Psoriatic Arthritis in Women

Women and men are equally affected by psoriatic arthritis but differ significantly in some key ways. Not only do women have specific vulnerabilities to developing the psoriatic arthritis, but they also tend to have poorer outcomes. Scientists are not entirely sure why this is and, to date, have offered few guidelines on how to better manage the disease in women.

Psoriatic arthritis belongs to a class of diseases known as spondyloarthropathies, the predominant features of which include inflammation and joint pain. With respect to psoriatic arthritis specifically, the location of the joint involvement varies significantly by sex.

Comparatively speaking:

While men with psoriatic arthritis tend to sustain greater joint damage, women will generally have worse symptoms overall. This is evidenced in part by a 2015 study in the Journal of Rheumatology in which investigators monitored 72 men and women with psoriatic arthritis for a period of five years. They found that:

• Men tend to show evidence of joint damage on X-ray far earlier than women.
• Women had a higher number of affected joints.
• Women have more severe symptoms, including pain, fatigue, and dactylitis (swollen, sausage-shaped fingers or toes).
• Women have lower quality-of-life scores.
• Women have greater work disability.
• Men have a better response to treatment and better chances of disease remission.

While pain perception may play a role in these differences given the subjectivity of some of the tests, the physiological expression of the disease was clearly demarcated between sexes. Further research is needed to determine if and how hormones, genes, and other factors contribute to these differences.

Pregnancy not only influences the risk of disease onset and flares, but it affects how psoriatic arthritis must be managed and treated. According to a 2015 study in the Annals of Brazilian Dermatology:

• One out of four women experience worsening of symptoms during pregnancy.
• Between 40% and 90% of women will experience a worsening of symptoms in the postpartum period (following delivery).
• For 30% to 40% of women with PsA, joint symptoms first appeared in the postpartum period.
• Changes in treatment are often required during pregnancy, including the avoidance of drugs like methotrexate, cyclosporine, acitretin, and Stelara (ustekinumab).

Both smoking and alcohol are risk factors for psoriatic arthritis. Although there has been little research to assess the difference in risk between men and women, several high-quality studies have been able to characterize the risk in women specifically.

This includes a 2011 study in the Annals of the Rheumatic Diseases that reviewed the medical histories of 84,874 female nurses in the United States. According to the study, former smokers had a 50% greater risk of developing psoriatic arthritis compared to non-smokers, while current smokers had no less than a three-fold increased risk of the disease.

Similarly, a 2016 study in the Journal of Rheumatology revealed that excessive alcohol use was associated with a higher risk of psoriatic arthritis in American women.

According to the study, drinking 15.0 to 29.9 grams of alcohol per day (roughly one and a half to three drinks) increased the risk of psoriatic arthritis by 43%, while drinking more than 30 grams increased the risk by over 400%.

Other risk factors have been identified in recent years that either increase the risk of psoriatic arthritis in women or give rise to comorbid (co-occurring) conditions. Among some of the key findings:

• A history of gallstones increases a woman's risk of having psoriasis with psoriatic arthritis by no less than 400%, according to a 2015 study in the British Journal of Dermatology.
• Hypercholesterolemia (high cholesterol) is associated with a 58% risk of psoriatic arthritis in women compared to a matched set of women with normal cholesterol, according to a 2013 study in Arthritis & Rheumatism. 
• Women with psoriatic arthritis have greater bone mineral loss and a higher risk of osteoporosis fractures than a matched set of women without the disease, according to a 2011 study in Arthritis Research & Therapy. They are also far more likely to develop metabolic syndrome.
• Temporomandibular disorders are more common in people with psoriatic arthritis than the general population, according to a 2015 study in the International Journal of Medical Sciences. Women, in general, are far are more affected by temporomandibular disorders than men.

A report from the National Psoriasis Foundation (NPF) strongly suggests that the emotional impact of psoriatic arthritis is greater in women than in men. This may be due to a societal pressure to "live up to" a certain definition of beauty that many women are affected by. Concerns about your appearance and how others perceive you can take a toll on your self-confidence and interpersonal relationships.

Moreover, the stress associated with the disease can significantly undermine your mental health, increasing the risk of alcohol abuse, depression, weight gain, and smoking. The NPF report suggests that no less than 60% of women with psoriatic disease report a diminished quality of life as a result of chronic or recurrent symptoms.

If you are depressed or are unable to cope, it is important to speak with your doctor and seek help from a mental health professional. Doing so may not only improve your state of mind but reduce your risk of flares.