Certain underlying health conditions are more common in people with psoriatic arthritis (PsA) than in the general population. Some people may have these conditions before their PsA diagnosis, while others may develop them as a complication (a result of the disease or its treatment).

PsA is a chronic (long-term) autoimmune condition that affects the joints and the areas where the tendons and ligaments connect to bone. This causes joint pain, tenderness, swelling, swollen fingers, and morning stiffness similar to rheumatoid arthritis.

Continue reading to learn more about conditions related to PsA and complications that can occur throughout the course of the disease.

What Are Common Comorbidities of PsA?

When someone has more than one health condition at the same time, these are called comorbidities.

According to the Arthritis Foundation, more than half of people living with PsA have at least one comorbid condition, and 40 percent have at least three comorbidities. In light of this, it’s important to manage your PsA with proper treatment. Doing so can lower your risk of developing other related conditions and help improve your health.

Cardiovascular Disease

People with PsA are more likely to develop cardiovascular (heart) disease. Research shows that people with PsA are 43 percent more likely to develop cardiovascular disease than those living without the condition. In addition, those with PsA have a 22 percent increased risk of developing cerebrovascular disease (such as stroke), which reduces blood flow to the brain.

In PsA, the immune system doesn’t work properly, which can lead to inflammation all over the body. The inflammation can affect the lining of blood vessels, which can cause the buildup of fatty plaques known as atherosclerosis. In turn, atherosclerosis can block blood flow through the vessels and arteries, potentially leading to serious complications, including heart attacks (also known as myocardial infarctions) or other issues, such as:

• Ischemic heart disease (inadequate blood supply to the heart)
• Peripheral vascular disease (problems in arteries throughout the body)
• Stroke (blocked blood supply to the brain)
• Pulmonary hypertension (high blood pressure in the lungs)
• Arrhythmia (irregular heartbeat)

Metabolic Syndrome

Metabolic syndrome refers to a group of conditions involving metabolic processes that regulate blood pressure, blood sugar, cholesterol, and body fat. Metabolic syndrome is a risk factor for other medical problems, such as stroke, heart disease, and type 2 diabetes mellitus. The set of conditions includes:

• Hypertension (high blood pressure)
• Large waistline
• High blood sugar levels
• Low “good” cholesterol (HDL)
• High blood triglycerides

Metabolic syndrome is very common. It’s estimated that 1 in 3 adults in the United States have this condition. Studies show that people with PsA are more likely to develop metabolic syndrome. This is related to the fact that people with PsA have an increased risk of obesity (characterized by a body mass index greater than 30) and type 2 diabetes. It’s estimated that about 45 percent of people with PsA have obesity. Additionally, people with PsA are about 43 percent more likely to develop diabetes compared to the general public.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is marked by chronic inflammation in the stomach, intestines, and colon. The two main types of IBD are ulcerative colitis and Crohn’s disease. These conditions can cause symptoms, such as:

• Vomiting
• Diarrhea
• Loss of appetite
• Weight loss
• Abdominal pain
• Damage to the intestines or other parts of the gastrointestinal tract

Many types of inflammatory arthritis — including PsA, reactive arthritis, and ankylosing spondylitis — are more common in people with IBD. Research shows that people with PsA, psoriasis, and ankylosing spondylitis can have as much as a four-fold increased risk of developing IBD compared to those without the conditions. The more severe your PsA, the higher your risk of developing IBD.

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a lung disease caused by inflammation in the lungs and airways. Symptoms include difficulty breathing, coughing, and wheezing. While the most common cause of COPD is smoking, inflammation from rheumatic diseases can also contribute to its development.

People with PsA have a higher risk of developing COPD compared to the general population. Researchers found that 11.5 percent of people with early PsA and 9.4 percent of people who have had PsA for more than two years had COPD.

Metabolic Dysfunction-Associated Steatotic Liver Disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) — previously known as nonalcoholic fatty liver disease (NAFLD) — is a liver disease associated with increased liver fat and liver inflammation that isn’t caused by drinking alcohol. MASLD is associated with metabolic syndrome. If it’s not treated, it can lead to cirrhosis (liver scarring) and liver cancer.

It’s estimated that around 25 percent of the general population has MASLD. In contrast, one study found that 65 percent of people with PsA have fatty liver disease. Increased risk of MASLD in people with PsA may be related to increased levels of inflammation and higher rates of obesity and type 2 diabetes.

MASLD can also complicate treatment and is associated with more severe clinical symptoms in people with PsA compared to those without it.

Uveitis

Uveitis is a type of inflammation found in the eye that affects the middle layer of tissue, known as the uvea. Uveitis symptoms can develop suddenly and quickly get worse. If you experience any of these symptoms, contact a health care provider immediately:

• Eye pain and redness
• Blurred or decreased vision
• Sensitivity to light
• Floaters (dark, floating spots in your vision)

Around 25 percent of people with PsA develop uveitis. Uveitis symptoms tend to appear more slowly in people with PsA. It’s important to contact your health care provider right away if you notice any changes in your vision. If uveitis isn’t treated, it can lead to permanent vision loss or other serious eye complications.

Anxiety and Depression

Depression and anxiety are commonly linked to PsA because this condition can affect both personal and social aspects of life. Research shows about 20 percent of people with PsA are living with depression, and inflammation plays a role in the association between the two conditions. Many people with PsA also have other comorbidities and complications, which can negatively affect their quality of life. Additionally, people with depression may be less likely to achieve remission (periods of reduced disease activity).

Symptoms of depression can include:

• Irritability
• Tiredness
• Feelings of sadness, hopelessness, or emptiness
• Changes in sleeping and eating patterns
• Reduced interest in activities you once liked
• Suicidal thoughts
• Trouble focusing or sitting still
• Feelings of worthlessness or guilt
• Difficulty making decisions

If you’re experiencing any of these symptoms, talk to your health care provider about treatment options. It’s important to take care of yourself both mentally and physically. Options can include:

• Medication, such as antidepressants
• Therapy or counseling
• Support groups or group therapy
• Healthy lifestyle habits, such as getting regular exercise and quality sleep

What Are the Common Complications of PsA?

Knowing your comorbidities can also help guide your PsA treatment to minimize complications. A complication refers to a medical issue that makes treating an existing disease more difficult. Complications can occur as a result of the disease itself, its treatment, or unrelated factors. Comorbidities, which are additional health conditions, can also be considered complications.

Joint Damage and Deformity

Severe PsA can cause permanent joint damage in some cases. About 5 percent of people with PsA have a severe form of the disease called arthritis mutilans. Arthritis mutilans involves severe inflammation that slowly destroys the bones in the hands and feet, leading to permanent disability and deformity.

Functional Limitations

PsA symptoms can affect many parts of your life. Stiff and sore joints and reduced range of motion can impact your ability to complete daily tasks. These symptoms may result in reduced productivity and more days off from work.

A 2023 study looked at 300 people with psoriasis and PsA and found that 19 of those with PsA had significant difficulty performing daily tasks. After hands, the most commonly affected joints are the feet and toes, knees, and lower back. When these joints are affected, it can make it more difficult to move and get around.

The Impact of Comorbidities and Complications

Some comorbidities and complications of PsA can affect your health and quality of life more than others. If you have any of these underlying health conditions, it’s important to speak with your health care provider about how to manage and treat them. Addressing these conditions can help you lead a healthier, more comfortable life.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis. On MyPsoriasisTeam, more than 131,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis and psoriatic arthritis.

Do you have other health conditions in addition to PsA? How have PsA comorbidities and complications affected your PsA treatment? Share your experience in the comments below, or start a conversation on your Activities page.