What Happens If You Don’t Treat Psoriatic Arthritis? Prognosis, Life Expectancy, and More

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 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’s a medication regimen out there for you. 

Most people would prefer not to take medication unless absolutely necessary. However, 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 is the typical prognosis of psoriatic arthritis?

The prognosis (or outcome) of PsA varies from person to person. It’s a chronic condition. And, if left untreated, it can cause permanent joint damage. This can lead to ongoing disability and decreased quality of life. Untreated PsA can also lead to other diseases, such as heart disease and depression. Treating PsA can help prevent serious complications.

Life expectancy

In general, PsA isn’t a life-threatening condition. However, some studies have shown that people with PsA may have a slightly shorter life expectancy than average due to severe complications like:

• Heart disease

• Lung disease

• Cancer 

What are the potential complications of untreated psoriatic arthritis?

Not treating PsA can cause problems, or complications, in many parts of the body. Let’s review the effects of untreated PsA below.

Joints

When you have PsA, your immune system can attack your joints. Generally speaking, joints (like the knee) are where two bones meet, allowing the body parts to move. They’re surrounded by fluid and a protective connective tissue called a synovial membrane. 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. 

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Unfortunately, this damage is permanent. There isn’t yet 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 (like walking, opening jars, or turning door knobs)

• Become difficult or impossible to bend at the joint 

• Cause painful, permanent deformities in which the joints are disfigured or bent out of shape.

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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 if it’s not treated. PsA rashes can be uncomfortable. They can appear as patches of flaky and itchy skin that’s red, brown, or gray. Severe rashes can leave the skin raw and at risk of infection, especially with scratching. Sometimes, the rash can cause permanent scarring and discoloration.

Nail psoriasis can cause many different changes in the nails, like tiny pits, discoloration, and crumbling. If PsA isn’t treated, you may see ongoing nail changes. 

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). Conjunctivitis, commonly known as pink eye, can also occur. This kind of conjunctivitis is due to inflammation, not infection. It’s different from the contagious kind you might be thinking of.

Inflammatory bowel disease

PsA doesn’t 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. 

Heart disease

PsA doesn’t 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. (More data on this is expected in the future, especially for newer PsA medicines.) 

Disability

People with PsA may have an increased risk of disability. This depends on how seriously their joints are affected and how treatment is working. When joint pain is severe, it can impact your quality of life and make it hard to work. 

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.

Early diagnosis and treatment is one way to decrease your risk of complications. It’s important to know that treatment doesn’t guarantee that you won’t have any lasting damage. But it’s the best way to protect yourself.

Here are some other things you can do to prevent complications of PsA:

• Take your medications as prescribed.

• Keep your medical appointments.

• Communicate with a healthcare professional 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’re struggling to take these actions, talk with a healthcare professional. They’re 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, here are some things you can do:

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

Frequently asked questions

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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:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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