What Happens If You Don’t Treat Psoriatic Arthritis?

Psoriatic arthritis (PsA) is a lifelong autoimmune condition that can cause inflammation in the skin, joints, spine, and tendons. When PsA is severe, it can lead to eye and joint problems and increase the risk of bowel and heart issues. 

There are many different medication options to help keep PsA under control. There’s no one-size-fits-all approach to treatment, so it can take time to find the medication that works well. But know that there is a medication regimen out there for you.  

While most people would prefer not to take medication unless absolutely necessary, it’s the best way to protect your body from permanent complications. Here we’ll explain why addressing your PsA is so important, and what could happen if it goes untreated.

What are the potential complications of untreated psoriatic arthritis?

Not treating PsA can cause problems, or complications, in many parts of the body.

Joints

When you have PsA, your immune system can attack your joints. Generally speaking, joints are where two bones meet, allowing our body parts to move. (The knee is a good example.) They are surrounded by protective connective tissue called a synovial membrane and fluid — sort of like a Ziploc bag full of WD-40 lubricating fluid. An additional layer of cartilage covers the bones.

When a person has PsA, the synovial membrane can get inflamed, causing joint pain and swelling. If left untreated, the immune system continues to attack the joint and eventually eats through the synovial membrane, down to the cartilage. Once it eats through the cartilage, it starts to attack the bones, causing erosions. Unfortunately, this damage is permanent.

We don’t yet have a way to repair the synovial membrane, cartilage, or bones once the immune system has damaged them. Joint replacement surgery is sometimes an option to treat hips and knees, but it’s not an option for every joint.

Pain and stiffness due to permanent joint damage can seriously decrease your quality of life. It can make it difficult to work, play, and do basic everyday tasks. It can become difficult or impossible to bend at the joint and, when the knees and hips are affected, hard to walk. The damage can also cause painful, permanent deformities in which the joints are disfigured or bent out of shape. In the hands, deformities can make it hard to grip things, open jars, or turn door knobs.

Spine

The pelvis and spine include joints, too. These joints look a bit different than those described above, but their purpose is also to allow movement. 

Inflammation of the joints in the pelvis and spine (sacroiliitis and spondylitis) can also occur because of PsA. This can cause chronic back pain. The spine also becomes less flexible, making it harder to twist and bend. The risk of spine complications is higher when PsA is left untreated.

Skin and nails

Most people with PsA have psoriasis, which can worsen when untreated. Psoriasis rashes, which appear as patches of red, flaky, and itchy skin, can be uncomfortable. Severe rashes can leave the skin raw and at risk of infection, especially with scratching, and sometimes cause permanent scarring and discoloration.

Nail psoriasis, which can cause tiny pits in the fingernails and toenails or crumbling of the nails, can also occur. If PsA is not treated, nails cannot grow back healthy and will continue to look abnormal. 

Eyes

Eye complications are less common with PsA, but the risk is increased when the condition is left untreated. People with untreated PsA and psoriasis are at a higher risk for uveitis (inflammation of a specific part of the eye) than people whose disease is well-controlled. Conjunctivitis, commonly known as pink eye, can also occur. This kind of conjunctivitis is due to inflammation, not infection — different than the contagious kind you might be thinking of.

Increased risk of inflammatory bowel disease

PsA does not directly cause gastrointestinal problems. However, people with PsA have a higher risk of developing inflammatory bowel disease (IBD) than other people. Common types of IBD are Crohn’s disease and ulcerative colitis. Many of the medications that treat PsA are also used to address IBD, so proper treatment benefits both conditions. 

Increased risk of heart disease

PsA does not directly attack the heart, but it increases the risk of heart disease. And psoriasis increases the risk of heart attacks, due to uncontrolled inflammation in the body. Taking medication to treat psoriasis and PsA may decrease a person’s risk of complications from heart disease. (We can expect to see more data on this in the future, especially for newer PsA medicines.) 

Mental health complications

PsA increases the risk of depression. Dealing with the discomfort and pain can be difficult, causing added stress. Stress can, in turn, trigger flare-ups and worsen symptoms. 

What can I do to prevent complications of psoriatic arthritis?

Treating your PsA helps you feel better — that means clear skin, joints that don’t hurt, and a better overall ability to do the things you want to do. But it also protects your body from permanent damage. Getting your PsA under control will decrease the risk of complications outlined above.

It’s important to know that treatment doesn’t guarantee that you won’t have complications. But it is the best way to protect yourself.

To prevent complications of PsA:

• Take medications as prescribed.

• Keep your medical appointments.

• Communicate with your provider when you aren’t feeling well, so that medications can be adjusted if needed.

• Follow these tips to prevent and identify PsA flare-ups.

If you are struggling to take these actions, talk with your healthcare provider. Providers are great at troubleshooting things like transportation to appointments, medication costs, and side effects, among others. But they can only help if they know what the problem is, so don’t hesitate to speak up.

To decrease your risk of heart disease associated with PsA:

• Eat a heart-healthy diet and maintain a healthy weight.

• Stop smoking, which can also improve PsA symptoms.

• Keep appointments with your primary care provider to keep an eye on blood pressure, cholesterol, and blood sugar levels.

Why trust our experts?

Written by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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