An Overview of Psoriatic Arthritis Triggers

Psoriatic arthritis (PsA) is a type of inflammatory arthritis that affects about seven Americans in 100,000. PsA primarily affects the joints and the skin. It can be painful, tiring, and weakening.

Researchers know that psoriatic arthritis flares when the immune system becomes overactive and creates inflammation, which leads to pain and swelling. They just don't know why it becomes overactive in the first place.

This article describes the eight primary triggers of psoriatic arthritis. It also explains how the symptoms and treatment options can vary.

Psoriasis Is Common

Psoriasis is one of the most common immune-mediated diseases that afflict adults in the United States.

What Is Psoriatic Arthritis?

Psoriatic arthritis (PsA) primarily affects people with psoriasis, an inflammatory condition in which skin cells first build up quickly and then turn to scales. The scales are usually whitish-silver before they turn into thick, red patches. Most people with PsA are diagnosed with psoriasis first, but it's possible to have joint symptoms before skin lesions occur.

Psoriatic arthritis often appears in people when they are between the ages of 30 and 50 and about 10 years after they develop psoriasis. However, some people develop PsA without ever developing or noticing psoriasis.

When severe, PsA can affect the fingers, toes, and spine. Both psoriasis and PsA are known for flare-ups—periods of high activity—and periods of remission, where symptoms are mild or mostly absent. 

psoriatic arthritis v. psoriasis
Verywell / Alexandra Gordon

Understanding Triggers

The causes of psoriasis and PsA are unknown. Researchers think a combination of genes and exposure to external triggers cause people to develop PsA. About 40% of people with PsA have at least one close family member with psoriasis or psoriatic arthritis. 

Many people with psoriasis will go on to develop PsA. Still, having genetic risk factors does not mean someone will necessarily develop psoriasis or PsA. Some of the same external triggers are also responsible for disease flare-ups and worsening symptoms. 

Psoriatic Arthritis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Stress

Dealing with psoriasis skin symptoms can be stressful enough, and most people with PsA report skin outbreaks during stressful times. One United Kingdom study found that people with PsA were more prone to increases in joint pain, psoriasis plaques, and/or fatigue when dealing with the psychological aspects of the disease.   

Illness

Certain illnesses, such as strep throat and the flu, can worsen symptoms in people with PsA. People with HIV and other conditions that compromise immune function can experience flare-ups of symptoms when the other conditions are not properly managed.

Give PsA the Big Chill

Staying healthy over the winter can take a concerted effort. Some common sense steps include exercising, eating well, getting plenty of rest, and taking vitamins. Avoiding close contact with people who are ill ought to help, too.

Skin Trauma

Skin trauma includes bruises, cuts, scrapes, infections, sunburns, and tattoos. Skin trauma may also trigger joint symptoms. The link between injury and flares is related to abnormal inflammatory responses.  

People with PsA can prevent skin trauma by wearing gloves when cooking, gardening, or shaving. Wearing long sleeves when performing activities that may cause injury is also a good idea. And wearing sunscreen can prevent sunburns.

Drug Interactions

Certain medications, such as those for treating bipolar disorder, high blood pressure, heart disease, and malaria can trigger PsA symptoms. Drug interaction concerns should be discussed with a primary care physician.

Alcohol and Cigarette Smoke

Both alcohol and smoking can worsen PsA and psoriasis symptoms. Quitting smoking may help to clear skin and improve overall health.

Alcohol can also interfere with the effectiveness of medications for treating PsA. One study in the International Journal of Dermatology confirmed that alcohol can intensify psoriasis symptoms. This study also found an increase in alcohol-related deaths in people with psoriasis as compared to those without the condition.

Diet

Diet can either intensify PsA symptoms or improve them. Certain foods, including gluten, sugar, and processed foods, may act as PsA flare triggers.  

There is also evidence that some foods can reduce inflammation in the body. Inflammation-combating foods include omega-3 fatty acids such as fatty fish, olive oil, flaxseed and walnuts, and colorful vegetables loaded with high levels of antioxidants. This group includes carrots, spinach, kale, blueberries, and strawberries.

Food Fights Inflammation

Harvard Medical School says that "one of the most powerful tools to combat inflammation comes not from the pharmacy but from the grocery store."

— Food Fights Inflammation

Cold and Dry Weather

Cold and dry weather can trigger PsA symptoms. At the same time, PsA pain, stiffness, and swelling may increase with cold, damp weather and barometric pressure changes.

While several studies have found a link between arthritis pain and changes in weather and barometric pressure, other researchers conclude there is no link between back pain and rain, temperature, humidity, or air pressure. The findings remain contradictory until more research can be done.

Symptoms

Symptoms of psoriatic arthritis vary greatly from one person to another. The symptoms could include:

  • Eye inflammation, especially uveitis, or inflammation of the middle layer of the eye; redness, eye pain, and blurry vision can develop and must be treated quickly to avoid vision loss
  • Fatigue and/or a lack of energy
  • Inflammatory bowel disease, which triggers inflammation in the digestive tract
  • Joint stiffness, pain, and swelling of one or more joints; the joints of the spine can also be affected, causing stiffness in the neck, lower back, and hips
  • Nail changes, such as pitting (tiny dents) or crumbling; nails can also separate from the nail bed
  • Painful swelling of a whole finger or toe
  • Scaly, inflamed patches of skin, often on the scalp, elbows, or knees
  • Tenderness in entheses, areas where tendons or ligaments attach to bones, such as the back of the heel and sole of the foot

Risk Factors Lurk


Fatigue isn't the only possible complication of psoriatic arthritis. Diabetes, high blood pressure, high cholesterol, and obesity are other risk factors.


Treatments

Treatment of psoriatic arthritis depends on a patient's symptoms, age, and general health as well as the status of the condition. Early diagnosis and treatment can help blunt joint damage. Some types of medication may help, too, including:

  • Biologic medicines (to ease inflammation)
  • Corticosteroids (also to relieve inflammation)
  • Nonsteroidal anti-inflammatory medicines (NSAIDs) to ease symptoms and immunosuppressive medicines (such as methotrexate) to reduce inflammation if the NSAIDs don't work
  • Vitamins and minerals, such as calcium and vitamin D, to slow bone deformation

Other treatments may include:

  • Exercise
  • Heat and cold
  • Management of psoriasis skin rash
  • Occupational therapy to help with daily activities
  • Physical therapy to aid muscle and joint function
  • Splints
  • Surgery to repair or replace a damaged joint—a remedy that often doesn't come until years after a diagnosis
  • Ultraviolet light treatment

Therapies

The goal of physical therapy is to improve a patient’s ability to move their bodies and manage their pain. The goal of occupational therapy is to help a patient regain their ability to undertake day-to-day tasks on their own.

No Known Cure

Treatment often becomes a high priority for people with PsA or psoriasis because there is no cure. The goal of treatment turns to slowing the progression of the disease, reducing pain, and protecting the joints.

PsA can cause complications and even disability if it's not managed properly.

Activity Matters

Good exercises for people with PsA include bicycling, swimming, walking, and yoga.

Summary

Psoriatic arthritis (PsA) is a type of inflammatory arthritis in which skin cells first build up quickly and then turn to scales. The scales are usually whitish-silver before they turn into thick, red patches. Most people with PsA are diagnosed with psoriasis first. There are eight primary triggers of psoriatic arthritis: stress, illness, skin trauma, drug interactions, alcohol and cigarette smoke, diet, and dry and cold weather. Symptoms can vary widely, and so can treatment options. Since there is no cure for PsA, treatment often focuses on relieving pain and slowing the progression of the condition.

A Word From Verywell

The National Psoriasis Foundation calls psoriasis "a challenge, not a roadblock." Adopting the right mindset about exercise can help make this statement more than a platitude. The foundation advises against overdoing it or trying to go for "Olympic gold" right from the start. It recommends a slow-and-steady approach: "If you were active before you had PsA, try to maintain a regimen as close to your old normal as possible. If you were inactive, start small." If you're stumped for an exercise plan that is both productive and enjoyable, consider consulting a fitness or health professional for ideas.

Was this page helpful?
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Liu JT, Yeh HM, Liu SY, Chen KT. Psoriatic arthritis: Epidemiology, diagnosis, and treatment. World J Orthop. 2014;5(4):537-43. doi:10.5312/wjo.v5.i4.537.

  2. National Institutes of Health. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Psoriatic arthritis.

  3. Armstrong AW, Mehta MD, Schupp CW, Gondo GC, Bell SJ, Griffiths CEM. Psoriasis prevalence in adults in the United StatesJAMA Dermatol. 2021;157(8):940–946. doi:10.1001/jamadermatol.2021.2007.

  4. National Psoriasis Foundation. Living with psoriatic arthritis.

  5. National Institutes of Health. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Psoriatic arthritis.

  6. Moverley AR, Vinall-collier KA, Helliwell PS. It's not just the joints, it's the whole thing: Qualitative analysis of patients' experience of flare in psoriatic arthritis. Rheumatology (Oxford). 2015;54(8):1448-53. doi:10.1093/rheumatology/kev009.

  7. National Psoriasis Foundation. Protect yourself from a nasty flu season.

  8. Arthritis Foundation. Managing psoriatic arthritis flares.

  9. Cassano N, Vestita M, Apruzzi D, Vena GA. Alcohol, psoriasis, liver disease, and anti-psoriasis drugs. Int J Dermatol. 2011;50(11):1323-31. doi:10.1111/j.1365-4632.2011.05100.x.

  10. Ford AR, Siegel M, Bagel J, et al. Dietary recommendations for adults with psoriasis or psoriatic arthritis from the medical board of the National Psoriasis Foundation: A systematic review. JAMA Dermatol. 2018;154(8):934-950. doi:10.1001/jamadermatol.2018.1412.

  11. Harvard Medical School. Foods that fight inflammation.

  12. Harvard Medical School. Does weather affect arthritis pain?

  13. Johns Hopkins Medicine. Psoriatic arthritis.

Additional Reading