Psoriatic arthritis?is an autoimmune disorder which affects skin as well as the joints. But the disease can involve many parts of the body, and its symptoms vary widely.
“[Psoriatic arthritis] causes a lot of inflammation,” says?Christopher Ritchlin, MD, MPH, a?rheumatologist?from the University of Rochester Medical Center in New York. “I don’t think many patients fully understand that if you have inflammation, you’re at risk for inflammation in other areas of the body.”
Here are eight surprising ways psoriatic arthritis can affect your body:
1. The Psoriatic Arthritis and Heart Health Connection
According to a?meta-analysis in the journal?Arthritis Care and Research, people with psoriatic arthritis were 43 percent more likely to have or develop heart disease compared with the general population. They also had a 31 percent higher?risk of heart failure.
“The reason patients are at risk is not entirely known,” says Dr. Ritchlin. People with psoriatic arthritis more commonly develop metabolic syndrome — a cluster of conditions that increase the?risk of heart disease?and other health problems. “But there are patients with psoriatic arthritis who do?not?have metabolic syndrome and are still at an increased risk for heart events,” he says.
2.?Increased Risk of Uveitis and Other Eye Problems
Having psoriatic arthritis ups your risk of?uveitis — a condition that causes inflammation of the uvea, or the middle layer of the eye, located under the white of the eye.
According to the National Psoriasis Foundation (NPF), about 7 percent of people with psoriatic arthritis will develop uveitis. If it’s not treated, uveitis can lead to vision loss.
The reasons for this higher risk are uncertain, but it’s likely the inflammation that causes joints to flare also can affect some of the tissues in the eye.
People with the gene for the human leukocyte antigen (HLA) B27 may have a higher risk for psoriatic arthritis and uveitis, according to an?article in the?Review of Optometry.
Other eye problems, such as?glaucoma?and?cataracts, are also more common in people with psoriatic arthritis, especially if they have taken steroid medications for any length of time. Additionally, people with psoriatic disease may be more likely to develop conjunctivitis, commonly known as pink eye. A study published in the journal Open Access Text found more than 64 percent of people with psoriasis report having conjunctivitis at some point.
3. Psoriatic?Inflammation and the Brain
Studies have shown that people with psoriatic disease are at an increased risk for?anxiety and depression.
One?survey found that more than 36 percent of people with psoriatic arthritis had anxiety and about 22 percent had depression. These numbers were much higher than what people with only psoriasis reported.
“Patients with psoriatic arthritis really have a sort of dysmorphic view of themselves,” Ritchlin says. “This is a disease that’s hard to hide. Other people can see it, and the patient can feel it.”
There is growing evidence that the inflammation that causes psoriatic disease can affect the brain. Inflammatory proteins called cytokines are associated with psoriatic arthritis and also commonly found in people with depression.
“We used to think inflammation was only in joints and skin,” says?Theoharis Theoharides, MD, PhD, a professor of immunology at Tufts University School of Medicine in Boston. “The type of inflammation present in psoriatic arthritis is probably in action in the part of the brain that regulates mood, given that psoriatic arthritis has a strong nervous system component.”
4. Increased Risk of Pancreatitis and Diabetes
A?study published in the journal?PLoS One found that psoriatic disease is associated with a “significantly increased risk” of chronic pancreatitis, an inflammatory disease of the?pancreas. Chronic pancreatitis can lead to permanent damage of the pancreas.
The researchers found that the incidence of chronic?pancreatitis?was roughly twofold in?people with psoriasis?compared with those without psoriasis. They also determined that psoriasis patients using?nonsteroidal anti-inflammatory drugs (NSAIDs) and methotrexate (Trexall), commonly used to?treat psoriatic arthritis, had a lower risk of developing chronic pancreatitis.
The pancreas produces insulin, which helps maintain the body’s blood glucose levels. If the pancreas isn’t functioning properly, it can lead to type 1 or type 2 diabetes. Research suggests the prevalence of diabetes mellitus is higher in patients with psoriatic arthritis. The risk of developing diabetes was shown to increase with elevated levels of psoriatic arthritis activity.
A review published in Rheumatology and Therapy found that people with psoriatic arthritis have a higher prevalence of type 2 diabetes compared to the general population. The authors of the study suggest that certain treatments for psoriatic arthritis may affect how the body maintains blood sugar.
5. Fatty Liver and Psoriatic?Disease
“There’s a much higher prevalence of fatty?liver disease?in people with psoriatic arthritis,” says Ritchlin.
A?review of studies in the?Journal of Clinical and Aesthetic Dermatology found that up to 47 percent of psoriatic patients develop nonalcoholic fatty liver disease (NAFLD) — a condition that causes fatty deposits to develop on the liver and can lead to permanent scarring or damage. According to a study published in the journal?Gastroenterology Review, “NAFLD is frequent in patients with psoriasis and is also associated with the duration and severity of the disease.”
Researchers believe the inflammation triggered by psoriatic arthritis may also affect different areas of the body, including the liver. Additionally, people with psoriatic arthritis are more likely to have obesity, diabetes, and metabolic syndrome, which are all NAFLD risk factors.
6. Jaw Pain and Psoriatic Arthritis
Psoriatic arthritis can affect any joint, including the temporomandibular joint (TMJ) that connects the jawbone to the skull. The TMJ is linked to the masseter — the strongest muscle in your body based on its weight. Because it works so hard, the TMJ is at risk for damage.
About?35 percent?of people with psoriatic arthritis will have symptoms in their TMJ,?according to the National Psoriasis Foundation.
Rheumatologists are encouraged to perform a “66-68 joint count,” which essentially measures swelling in 66 joints and tenderness and pain in 68 joints. Still, doctors often miss signs of TMJ damage.
“In clinical practice, rheumatologists aren’t necessarily used to looking at the TMJ. They are part of the 66-68 joint count, which was … endorsed as a mandatory measure for clinical trials and longitudinal studies,”?Ana-Maria Orbai, MD, an assistant professor of rheumatology at Johns Hopkins University in Baltimore, and an NPF medical board member, told the National Psoriasis Foundation. “But most people in practice will just look at patients’ hands. Because practitioners aren’t doing the full joint count, they may miss the TMJ.”
Treatment options, such as biologics and disease-modifying anti-rheumatic drugs (MARDs), can help prevent or slow TMJ damage. Additionally, you should try to avoid chewing hard foods to reduce pressure on your jaw.
7. Psoriatic Arthritis and Your Lungs
The inflammation associated with psoriatic arthritis can also harm your lungs and increase the risk of?chronic obstructive pulmonary disease (COPD), a group of lung conditions that cause breathing difficulties.
In a?review published in the Journal of Dermatological Treatment, researchers concluded that people with psoriasis are at an increased risk for COPD.
A Taiwanese?study published in the?Journal of the European Academy of Dermatology and Venereology showed the risk for COPD was even higher in men and those over age 50 with psoriasis.
In a meta-analysis published in the journal Allergy and Asthma Proceedings, researchers looked at the association between psoriasis and asthma in 66,772 people with psoriasis and 577,415 control patients. They found the risk of asthma was greater in individuals with psoriasis, especially among older patients.
If you have psoriatic arthritis, you might want to avoid smoking, lung irritants, and dust, which could raise your chances of developing COPD.
8. Digestive Disorders and Psoriatic Arthritis
Did you know having psoriatic arthritis might also affect your gut?
A?study published in Clinical Rheumatology?found people with psoriatic arthritis are at risk for having the following conditions:
- Crohn’s disease, a chronic inflammatory bowel disease that affects the lining of the digestive tract
- Ulcerative colitis, a chronic inflammatory bowel disease that causes inflammation in the digestive tract
- Reflux esophagitis, a condition where inflammation damages the esophagus
- Peptic ulcer disease, a condition that causes painful sores or?ulcers in the lining of the stomach or small intestine
The authors concluded: “These findings suggest that psoriasis is significantly associated with IBD. Gastroenterology consultation may be indicated when patients with psoriasis present with bowel symptoms.”
Scientists believe that the same gene mutations that are associated with psoriasis may also be related to the gut disorders.