10 Uncommon Complications of Psoriatic Arthritis
Beth Howard | Jan 9, 2018
If you have psoriatic arthritis, you know to expect flare-ups of red, patchy skin, skin lesions, pain, swelling, and stiffness in your body’s joints. But people with the condition can encounter other health problems due to the condition or its treatments. “Often if you can catch problems early enough, you can stop them before they cause damage,” says Stuart Kaplan, M.D., chief of rheumatology at South Nassau Communities Hospital in Oceanside, NY. Here are complications to watch for.
Back and neck pain
As many as 40 percent of people with psoriatic arthritis have pain in the spine, research shows. Pain occurs when there is inflammation in the joints between the vertebrae, called psoriatic spondylitis, or in the joints between the spine and pelvis, called sacroiliitis, Dr. Kaplan says. This pain can occur on just one side of the body. While sacroiliitis triggers pain and stiffness in the lower back, spondylitis can affect the lower and upper back as well as the neck.
Eye pain and vision problems
Inflammation of the uvea — the eye’s middle layer — affects about 7 percent of people with psoriatic arthritis, according to the Arthritis Foundation. Uveitis, as it’s called, can cause pain, floaters, and blurring and can lead to cataracts, vision loss, glaucoma, and detached retina. It’s important to see an ophthalmologist to get a correct diagnosis. Treatment with corticosteroids, disease-modifying antirheumatic drugs (DMARDs) and biologics can alleviate the problem before the damage is severe.
About 5 percent of people with psoriatic arthritis can develop arthritis mutilans, a severe form of the disease that affects the joints of the hands and feet, according to the Arthritis Foundation. With arthritis mutilans, the joints of the feet and hands start to erode and shorten and the skin tissue around the joints contracts, causing permanent damage. The good news: [Research](https://www.ncbi.nlm.nih.gov/pubmed/193638 60) shows that treatment with biologics can prevent this damage.
“With any type of inflammatory arthritis that we treat with immuno-suppressant agents, you can have complications related to the treatments, especially the newer biologic treatments,” says Dr. Kaplan. “Infection is one of them.” Among people with psoriatic arthritis, viral infections and infections treated with antibiotics are more prevalent than in healthy people.
Data suggest that people with psoriatic arthritis are more prone to cardiovascular complications like high blood pressure and heart attacks. Hypertension and angina — chest pain due to poor blood flow — are almost twice as likely among patients than people in the general population, and those with psoriatic arthritis have nearly a three-fold higher risk of having a heart attack. Fortunately TNF inhibitors, a type of biologic treatment, can cut the risk of cardiovascular events, research shows.
Anxiety and depression
One in five patients with psoriatic arthritis contends with mood disorders — a significantly higher rate than in patients with psoriasis without arthritis (9 percent) and the population at large, research shows. Chronic pain and worries about having visible skin problems may explain the high prevalence. Ask your doctor about treatments, which can include antidepressants, behavioral counseling, and exercise.
The same study found that people with psoriatic arthritis develop type 2 diabetes at a higher rate than those without the condition, putting them at risk for a host of additional problems — including heart disease, visual loss, and kidney disease — if blood sugar levels aren’t controlled. One explanation: “Treatment with corticosteroids can make you more susceptible to diabetes,” Dr. Kaplan says.
The prevalence of neurologic conditions, including neuropathy (weakness, numbness, and pain, particularly in your hands and feet) and seizures, was about 9 percent in psoriatic arthritis patients, significantly higher than in people with psoriasis without arthritis. Research suggests this can be related to peripheral neuropathy due to the presence of diabetes or carpal tunnel syndrome resulting from inflammation and swelling in the wrist joints.
A recent study found that psoriatic arthritis was linked to several GI conditions, including Crohn’s disease, ulcerative colitis, reflux esophagitis, peptic ulcer disease, and irritable bowel syndrome. The association held even after researchers accounted for known disease risk factors. Talk with your doctor if gastrointestinal problems arise to get a proper diagnosis and treatment.
Data suggest that people with psoriatic arthritis are particularly prone to obesity. A 2015 study found that overweight and obese people with the condition were almost 50 percent less likely to get relief from their pain, joint swelling, and skin problems. To avoid this complication and its consequences, emphasize plant foods in your diet, minimize saturated fat and trans fats, and find an exercise routine that works for you.