8 Psoriatic Arthritis Complications

Diabetes, heart disease, and cancer are among the concerns

Psoriatic arthritis is mainly characterized by its effect on the joints and skin. The symptoms of the disease are largely the result of the long-term inflammation arising from psoriasis. Over time, the persistent inflammation can affect other organ systems, sometimes significantly.

It is for this reason that early diagnosis and treatment are essential to slowing the progression of psoriatic arthritis and avoiding potentially serious complications.

Here are 8 complications of psoriatic arthritis you should know about:

Uveitis

Psoriatic arthritis increases the risk of an inflammatory eye condition known as uveitis. According to a 2012 review in the Annals of Brazilian Dermatology, around 7 percent of people with psoriatic arthritis are affected, leading to eye redness, swelling, blurring, and floaters.

Uveitis is closely linked to blepharitis (eyelid inflammation), the condition of which is caused when psoriatic plaques alter the shape of the eyelid. This can lead to eye dryness due to the lifting of the eyelid and irritation as eyelashes scrape against the eyeball. Both of these are key contributors to uveitis.

Type 2 Diabetes

People with psoriatic arthritis have an increased risk of developing type 2 diabetes. According to a 2013 review of studies in JAMA Dermatology, mild psoriatic arthritis increases the risk of type 2 diabetes by 53 percent, while severe diabetes nearly doubles the risk of the disease.

What this strongly suggests is that the early and effective treatment of psoriatic arthritis may reduce the risk of diabetes irrespective of all other factors.

Obesity and Metabolic Syndrome

There is a known link between psoriatic arthritis and obesity. This is evidenced in part by a 2010 study in the Archives of Dermatology which showed that obesity before the age of 18 not only increases the risk of psoriatic arthritis but leads to the earlier onset of disease symptom.

In addition, psoriatic arthritis nearly doubles your risk of metabolic syndrome—and, in turn, your risk of high blood pressure and heart disease—from 23 percent to 44 percent.

Losing weight may help you reverse the risk of psoriatic arthritis as well as reduce the recurrence of flares if you already the disease.

Cardiovascular Disease

People with psoriatic arthritis have a significantly higher risk of developing cardiovascular disease than the general population, says a 2016 study in the Annals of Rheumatic Diseases.

While this is due in part to the high incidence of metabolic syndrome in people with psoriatic arthritis, there are other biological factors that contribute.

Chief among these is the effect that chronic inflammation has on blood vessels, causing the walls to "harden (a condition referred to as atherosclerosis). Not surprisingly, the risk is highest in people over 70.

Given the increased risk, the early and sustained control of psoriatic arthritis should be considered central to the prevention of heart disease.

Osteoporosis

There is a close connection between osteoporosis and psoriatic arthritis, particularly in postmenopausal women who at an inherent risk of bone loss. While psoriatic inflammation is believed to accelerate bone loss, other factors may also contribute.

For example, joint pain and stiffness may lead to physical inactivity and weight gain, the latter of which amplifies inflammation. The use of corticosteroid drugs can inhibit bone growth, while nutritional deficits common in older people can lead to calcium and vitamin D deficiencies. Bone fractures are especially common in older women with psoriatic diseases.

A 2015 study in Osteoporosis International concluded that psoriatic arthritis increases the porosity of the outer surface of bones, called cortical bone, supporting the theory that inflammation is the key contributor to psoriatic bone loss.

Inflammatory Bowel Disease

There is a clear link between psoriatic arthritis and inflammatory bowel diseases such as Crohn's disease and ulcerative colitis.

A 2018 review of studies in JAMA Dermatology reported that, among nearly 6 million people included in the review, psoriatic arthritis was associated with a 1.7-fold increased risk of ulcerative colitis and a 2.5-fold increased risk of Crohn's disease.

It has also been suggested that psoriatic arthritis and Crohn's disease share similar genetic risk factors, including many of the same human leukocyte antigen (HLA) gene mutations.

Non-Alcoholic Fatty Liver Disease

People with psoriatic arthritis may be at greater risk for developing a liver condition known as non-alcoholic fatty liver disease (NAFLD).

According to a 2015 study from George Washington University, the risk of NAFLD was 1.5 times greater in people with psoriatic disease than those without. With that being said, it is unclear whether the two diseases are directly linked or if metabolic syndrome, common in both conditions, is the ultimate cause.

Whatever the underlying cause, people with NAFLD and untreated psoriatic arthritis typically experience worse skin symptoms and a higher degree of liver scarring (fibrosis).

Cancer

People with psoriatic arthritis have an increased risk of certain cancers. Interestingly, the types of malignancy differ from those associated with other autoimmune inflammatory diseases. According to a 2016 study in Clinical Rheumatology:

  • Psoriatic arthritis is closely associated with leukemia, lymphoma, and breast cancer
  • Psoriasis is closely linked to leukemia, lymphoma, and non-melanoma skin cancers.
  • Rheumatoid arthritis is closely linked to both lymphoma and lung cancer.

The reasons for these differences are unclear. Some hypothesize that the tissues targeted for inflammation may play a major role (such as with psoriasis and skin cancer). Other associations are far less clear.

People with psoriatic arthritis have a 64 percent increased risk of cancer compared to the general population. With that said, if the disease is properly controlled, there is no statistical difference in the risk of cancer in either group.

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