Causes of Psoriatic Arthritis, Plus Risk Factors and Triggers

Like psoriasis, PsA is an autoimmune disease. In an autoimmune disease, the immune system mistakenly attacks healthy tissues in the body. Other examples of autoimmune diseases are rheumatoid arthritis (RA) and lupus.

When the immune system attacks healthy tissues, it can lead to inflammation and tissue damage. This is what causes the symptoms of PsA.

However, it’s currently unclear why the immune system acts in this way in PsA. A complex mix of genetic and environmental influences are believed to play a role in the development of the condition.

Genetic influences

The most well-studied genes associated with PsA are those in the human leukocyte antigen (HLA) complex. This is a group of genes that helps your immune system to tell the difference between its own proteins and those of pathogens like bacteria and viruses.

HLA genes naturally have many variations, which help the immune system to respond to a multitude of foreign proteins. However, some HLA variations are associated with different types of PsA, as well as PsA severity and progression.

Several other non-HLA genes have also been associated with PsA. These genes are involved in controlling different aspects of immune system signaling and activation.

Environmental influences

Several different environmental factors have been identified as having a role in the development of PsA, particularly in individuals who have a genetic predisposition for the condition. Scientists are still working to learn more about this topic.

Some of the potential environmental factors that may contribute to the development of PsA include:

• infections, such as those with Streptococcus bacteria
• physical injuries or trauma
• physical or psychological stress, such as frequently lifting heavy loads or moving to a new house

Now let’s examine some of the risk factors associated with PsA. A risk factor is anything that increases your likelihood of developing a condition.

Having psoriasis

If you have psoriasis, you’re more likely to develop PsA. According to the National Psoriasis Foundation, about 30 percent of people with psoriasis also have PsA.

Most of the time, PsA develops after an individual has been diagnosed with psoriasis. However, in about 17 percent of people with PsA, arthritic symptoms come on prior to the skin symptoms of psoriasis.

Age

PsA typically develops years after the onset of psoriasis. As such, it most often occurs in individuals between the ages of 30 and 50. Younger individuals can also develop PsA, although this is less common.

Family history

PsA can run in families. In fact, it’s estimated that between 33 and 50 percent of people with PsA have at least one close family member who has either psoriasis or PsA.

Because of this, if you have a close family member, such as a parent or sibling, who has psoriasis or PsA, you may be at an increased risk of developing one or both conditions.

Psoriasis symptoms

Cohort and population-based studies of individuals with psoriasis have identified some types of psoriasis symptoms as risk factors for the development of PsA. These include:

• severe psoriasis
• psoriasis that impacts the scalp or buttocks
• nail changes, such as pitting or cracking
• uveitis

Having obesity

Some studies have identified having obesity as a risk factor for developing PsA in people with psoriasis. The risk of PsA was observed to rise with increasing body mass index (BMI).

Environmental exposures

As we discussed earlier, along with genetic factors, certain environmental factors are associated with the onset of PsA in people with psoriasis. As such, if you have psoriasis, exposure to the following may raise your risk of PsA:

• certain infections
• physical injuries or trauma
• physical or psychological stress

PsA symptoms can sometimes get worse over a period of time. This is called a flare-up. During a PsA flare-up, it’s possible to experience increased:

• symptoms in affected joints, such as:
  • pain
  • stiffness
  • swelling
  • warmth
• skin symptoms of psoriasis
• fatigue
• psychological symptoms, such as depression or anxiety

PsA flare-ups can be triggered by a variety of things. Because the immune response is dysregulated in PsA, the flare-up triggers are often things that increase inflammation in the body, particularly if they impact the skin or joints.

Some PsA flare-up triggers to be aware of include:

• skipping or stopping your psoriasis or PsA medications
• stress
• strain on your joints, due to things like physical labor or having overweight or obesity
• physical injury or trauma such as bumps, blows, or falls
• dry skin
• injury or trauma to your skin, which can happen due to things like:
  • cuts or scrapes
  • sunburns
  • dermatitis
  • bug bites
  • skin infections
  • getting a tattoo or piercing
• infections like strep throat or the flu
• smoking
• frequent or heavy alcohol consumption
• cold, dry weather
• certain medications, such as:
  • lithium
  • beta-blockers
  • antimalarial drugs

It’s important to note that the things that trigger a PsA flare-up can vary between individuals. If you have PsA, it’s important to determine what your flare-up triggers are so that you can take steps to avoid them.

While not all PsA flare-up triggers can be avoided, there are some lifestyle changes that you can implement in your daily life to help prevent PsA flare-ups from happening. Let’s take a look at these now.

Protect your skin

Injury or trauma to the skin can trigger flare-ups of PsA. There are many things that you can do in your day-to-day life to help protect your skin. Some tips include:

• Use a moisturizing lotion or cream regularly to keep your skin from drying out. Some times where it’s important to moisturize include:
  • after bathing or showering
  • after swimming
  • during weather that’s cold or dry
• When bathing or showering, try to keep the water temperature warm, not hot.
• Be sure to choose fragrance-free laundry and skin care products, which are less likely to lead to skin irritation.
• Use sunscreen and sun-protective clothing to prevent sunburn whenever you go outside.
• If you do have dermatitis or a bug bite, use a cool compress or anti-itch cream to ease itching. Resist the urge to scratch, as this can further irritate your skin.
• Treat any cuts or scrapes promptly.
• Avoid getting tattoos or piercings.

Take steps to lower stress

Stress a very common trigger for PsA flare-ups, so it’s important to explore effective ways to reduce stress in your day-to-day life. Some examples of things to consider include:

• getting regular exercise
• doing yoga
• trying out meditation
• using breathing exercises
• going for a walk outside
• listening to calming music
• curling up with a good book
• engaging in a hobby that you enjoy
• joining a support group for people with psoriasis or PsA

Consider food and drink

Drinking alcohol frequently or heavily can impact how your psoriasis or PsA medications work, potentially leading to a flare-up. Because of this, aim to consume alcohol in moderation.

It may also be helpful to introduce more anti-inflammatory foods into your diet. Some examples of such foods include:

• fresh vegetables like broccoli, spinach, and kale
• fresh fruits, such as berries, grapes, and tomatoes
• healthy fats like those found in fatty fish, avocados, and extra virgin olive oil
• whole grains
• spices with anti-inflammatory properties, such as turmeric and ginger

It’s also a good idea to cut out foods that can lead to inflammation. Some examples include fried foods, refined carbohydrates, and processed meats.

Quit smoking

Smoking is a risk factor for a variety of conditions and may also lead to PsA flare-ups. As such, it’s important to take steps to quit smoking. If you smoke, work with your doctor to develop a quit plan that you can stick to.

Mind your medications

Skipping or stopping your PsA medications can cause a flare-up. Because of this, always take your medications exactly as directed by your doctor.

Some types of medications can trigger PsA flare-ups. If you think that a medication is causing your PsA to flare, discuss it with your doctor. It’s possible that they can adjust the dosage or switch you to a different type of medication.

Never stop taking any medications without first consulting your doctor. Doing so could potentially be harmful to your health.

Keep a diary

If it’s still unclear what triggers your PsA flare-ups, it may be helpful to keep a diary to log things that happen in your day-to-day life. Some examples of things to include in your diary are:

• diet
• stress levels
• skin-care routines
• sleep quality
• recent illnesses
• medications or supplements you’ve taken
• any recent bumps, blows, or skin injuries

You can refer back to this diary when you experience a PsA flare-up in order to pinpoint what may be triggering your flare-ups to occur.

While medical management for PsA is important, social support is also vital. Many people with PsA can report feelings of anxiety or depression. Seeking support and connecting with others can help.

The National Psoriasis Foundation has a great deal of educational information about psoriasis and PsA. They also provide many different types of support resources, such as:

• the Patient Navigation Center, which can be accessed using phone, email, or online chat and aims to help you:
  • find a healthcare provider in your area
  • learn about different PsA treatment options
  • discuss health insurance and ways to lower the cost of medications
  • connect with other individuals with PsA
• MyPsoriasisTeam, which is a secure online community with over 90,000 members where you can connect with other individuals around the world that are living with psoriasis or PsA
• a library of podcasts, which provide up-to-date information about various psoriasis and PsA topics
• a list of events, either in-person or online, where you can interact with others that are living with psoriasis or PsA

The Arthritis Foundation provides information and resources for individuals with all types of arthritis, including PsA. Some of their support resources include:

• the Live Yes! Arthritis Network, which includes an online community and virtual group chat where you can meet other people who are sharing similar experiences
• a blog, which is updated regularly and covers a variety of arthritis-related topics

It may also be helpful to talk to your doctor about support resources. They can refer you to a mental health professional that specializes in helping people with chronic conditions and may also have information about PsA support groups near you.

PsA is an autoimmune disease where the immune system mistakenly attacks healthy tissue. The exact cause of PsA is unknown but is believed to be a complex combination of genetic and environmental factors.

There are also several risk factors that may increase the risk of PsA in people who have psoriasis. Some examples include family history, age, and having certain types of psoriasis symptoms.

Individuals living with PsA can also have periodic flare-ups, during which their symptoms worsen. These can have a variety of triggers, such as stress, skin injury, or skipping PsA medications.

There are several things that you can do in your daily life to help prevent PsA from flaring up. Examples include protecting your skin and reducing your stress levels. If you find that your PsA flares up frequently, be sure to see your doctor.