Can psoriatic arthritis get worse over time if not treated?

Joint pain

Synopsis

Yes. If untreated, psoriatic arthritis (PsA) can get worse over time and can cause permanent deformities and incapacities. If a general practitioner or dermatologist suspects that a patient is developing PsA, they will refer them to a rheumatologist who will be able to confirm the diagnosis. Up to 35% of people with psoriasis are eventually affected by PsA.

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Expert Answers

Dr. Marc Bourcier:

Yes, absolutely. It is important to remember that between 25 and 35 % of people with psoriasis will also develop psoriatic arthritis (PsA) at some point. Generally speaking, PsA will start to manifest 10 years after psoriasis and up to 30 years later, for some people. In rare cases, PsA will develop before psoriasis.

PsA can cause permanent deformities and incapacities, so it is important to treat it. Rheumatologists want to examine the patients as soon as possible, because some irreversible damage can occur as soon as six months after the first manifestations of PsA. Those damages are often visible with x-rays.

When we see patients affected by psoriasis, we look for signs and symptoms of psoriatic arthritis. However, joint pain can often be totally unrelated to PsA. Almost everyone experiences some type of joint pain at a moment or another. Dermatologists may use some questionnaires to determine if it is PsA or not. When that’s the case, we refer the patients to a rheumatologist.

When a treatment is successful, it can ease symptoms and stop joint deterioration.

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Sandra Walsh:

Yes, psoriatic arthritis (PsA) can definitely get worse if not treated. It is advised that you see a rheumatologist if you have symptoms of PsA since they are specialized in reading X-rays and other images of the joints and pick up subtle signs of disease that may be missed by radiologists. They also do blood tests that can help confirm the diagnosis and be helpful in predicting how aggressive your disease may be. There are other factors that can give them an idea about how they should treat your disease such as the number of joints involved, the amount of damage to the joints, and how you responded to previous treatments. A couple of research studies have demonstrated that people with PsA have less progression of their disease when seen earlier by a rheumatologist.

It is possible to go into a remission where you are free of any active joint inflammation. One research study found that 18% of 391 patients with PsA achieved a remission and half of them stayed in remission without any medication use for an average of two and a half years. I have seen this in my practice, a few patients say that they no longer have active PsA as they have not had symptoms for years. Generally, most patients will have a recurrence within months and therefore stay on their medications, perhaps with fewer medications or reduced dosage depending on the medication. I also have patients who do not believe that their joint disease is a problem; however, when they start a medication that relieves their joint symptoms they then realize how much of an impact their joint disease had all along on all aspects of their life.

One of the rheumatologists that we partner with feels so passionate about the benefits of early diagnosis of PsA that she is currently doing a research study to show just how important it is. The research has been a good reminder for healthcare practitioners to look for PsA and make the referral since about 85% of people with PsA develop psoriasis first. I know that your dermatology and general practitioner are busy, but it is important to talk to them about your joint issues and ask if a referral to the rheumatologist is right for you.

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Simmie Smith:

Yes, if not treated the inflammation can spread which may cause other joints to become painful and reduce mobility. If not treated you are also at risk to develop joint deformities which are irreversible. Ignoring your joint pain will only lead you to become further fatigued as your body is fighting hard to deal with the inflammation. 

I’ve been very fortunate not to have suffered permanent joint damage. I tribute this to my persistency to find the right medication with my doctor that worked to reduce my joint inflammation.

It took me over eight months to find the correct treatment. It was a trial and error. I learned what works well for one person suffering from the same disease may not be the same for someone else. The treatment plan is individualized.

Of course, I always live with the worry that treatments can stop being effective but I also feel somewhat optimistic to know there are more options becoming available for those of us managing the disease. 

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Painful joints might hide something else

I want to know what it is