plaque psoriasis often occur on the arms, legs, scalp, buttocks, and trunk.3-5

Cardiovascular disease

Cardiovascular 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. Researchers have developed a concept called the “psoriatic march” that links PsA and psoriasis with an increased risk of cardiovascular disease. According to this model, the inflammation produced by psoriatic disease causes insulin resistance and dysfunction in the lining of the blood vessels, which lead to atherosclerosis (the formation of abnormal fatty masses in the arteries) and ultimately to major cardiovascular events. Fortunately, heart disease can be decreased by managing traditional risk factors, such as smoking cessation and treatment of high blood pressure, as well as lifestyle changes, including weight loss and increased physical activity.1,2,6

Obesity

Obesity, defined as having too much body fat, has been observed at a higher rate in PsA patients. Obesity occurs over time when more calories are consumed than used. Research has shown that people with PsA are more likely to be obese than the general population. In addition, obesity may negatively affect disease activity and response to treatment.1,7

Metabolic syndrome

Metabolic syndrome is a cluster of three or more of the following risk factors: insulin resistance, elevated fasting blood sugar, high blood pressure, elevated triglycerides in the blood, reduced HDL cholesterol (the “good” cholesterol), and abdominal obesity. Metabolic syndrome puts patients at a high risk for type 2 diabetes, cardiovascular disease and stroke. Patients with PsA are more likely to have metabolic syndrome than the general population.1,7,8

Diabetes

Type 2 diabetes, a disease in which blood sugar levels are too high, has been observed in up to 18% of patients with PsA. The link between the two diseases is partially explained by the increased obesity prevalent in PsA patient groups, and may possibly be related to insulin resistance that is driven by PsA inflammation. Diabetes can cause serious problems, damaging eyes, kidneys, and nerves, and increasing the risk of heart disease, stroke, and loss of limbs due to amputation.1,10

Inflammatory bowel diseases

Inflammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis, have been observed at a higher incidence in patients with PsA. IBD and PsA share similar genetic mutations, and both PsA and IBD are associated with an abnormal immune response, causing excess inflammation in the body. While the inflammation is most noticeable in the joints in people with PsA, inflammation is also present throughout the body, which may increase the risk of IBD.1,6,7,10

Hearing loss

A recent study has indicated that a greater percentage of people with PsA have hearing loss. In addition, a higher percentage of PsA patients had impaired balance compared to the general population. People with PsA seem to be at a higher risk of damage to the inner ear or auditory nerve, which usually results in permanent hearing loss and can cause balance problems. Experts believe the inner ear damage is due to the presence of chronic inflammation from PsA.7,9,10

Autoimmune ophthalmic 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. The effect of uveitis can range from slightly reduced vision to severe vision loss. Uveitis can affect one or both eyes, and symptoms often develop rapidly. However, in some patients, the symptoms can occur more gradually.1,7

Osteoporosis

Studies have shown a link between PsA and osteoporosis, and risk of developing the bone disease is correlated with the longer a person has psoriatic disease.1,7

Fatty liver disease

Fatty liver disease, particularly non-alcoholic fatty liver disease, has an increased prevalence in patients with psoriasis. Patients with PsA may be at a greater risk for developing it as well.1,7

Kidney disease

Kidney disease has been associated with both psoriasis and PsA. Specific to PsA, there is a higher risk of chronic kidney disease than the general population.1

Depression and anxiety

Mood disorders like depression and anxiety have been identified in a higher percentage of patients with PsA than those with psoriasis alone. Depression and anxiety have been associated with a higher number of inflamed joints, as well as disability, pain, and fatigue.11

Cancer

Several research studies have shown an increased risk of some cancers among patients with PsA, particularly lymphoma and non-melanoma skin cancer.7

view references
  1. 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.
  2. Gelfand JM, Neimann AL, Shin DB, Wang X…Risk of myocardial infarction in patients with psoriasis. JAMA. 2006 Oct. 296(14):1735-1741.
  3. 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.
  4. Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005 Mar;64 Suppl 2:ii14-7.
  5. Weigle N, McBane S. Psoriasis. Am Fam Physician. 2013 May 1;87(9):626-33.
  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. Taber’s Medical Dictionary. Accessed online on 4/15/16 at http://www.tabers.com.
  9. 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.
  10. Medline Plus, U.S. National Library of Medicine. Accessed online on 4/16/16 at https://www.nlm.nih.gov/medlineplus/.
  11. McDonough E, Ayearst R, Eder L, Chandran V, Rosen CF, Thavaneswaran A, Gladman DD. Depression and anxiety in psoriatic disease: prevalence and associated factors. J Rheumatol. 2014 May;41(5):887-96.
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