9 Psoriatic Arthritis Complications

Diabetes, heart disease, and cancer are among the concerns

Psoriatic arthritis is a complex disease that mainly affects the joints but that can also cause problems in other parts of the body. Over time, the persistent inflammation may begin to affect the eyes, bones, heart, and liver, and increase the risk of certain diseases, including diabetes and cancer. These complications of psoriatic arthritis may seem disconnected from what you're experiencing as the result of your disease right now, but their reality underscores the importance of good care.

The risk of complications may be reduced if the disease is diagnosed and treated early. By slowing the progression of psoriatic arthritis, you can avoid many of the more severe manifestations of the autoimmune disorder and maintain a high quality of life.

Here are nine 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% of people with psoriatic arthritis develop uveitis, leading to eye redness, swelling, blurring, and floaters.

Uveitis is closely linked to blepharitis (eyelid inflammation), a condition caused when psoriatic plaques alter the shape of the eyelid. This can lead to eye dryness and irritation as eyelashes scrape against the eyeball. Both of these symptoms can contribute to the development of uveitis.

Obesity

There is a known link between psoriatic arthritis and obesity. Because of the effect inflammation has on blood sugar and metabolism, obesity occurs at a higher rate in people with psoriatic arthritis (27.6%) than the general population (22%). The risk is especially high in those with spinal involvement.

On the flip side, a 2010 study in the Archives of Dermatology showed that obesity before the age of 18 not only increases the risk of psoriatic arthritis but leads to the earlier onset of joint symptoms.

Losing weight may help reduce the risk of psoriatic arthritis. If you already have the disease, it may decrease the frequency or severity of acute flares.

Metabolic Syndrome

Metabolic syndrome is a cluster of conditions that includes high blood pressure, high blood sugar, excess fat around the waist, and abnormal cholesterol levels. For reasons not entirely understood, psoriatic arthritis jumps one's risk of metabolic syndrome from 23% to 44%.

Psoriatic inflammation is believed to have a twofold effect on the body. On the one hand, it diminishes organ function, making it harder to control blood sugar and blood pressure. On the other, it increases inflammatory proteins called cytokines that alters insulin sensitivity and increase "bad" LDL cholesterol levels. All of these things contribute to weight gain and obesity.

Older age and worsening psoriatic arthritis symptoms are associated with an increased risk of metabolic syndrome. In contrast, the length of time a person has psoriatic arthritis does not affect the risk.

Type 2 Diabetes

Psoriatic arthritis is closely linked to type 2 diabetes. According to a 2013 review in JAMA Dermatology, mild psoriatic arthritis increases the risk by 53%, while severe psoriatic arthritis nearly doubles the risk.

This phenomenon can be explained, in part, by the impact metabolic syndrome has on blood sugar. Metabolic syndrome is known to reduce insulin sensitivity (the ability to absorb sugar from the bloodstream). On top of that, long-term inflammation can undermine the function of the pancreas, reducing the amount of insulin that it produces.

This strongly suggests that the early, effective treatment of psoriatic arthritis may reduce the risk of diabetes irrespective of all other factors.

Cardiovascular Disease

Heart disease, already a concern with many older adults, may be all the more worrisome in people with psoriatic arthritis. According to a 2016 study in Arthritis Care & Research, psoriatic arthritis as an independent risk factor increases the risk of cardiovascular disease by 43% compared to the general population.

This is partly due to the high incidence of metabolic syndrome in people with psoriatic arthritis, but other factors also contribute. Chief among these is the effect that chronic inflammation has on blood vessels, causing arterial walls to stiffen and narrow. This increases the risk of atherosclerosis, heart attack, and stroke. The risk is highest in people over 70.

Osteoporosis

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

For example, joint pain and stiffness can 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 in older adults can lead to calcium and vitamin D deficiencies, causing the abnormal thinning of bones. 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

As an autoimmune disease, psoriatic arthritis is characterized by an immune system gone awry. A similar thing occurs with inflammatory bowel disease (IBD), a group of intestinal disorders believed to have autoimmune characteristics.

In recent years, scientists have found a close link between psoriatic arthritis and IBD, specifically Crohn's disease and ulcerative colitis. A comprehensive 2018 review of studies in JAMA Dermatology concluded that 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.

The cause for this is not entirely clear, although each of the three diseases is characterized by chronic inflammation. It has been suggested that psoriatic arthritis and Crohn's disease have similar genetic characteristics and many of the same gene mutations.

Non-Alcoholic Fatty Liver Disease

The liver is frequently impacted by the "spillover" of inflammation from psoriatic arthritis, especially in people with obesity, type 2 diabetes, high cholesterol, and insulin resistance. This translates to an increased risk of a liver disorder known as non-alcoholic fatty liver disease (NAFLD).

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

People with untreated psoriatic arthritis and non-alcoholic liver disease not only have worse joint symptoms, but a higher degree of fibrosis (liver scarring).

Cancer

Although it is unclear how psoriatic arthritis contributes to the development of cancer, researchers have found patterns in how certain autoimmune diseases increase the risk of blood and/or solid tumor malignancies. According to a 2016 study in Clinical Rheumatology:

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

Scientists have several theories as to why this occurs. For one, the systemic inflammation caused by these autoimmune disorders places stress on blood cells, increasing the risk of blood cancers like leukemia or lymphoma.

Others contend that each disease has its own type of inflammation. Differences in autoimmune cells (called autoantibodies) trigger different types of cytokines, including tumor necrosis factor (TNF) and interleukin. Some of these may be more damaging to the DNA of skin cells, while others may cause harm to lung cells. This could explain why the risk of breast cancer is high with psoriatic arthritis but not with psoriasis or rheumatoid arthritis.

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

Was this page helpful?

Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. De Azevedo Fraga , De Oliveira M, Follador I, et al. Psoriasis and uveitis: a literature review. An Bras Dermatol. 2012 Nov-Dec; 87(6): 87-83. doi:10.1590/S0365-05962012000600009

  2. Queiro R, Lorenzo A, Tejón P, Coto P, Pardo E. Obesity in psoriatic arthritis: Comparative prevalence and associated factors. Medicine (Baltimore). 2019;98(28):e16400. doi:10.1097/MD.0000000000016400

  3. Soltani-Arabshahi R, Wong B, Feng B, et al. Obesity in early adulthood as a risk factor for psoriatic arthritisArch Dermatol. 2010 Jul;146(7):721-6. doi:10.1001/archdermatol.2010.141

  4. Gelfand JM, Yeung H. Metabolic syndrome in patients with psoriatic disease. J Rheumatol Suppl. 2012;89:24-8. doi:10.3899/jrheum.120237

  5. Armstrong A, Harskamp C, Armstrong E. Psoriasis and the risk of diabetes mellitus: a systematic review and meta-analysis. JAMA Dermatol. 2013 Jan;149(1):84-91. doi:10.1001/2013.jamadermatol.406

  6. Polachek A, Touma Z, Anderson M, Eder L. Risk of Cardiovascular Morbidity in Patients With Psoriatic Arthritis: A Meta-Analysis of Observational Studies. Arthritis Care Res (Hoboken). 2017;69(1):67-74. doi:10.1002/acr.22926

  7. Zhu T, Griffith J, Qin L, et al. Density, structure, and strength of the distal radius in patients with psoriatic arthritis: the role of inflammation and cardiovascular risk factors. Osteoporos Int. 2015 Jan;26(1):261-72. doi:10.1007/s00198-014-2858-3

  8. Fu Y, Lee C, Chi C, et al. Association of Psoriasis With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. JAMA Dermatol. 2018;154(12):1417-23. doi:10.1001/jamadermatol.2018.3631

  9. Prussick R, Prussick L, Nussbaumah D. Nonalcoholic Fatty Liver Disease and Psoriasis: What a Dermatologist Needs to Know. J Clin Aesthet Dermatol. 2015 Mar;8(3):43-5. PMID:25852814

  10. Wilton K, Crowson C, Matteson E. Malignancy Incidence in Patients with Psoriatic Arthritis: A Comparison Cohort-Based Incidence Study. Clin Rheumatol. 2016 Oct;35(10):2603-7. doi:10.1007/s10067-016-3396-5