Psoriatic arthritis is common among people with psoriasis, according to the National Psoriasis Foundation (NPF), affecting about one in three, and often developing about 10 years after psoriasis does. And while the exact cause of psoriatic arthritis is still unknown, genetics play a key role. “There is a strong hereditary component, especially in first degree relatives. Certain genes are higher risk for creating the specific inflammation marker we see in psoriasis,” says Masoom Modi, MD, a rheumatologist and assistant clinical professor of medicine at the University of California in Los Angeles. Other factors that contribute to psoriatic arthritis risk include how much of your skin is affected by psoriasis, where the psoriasis is located, and whether you have any other autoimmune diseases, explains Dr. Modi. “Usually people with more severe psoriasis are at higher risk, as well as certain categories of psoriasis — inverse, scalp, psoriatic nail disease,” says Modi, adding, “Some people who have inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis, may carry a risk of developing psoriatic arthritis, or a subtype called enteropathic arthritis.” While you can’t control your genetics, new research suggests there are several risk factors you may be able to influence that can help you lower your odds of developing psoriatic arthritis down the line. Here are some things you can do to help keep psoriatic arthritis at bay. RELATED: 10 Signs It’s Time to Call Your Dermatologist About Psoriasis
Maintain a Healthy Weight to Lower Your Psoriatic Arthritis Risk
In a recent review in the March 2021 issue of the Journal of the American Academy of Dermatology, researchers looked at whether lifestyle factors affected risk of developing psoriatic arthritis among people with psoriasis. Interestingly, the study suggests that making certain changes, such as losing weight if you are overweight or obese, could make a difference. Participants in the study who were overweight or obese were found to have an increased psoriatic arthritis risk — and the higher their body mass index, or BMI, the higher their risk. According to a review published in June 2020 in Rheumatology and Therapy, this is likely because fat tissue plays a role in inflammation throughout the body. “There is no question there is a link between obesity and psoriasis, and that there is a higher link in those with obesity of developing psoriatic arthritis on top of psoriasis,” says Eric Ruderman, MD, a rheumatologist and professor of medicine in the division of rheumatology at Northwestern University Feinberg School of Medicine in Chicago. Maintaining a healthy weight plays a vital role in lowering psoriatic arthritis risk, says Modi. Not only can weight loss decrease inflammation in your body if you’re overweight or obese but it can also relieve stress on your joints and tendons, Modi adds. “Extra weight leads to higher demands on the joints and tendons, which can cascade into increased inflammation,” she says. So, how can you reach a healthy weight? One key step is to stick to a healthy, anti-inflammatory diet — which is often recommended for people with psoriasis or psoriatic arthritis, according to the NPF. Some anti-inflammatory foods you can try are:
TomatoesOlive oilNuts, including walnuts and almondsGreen leafy vegetables, such as kale and spinachFruit, such as cherries, blueberries, oranges, and strawberriesFatty fish, including salmon, tuna, sardines, and mackerel
Dr. Ruderman also recommends limiting processed foods and excess sugar. “A more balanced diet with lots of veggies is always encouraged. Diet is not one size fits all. This may also include going on an elimination diet [a short term diet where you cut out a particular food for two to four weeks to see if your symptoms decline, according to Harvard Health] to determine which foods may trigger your psoriatic arthritis symptoms,” he explains. On top of diet, staying physically active is another important part of any weight management toolbox. According to the NPF, people with psoriasis should aim to fit in 30 minutes of moderate exercise each day for at least five days a week, along with additional strength-training exercises. Wondering what exercises to try? The NPF specifically recommends yoga and tai chi to promote flexibility and range of motion.
Physical Trauma Could Raise Psoriatic Arthritis Risk
The March 2021 review article also showed that psoriatic arthritis risk was influenced by physical trauma, which could include fractures and other incidents requiring any type of medical care. Earlier research yielded similar findings: In a study published in June 2015 in Annals of the Rheumatic Diseases, researchers found that physical trauma, especially to bones and joints, was tied to an increased risk of psoriatic arthritis in people with psoriasis. So why might physical trauma raise your odds of developing psoriatic arthritis? According to the authors of the 2015 study, this is due to the Koebner phenomenon — a link between the development of psoriasis lesions after damage to the skin. And the same goes for damage to bones or joints caused by trauma, which experts call the “deep Koebner” effect. “We have seen [the Koebner phenomenon] more often in skin — for example, vitiligo, psoriasis,” says Modi. Wondering how can you protect yourself from the Koebner phenomenon if you have psoriasis? If you have a cut or other skin wound, be sure to promptly clean and dress it to avoid infection. And to prevent cuts during outdoor activities, wear long sleeves and pants when you can. RELATED: 10 Signs It’s Time to Call Your Dermatologist About Psoriasis
Care for Your Mental Health to Lower Your Odds of Developing Psoriatic Arthritis
Your mental health could play an important role in preventing psoriatic arthritis. In fact, Modi says stress and anxiety are underrated modifiable risk factors for psoriatic arthritis. “We tend to think that our mental health does not have an impact on our physical symptoms, when in fact, stress and anxiety have an impact on our bodies’ cortisol levels,” says Modi. “This can directly lead to disruptions in our metabolism and the inflammation cascade.” Incorporating self-care into your daily routine can give your mental health a boost. According to the Arthritis Foundation, self-care could include:
AcupunctureMassageYogaPhysical activityHealthy nutritionMeditationVisualizationSupport groups
While these strategies can all help, you may also want to talk with a psychologist or other therapist to discuss any mental health challenges you’re struggling with. RELATED: 7 Things You Should Know About Psoriatic Arthritis and Emotional Health
Last, But Not Least: Be Diligent About Your Psoriasis Medication
Modi adds that managing psoriasis with medication may play a role in staving off psoriatic arthritis. “Unfortunately, there is no preventive medication if you haven’t exhibited arthritic symptoms,” she says. “But if your doctor advises you to take therapy to prevent erosions or worsening damage — due to high inflammation, or other objective markers such as X-ray or MRI changes — there are several reasons to take it.” So if your doctor has told you to take psoriasis medication, it’s important you do so. “Your doctor didn’t prescribe this lightly,” says Modi. “If you have questions or doubts about a particular medication, talk to your doctor first before discontinuing it on your own.” RELATED: What to Do if Topical Treatments Aren’t Enough for Your Psoriasis
