Beyond Joints: How Psoriatic Arthritis Affects the Body

This autoimmune, inflammatory disease can reach beyond skin and joints to attack organs and more.

Joint pain is a big part of living with psoriatic arthritis (PsA). But the inflammation that affects your joints can cause problems for other organs and tissues, too, and comorbidities, or conditions that often occur with PsA, including obesity and diabetes, bring additional effects not directly related to joints. You’ll probably think of skin issues first, but your eyes, heart, lungs, gastrointestinal (GI) tract (stomach and intestines), liver and kidneys may also be affected.

Skin. Psoriasis appears first in 60% to 80% of patients, usually followed within 10 years — but sometimes longer — by arthritis. Some people are diagnosed with both diseases at the same time, and 10% to 15% have psoriatic arthritis symptoms before psoriasis. Psoriasis creates thick, reddish, inflamed patches of skin, often with silvery-white scales. These patches, which sometimes itch and burn, may appear anywhere on the body, but are most common on the elbows, knees, scalp, back, face, palms and feet. It’s considered severe when more than 10% of the body is covered.

Eyes. PsA or psoriasis can also affect your eyes. You might get pink eye (conjunctivitis); dry eye syndrome, which causes dry, burning, gritty-feeling eyes; or swelling in the white part of the eye (scleritis). About 7% to 25% of those with PsA develop called “uveitis,” inflammation of the uvea, the center of the eye behind the sclera. The condition can affect one or both eyes, causing pain, redness, irritation and disturbed vision, and it can lead to permanent vision loss.

GI Tract. Having psoriatic arthritis may make you more likely to have inflammatory bowel disease, especially Crohn’s disease, which causes diarrhea and other gastrointestinal issues. A study published in 2018 in Annals of the Rheumatic Diseases found people with PsA had almost three times the risk of Crohn’s disease and a 30% higher risk of ulcerative colitis than the general population. 

Heart. Cardiovascular complications from chronic inflammation are among the most concerning PsA comorbidities, and the higher incidence of obesity with PsA amps up these risks. Inflammation — not only from PsA but also generated by fat cells — conspires with other factors, such as high cho­lesterol – another common problem for PsA patients – to clog arteries. People with PsA are 43% more likely than those who don’t have it to have a heart attack and 22% more likely to have a stroke, according to a 2017 study in Arthritis Care & Research. Controlling PsA with medication may help reduce these risks, but some PsA meds are more effective than others for cardiovascular issues.

Lungs. The inflammation that causes PsA may also harm your lungs, causing a condition known as interstitial lung disease that leads to shortness of breath, coughing and fatigue. This condition occurs less frequently with PsA than with certain other rheumatic diseases, such as rheumatoid arthritis.

Liver and Kidneys. Having psoriasis increases your risk of having chronic kidney disease and a type of nonalcoholic fatty liver disease. Once study of more than 1,000 PsA patients found 32% had liver abnormalities or disease. Research also has found that people with psoriasis are at increased risk of kidney disease, so your doctor should be monitoring your kidney and liver function.

Caring for your joints is important. Be sure to talk to your doctor about your non-joint symptoms. Open communication with your doctor will help you develop an effective treatment plan for your whole health.

Last reviewed 4/21/2021