Psoriatic arthritis is not necessarily a progression of psoriasis, but these conditions are both part of psoriatic disease. Treatment and lifestyle changes can help manage symptoms and can lower the risk.

Psoriasis and psoriatic arthritis (PsA) are two separate conditions that make up psoriatic disease, an immune-mediated state of cutaneous and systemic inflammation throughout the body.

Cutaneous (skin-related) symptoms, which make up psoriasis, include the formation of itchy, scaly patches of skin that may be raised, discolored, or pustule-like. Psoriasis is the result of an overactive immune response that triggers your skin cells to multiply faster than they can shed.

PsA is a part of systemic psoriatic disease. It’s characterized by swelling and stiffness in the joints and connective tissues, caused by inflammation as your body’s immune system targets healthy cells.

While many people living with psoriasis also develop PsA, you don’t have to have one to experience the other.

There’s no definitive evidence that shows psoriatic arthritis is a progression of psoriasis. They’re separate conditions believed to share underlying causes.

According to the National Psoriasis Foundation, about 30% of people living with psoriasis also develop PsA. Most people living with PsA are diagnosed with psoriasis first, with PsA following an average of 10 years later.

You can develop PsA without psoriasis. PsA can affect anyone, though living with psoriasis increases the chances you’ll develop psoriatic arthritis.

It’s estimated that more than 80% of people living with PsA develop psoriasis first.

Is psoriasis progressive?

Psoriasis is considered a progressive condition with an unpredictable course. This means your psoriasis may remain stable for years, may never change, or may progress quickly compared to someone else.

Doctors rate psoriasis severity based on the amount of your body affected, your level of discomfort, and a 5-point dermatological scale called the Investigator’s Global Assessment (IGA).

Based on your score, psoriasis is diagnosed as mild, moderate, or severe.

Having severe psoriasis does not mean you’ve developed PsA. Severe psoriasis may refer to your skin symptoms only, but your doctor will factor in other symptoms of psoriatic disease and common comorbid conditions.

Does psoriatic arthritis progress?

PsA can also progress unpredictably. You may experience more frequent flare-ups, more joint involvement, or permanent changes to your bones over time.

Like psoriasis, there’s no linear timeline for how — or if — PsA will progress.

Can treatment delay progression?

Because the progression of psoriatic disease is not well understood, it’s unclear whether treatment can delay disease progression.

Treatment can, however, delay or prevent damage to your body caused by prolonged inflammation. Some experts believe managing inflammation may be the key to halting psoriatic disease progression, though more research in this area is needed.

Receiving treatment for psoriatic disease can decrease your chances of developing other conditions related to systemic inflammation, like type 2 diabetes and kidney disease.

The majority of people living with PsA experience psoriasis first, but there’s no way to know with certainty if PsA will develop over time.

Certain factors may predict the likelihood of PsA after psoriasis, including:

  • nail pitting
  • psoriasis in the scalp and genital area
  • obesity
  • pre-existing joint paint
  • musculoskeletal pain with no identifiable cause
  • a history of uveitis
  • having a close relative with PsA
  • severe psoriasis symptoms
  • presence of specific genetic markers

In some people, diagnostic imaging can reveal asymptomatic changes in joints that suggest PsA is developing.

If you’re concerned that your psoriasis is a precursor to PsA, symptoms of psoriatic arthritis to watch for include:

  • joint tenderness
  • tendon pain or swelling
  • fatigue
  • stiffness or throbbing in one or more joints
  • bodily stiffness and fatigue after waking
  • nail changes
  • eye redness

Some treatments for psoriatic disease can work for both psoriasis and psoriatic arthritis. As separate conditions, however, psoriasis and PsA have condition-specific treatments.

Psoriasis treatment typically includes topical, injectable, or oral medications. These therapies help relieve symptoms like itching and dryness or work to suppress the immune response causing excessive cell growth and inflammation.

Skin care, such as moisturizing and avoiding prolonged sun exposure, is also an essential component to psoriasis management.

PsA treatment aligns with psoriasis treatment through medications that suppress your body’s immune response and decrease inflammation. In PsA, pain medications and arthritis medications are also prescribed to help joint-specific symptoms.

Your rheumatologist will recommend joint care and strengthening therapies, such as low intensity exercises and joint impact reduction strategies.

Lifestyle changes

Lifestyle changes can help manage and prevent conditions of psoriatic disease. Universal steps to improve symptoms and reduce your risk of psoriasis and PsA include:

  • maintaining a moderate weight
  • avoiding smoking
  • limiting or eliminating alcohol consumption

If you’ve been diagnosed with PsA following psoriasis, modifications to your current routine may be necessary.

Rigorous exercise in a weight-management program, for example, might need to be minimized to avoid undue stress on your joints.

Psoriasis and psoriatic arthritis make up psoriatic disease. While connected, they’re separate conditions.

The majority of people living with PsA develop psoriasis first, but that doesn’t mean psoriasis is the first stage of PsA.

Psoriatic arthritis can affect anyone, and having psoriasis first is not a requirement. Living with psoriasis, experiencing severe psoriasis symptoms, and having a family history of PsA, are all factors that can raise your chances of developing psoriatic arthritis.

Treatment can help reduce the damage caused by persistent inflammation, but it’s unclear if treatment can delay psoriatic disease progression.