What You Need to Know About Comorbidities in Psoriatic Arthritis

Psoriasis, Heart Disease, Diabetes, and More

People with psoriatic arthritis (PsA) are at higher risk for other diseases, called comorbidities. In medicine, a comorbidity is defined as the presence of one or more conditions co-existing with a primary condition. The morbidity is each additional condition. For example, a comorbidity commonly associated with PsA is an inflammatory skin condition called psoriasis. Other comorbid conditions associated with PsA include inflammatory bowel disorders, cardiovascular disease, diabetes, and metabolic syndrome.

Prevalence studies show people with PsA are at risk for numerous comorbidities that carry significant risk for other diseases and an increased risk for early death. Comorbidities of PsA tend to be associated with worse prognosis, decreased quality of life, and increased risk for mood disorders.

The Arthritis Foundation notes that more than half of the people with PsA have a comorbid condition, and up to 40% have three or more comorbid conditions.

Here is what you need to know about comorbidities associated with PsA, their effect, and reducing your risk.

Psoriatic Arthritis Prognosis and Quality of Life
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Psoriasis

PsA and psoriasis are two types of psoriatic disease. PsA is known for causing joint pain, stiffness, and swelling, while psoriasis causes skin cells to renew too quickly, leading to a buildup of red, scaly, and silvery-looking skin patches, called plaques.

These two conditions often occur together, and according to the National Psoriasis Foundation, up to 30% of people with psoriasis will eventually go on to develop PsA. While it is less common, you can be diagnosed with PsA first and then develop skin problems later on.

Cardiovascular Disease

PsA and other types of inflammatory arthritis are systemic, which means they affect the entire body, including the heart. There is a strong link between the risk of heart disease and PsA. One 2016 study reported in the journal Arthritis Care & Research finds people with PsA are 43% more likely than others in the general population to develop cardiovascular disease. The study also found that people with PsA also have a 22% higher risk for cerebrovascular disease, which may lead to a stroke.

Inflammation can also cause blood vessels to harden and become damaged, a condition called atherosclerosis, which increases the risk for a stroke or a heart attack. And having other comorbidities, including diabetes, can increase further increase a person’s risk for cardiovascular disease.

Because of the increased risk for cardiovascular disease, it is important to know the warning signs of a heart attack and stroke. Signs of a heart attack include shortness of breath, pain in the upper part of the body, extreme discomfort or pain in the chest. Signs of a stroke include trouble speaking, numbness or weakness in the face, arm, or leg, usually on one side of the body.

To reduce your risk for heart disease and stroke, manage the risk factors you can control, such as blood pressure, cholesterol, and blood sugar.

Ask your doctor about what screening tests you should get. It is also a good idea to get regular activity/exercise, consider an anti-inflammatory diet, and quit smoking.

Metabolic Syndrome        

Metabolic syndrome is defined as a having a combination of central obesity (fat around the waist), high blood pressure, insulin resistance and dyslipidemia (high triglycerides, high bad cholesterol, low good cholesterol). The risk for metabolic syndrome tends to be higher in people with PsA, this in comparison to those who only have psoriasis or neither condition. And people with both PsA and metabolic syndrome tend to have more severe PSA and a low chance for remission or minimal disease activity of PsA.

Diabetes

People with a PsA have an increased risk for type 2 diabetes, a metabolic disease. Type 2 diabetes results when a person’s body is unable to use insulin properly and blood sugar levels become elevated. The prevalence of diabetes mellitus (DM) is significantly higher in people with PsA who experience high disease activity with PsA, this according to a study reported in 2017 by The Journal of Rheumatology.

DM refers to a group of diseases that cause high blood sugar, including pre-diabetes, types 1 and 2 diabetes, and gestational diabetes. The PsA-DM researchers found a 43% higher risk of developing DM with PsA, this compared to others in the general population.

Researchers are not sure why PsA and DM are connected but they speculate it may be because the diseases have similar systemic inflammatory processes. In addition, diabetes and PsA have similar risk factors, including genetics, obesity, and metabolic causes. Talk to your doctor if you experience signs of type 2 diabetes, including thirst, hunger, blurred vision, and extreme fatigue. Additionally, tell your doctor if diabetes runs in your family so your blood sugar can be monitored for pre-diabetes.

The two best ways to reduce your risk for type 2 diabetes are to get regular physical activity and to lose weight if you are overweight. Losing weight can also improve PsA symptoms, prevent diabetes, and help you get better control of diabetes if you have already been diagnosed.

Osteoporosis

Osteoporosis—a condition that cause bones to become weak, fragile, and prone to fractures—is linked to PsA. A study reported in 2014 from researchers out of the University of Rome "Sapienza" found a high prevalence of osteopenia in people with psoriatic disease.

Osteopenia is a condition where the body isn’t making new bone as quickly it is reabsorbing old bone. Osteopenia is considered an early form of osteoporosis. In the mentioned Italian study, researchers were looking for signs of osteoporosis and osteopenia in 43 people with PsA. What they found was 60% had osteopenia and 18% were living with osteoporosis.

The PsA-osteoporosis connection has several possible theories. One is that the same inflammatory process that causes PsA also causes osteoporosis. A second possible explanation is that corticosteroid medications used to control PsA inflammation can also cause bone thinning. Additionally, joint pain and stiffness can cause a person to be less active and lack of movement can cause bones to become weak.

Osteoporosis is an asymptotic condition—that means it doesn’t cause symptoms so you may not know you even have it until you experience a fracture. If you have other risk factors for osteoporosis, including family history, talk to your doctor about bone density screening to check for signs of osteoporosis before you experience a fracture.

You can slow down bone loss by staying active, and by taking vitamin D and calcium supplements and osteoporosis medications if your doctor recommends them.

Gout

Gout is a type of inflammatory arthritis that is caused by uric acid buildup in the blood. Uric acid is a normal waste product in the body. When uric acid levels are elevated, they build up and accumulate in a joint and cause inflammation, triggering pain and swelling. Excess uric acid can be caused by rapid cell turnover, a feature of psoriasis.

One study reported in 2015 by the Journal of Rheumatic Diseases finds a connection between high uric levels and psoriasis, and a strong connection with PsA. For both men and women with PsA and psoriasis, their risk is five times higher than their peers who do not have psoriasis or PsA.  

If gout runs in your family, it is a good idea to look to your diet to reduce your risk. Limit foods that are more likely to increase uric acid levels in the body, including alcohol and fatty foods.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis (UC), is known for co-occurring with PsA. IBD causes the body to overact and attack the walls and tissues of the intestines.

A review of studies in the journal JAMA Dermatology found people with PsA had a 1.7-fold increased risk for UC and a 2.5-fold increased risk for Crohn’s disease. This is likely due to the fact that some of the same genetic variations associated with PsA are also associated with IBD.

Talk to your doctor if you experience symptoms of inflammatory bowel disease, such as blood in the stool, abdominal pain, cramping, and frequent diarrhea. IBD is often successfully managed with diet and medication.

Depression

Mood disorders, such as depression, are more common in people with arthritis conditions, but people with PsA have an even higher risk. A study reported in 2014 by the Journal of Rheumatology found people with both PsA and psoriasis experience higher levels of anxiety and depression than people living with psoriasis alone.

PsA can severely affect a person’s life. For example, psoriasis skin problems affect appearance and self-esteem, while joint pain, reduced mobility, and fatigue can make it harder to be social and active, resulting in isolation. And these factors all play a part in causing emotional distress and contributing to the development of depression. Additionally, it has been shown that Inflammation can create brain changes that affect emotional state.

Symptoms of depression include:

  • Loss of interest in activities once enjoyed
  • Feeling sad, helpless, and hopeless often
  • Sleep problems
  • Problems with concentration and focus
  • Withdrawing from friends and family

Depression can have a serious effect on your life. If you think you might be depressed, talk to your doctor about the ways in which it can be treated and managed, as not treating it will make PsA worse. 

Vision Problems

PsA has been liked to the eye disease uveitis, which causes inflammation of the uvea—the middle layer of the eye. Symptoms of uveitis include redness, eye pain and swelling, watery eyes, sensitivity to light, and blurred and impaired vision.

Uveitis is known for becoming severe quickly and, if left untreated, can cause vision loss. If you think you may have it, talk to your rheumatololgist or other treating physician about what you can do to treat it and reduce the risk of complications.

You should also visit an ophthalmologist at least once a year to get your eyes checked and see an eye doctor right away if experience unusual vision changes or severe eye symptoms.

Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is the result of fat accumulating in liver cells and deposits. It has nothing to do with alcohol abuse. Having inflammatory arthritis can increase your risk of NAFLD.

This disease has few symptoms early on so it is likely once you are diagnosed, the disease has already advanced. This is why doctors monitor liver function with blood work in people with PsA. Weight loss and exercise can reduce your risk for NAFLD.

Arthritis Mutilans

Arthritis mutilans (AM) is a term used in PSA patients that have a severe form of deforming arthritis as part of their disease, affecting around 5% of people with PsA. Despite its rarity, it is a comorbidity of PsA known for damaging and destroying bones.

In people with AM, once destroyed, bones cannot be rebuilt, and soft tissues of bones end up collapsing. AM mainly impacts the fingers, hands, wrists, and feet. The good news is that it is rare in people with PsA who are treated with biologics. And even if a person develops the condition, early treatment can prevent further bone loss and slow down bone destruction.

A Word From Verywell

There are things you can do to reduce your risk of developing a comorbid condition with PsA. Make sure you are seeing your primary care doctor annually to screen for cardiovascular risk factors, check blood pressure and blood sugar levels, and to perform other relevant screenings. If you smoke, it is a good idea to quit. Reducing alcohol intake can also help, as will regular exercise and eating a healthy diet.

Making sure that PsA is well-managed can also reduce the risk of comorbidities. And because depression is so common in PsA, don’t be afraid to ask for help from loved ones, through a support group, or by talking with a mental health professional.

If you have already been diagnosed with a comorbidity, make sure you are seeking care from a specialist for your condition. Seeing the right doctors makes a big difference in your overall health and treatment outcomes. 

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  1. Haddad A and Zisman D. Comorbidities in patients with psoriatic arthritis. Rambam Maimonides Med J. 2017 Jan; 8(1): e0004. doi:10.5041/RMMJ.10279

  2. Arthritis Foundation. Metabolic comorbidities of psoriatic arthritis.

  3. National Psoriasis Foundation. Statistics.

  4. Polachek A, Touma Z, Anderson M, et al. Risk of cardiovascular morbidity in patients with psoriatic arthritis: a meta-analysis of observational studies. Arthritis Care Res (Hoboken). 2017 Jan;69(1):67-74. doi: 10.1002/acr.22926

  5. American Heart Association. Understand your risks to prevent a heart attack. Updated June 30, 2016.

  6. American Heart Association. About metabolic syndrome. Updated July 31, 2016.

  7. Gelfand JM and Yeung H. Metabolic syndrome in patients with psoriatic disease. J Rheumatol Suppl. 2012 Jul; 89: 24–28. doi:10.3899/jrheum.120237

  8. Eder L, Chandran V, Cook R, Gladman DD. The risk of developing diabetes mellitus in patients with psoriatic arthritis: a cohort study. J Rheumatol. 2017 Mar;44(3):286-291. doi:10.3899/jrheum.160861

  9. National Institute of Diabetes and Digestive and Kidney Diseases. Preventing type 2 diabetes. Updated December, 2016.

  10. D'Epiro S, Marocco C, Salvi M, et al. Psoriasis and bone mineral density: implications for long-term patients. J Dermatol. 2014 Sep;41(9):783-7. doi:10.1111/1346-8138.12546

  11. Johns Hopkins Medicine. Osteoporosis: What you need to know as you age.

  12. Merola JF, Wu S, Han J, et al. Psoriasis, psoriatic arthritis and risk of gout in US men and women. Ann Rheum Dis. 2015 Aug; 74(8): 1495–1500. doi:10.1136/annrheumdis-2014-205212

  13. Fu Y, Lee CH, Chi CC. Association of psoriasis with inflammatory bowel disease: a systematic review and meta-analysis. JAMA Dermatol. 2018 Dec 1;154(12):1417-1423. doi:10.1001/jamadermatol.2018.3631

  14. McDonough E, Ayearst R, Eder L, et al. Depression and anxiety in psoriatic disease: Prevalence and associated factors. J Rheumatol. 2014 May;41(5):887-96. doi: 10.3899/jrheum.130797

  15. Miller AH and Raison CL. The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nat Rev Immunol. 2016 Jan; 16(1): 22–34. doi:10.1038/nri.2015.5

  16. Fotiadou C, Lazaridou E. Psoriasis and uveitis: links and risksPsoriasis (Auckl). 2019;9:91–96. Published 2019 Aug 28. doi:10.2147/PTT.S179182

  17. Prussick R, Prussick L, Nussbaum D. Nonalcoholic Fatty liver disease and psoriasis: what a dermatologist needs to knowJ Clin Aesthet Dermatol. 2015;8(3):43–45.

  18. Genetics Home Reference. Psoriatic arthritis. Updated December 10, 2019.