Beyond Joints: How PsA Affects The Body
Besides skin and joint symptoms, psoriatic arthritis can impact the body in various ways.
Joint pain and skin rash are two of the most common symptoms of psoriatic arthritis (PsA), but inflammation can cause problems for other body parts, too. In some cases, PsA is also linked to other chronic conditions, like heart disease and depression.
Educate yourself about the various impacts of PsA and discuss ways to prevent them with your primary care doctor, rheumatologist and other health care professionals.
Common Body Parts Affected by PsA
Here are some common ways PsA can affect the body and what to look out for:
Skin. Typically, psoriasis appears before joint symptoms. But in about 20 percent of cases, joint pain occurs before skin symptoms. Psoriasis causes patches of skin to become thick, reddish and inflamed, often with silvery-white scales. These patches – which sometimes itch and burn – may appear anywhere on the body, but are commonly found on the elbows, knees, scalp, back, face, palms and feet. Psoriasis covering 10 percent or more of the body is considered severe.
Eyes. People with PsA are more likely to get pink eye (conjunctivitis), dry eye syndrome, which causes dry, burning, gritty-feeling eyes and swelling of the white of the eye. About 7 to 25 percent of people with PsA will also develop eye inflammation, or uveitis, which can cause pain, redness, irritation and blurred vision. Other times, it can cause no symptoms at all. Left untreated, uveitis can cause vision loss, so yearly screening and eye exams are important.
GI Tract. PsA increases the risk of developing inflammatory bowel disease (which includes autoimmune diseases like ulcerative colitis and Crohn’s disease), peptic ulcer disease and reflux esophagitis, according to a 2016 Clinical Rheumatology study. Some of GI conditions also respond well to biologic therapies used to control PsA.
Heart. Chronic inflammation can damage blood vessels, increasing the risk of heart attacks and strokes. People with PsA are 43 percent more likely to have heart attacks and 22 percent more likely to have strokes, according to a 2017 study in Arthritis Care & Research. Keeping PsA under control with a biologic may help control these risks.
Lungs. A less common, but serious, side effect of inflammation is interstitial lung disease (ILD). It tends to affect people with other rheumatic diseases, such as rheumatoid arthritis and ankylosing spondylitis. Your doctors will monitor your lung health and look for signs of ILD, including shortness of breath, coughing and fatigue.
Liver and Kidneys. Patients with moderate to severe psoriasis (coverage of 3% of more) have an increased risk of having chronic kidney disease and a type of nonalcoholic fatty liver disease. Since so many people with psoriatic arthritis have psoriasis, doctors will monitor liver and kidney function.
Other Related Conditions
Gout. People with PsA are nearly twice as likely to develop gout, another form of arthritis, according to a 2019 study in the Journal of Managed Care & Specialty Pharmacy.
Depression and Anxiety. People with PsA have a three-fold increased risk for depression. Inflammation may affect brain chemistry, but living with a painful chronic condition can also contribute to depression and anxiety. Let your doctor know if you notice any dramatic changes in your mood.
Fatigue. For some, inflammation-driven fatigue improves after beginning a biologic. For others, fatigue is driven by stress, depression and pain-related sleep disturbance. Healthy lifestyle and mind-body interventions such as mindfulness training, yoga, regular exercise and seeing a therapist or counselor can help.
Obesity. About 45 percent of PsA patients are obese, meaning they have a BMI of 30 or higher. Fat cells fuel inflammation, and extra pounds add stress to joints. A 2019 study in Arthritis Research & Therapy found that overweight PsA patients who shed pounds reduced their pain levels, had fewer tender joints and felt less fatigue. The more weight people lost, the more their symptoms improved.
Metabolic Syndrome. PsA increases the risk of having of metabolic syndrome, a cluster of conditions that includes excess belly fat, high blood pressure, high cholesterol and high blood sugar. Metabolic syndrome is linked to heart disease and diabetes, which is 43 percent more common in people with PsA, according to a 2017 study in The Journal of Rheumatology. Eating healthfully, exercising and losing weight can help lessen these risks.
Fibromyalgia. Fibromyalgia is more common in people with PsA but often goes undiagnosed. Fibromyalgia requires specific medical therapy, so getting the diagnosis right is essential. If your PsA is well-controlled, but you’re experiencing fatigue and widespread muscle pain, talk to your doctor the possibility of fibromyalgia.
Coping with PsA’s health effects may sound like a full-time job, but open communication with your doctor will help you develop an effective treatment plan that cares for your whole body.
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