Psoriasis and Psoriatic Arthritis

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Mortality and Prognosis


Psoriasis KaleidoscopePsoriasis is an autoimmune skin disease that causes scaly red patches of skin. Sometimes people with psoriasis develop joint pain, which is called psoriatic arthritis.

If you develop a scaly red rash that doesn't go away in a reasonable period of time with the usual over-the-counter products, see your doctor as it may be psoriasis or another skin condition. (Also see Autoimmune Diseases and Skin Diseases)

Support for Psoriasis. The National Psoriasis Foundation is a patient-driven, nonprofit organization that is the voice for the millions of Americans affected by psoriasis and psoriatic arthritis. NPF.


The Role of the IL-23/IL-17 Pathway in the Pathogenesis of Spondyloarthritis In this review, we summarize the current knowledge of the pathomechanism by focusing on the IL-23/IL-17 pathway. PubMed, Int J Mol Sci, 2020 Sep 3;21(17):E6401. (Also see Interleukins)

Negative regulation of dendritic cell (DC) activation in psoriasis mediated via CD100-Plexin-B2. Our results uncovered a negative regulatory mechanism for DCs activation in psoriasis, which was mediated via CD100-Plexin-B2 in a cell type- and receptor- specific manner. PubMed, J Pathol, 01/14/2020. (Also see Dendritic Cells)

Immune responses to stress in rheumatoid arthritis (RA) and psoriasis. Patients with RA have a different immune response to stress than patients with psoriasis or healthy controls. More needs to be learned about the complex interaction between stress, immune parameters and chronic inflammation. PubMed, Rheumatology (Oxford). (Also see Rheumatoid Arthritis and Stress)


Suicidal risks with psoriasis and atopic dermatitis: Systematic review and meta-analysis. The study findings support emerging evidence of increased risk of suicidal ideation and behavior with psoriasis. PubMed, J Psychosom Res, 2021 Feb;141:110347. (Also see Suicide Prevention)

Molecular and Cellular Mechanisms of Itch in Psoriasis. In this review, we describe the clinical features of pruritus in psoriasis. PubMed, Int J Mol Sci, 2020 Nov 9;21(21):E8406.

Metabolic Syndrome and Female Gender, but Not Methotrexate, Are the Important Associations of Significant Liver Fibrosis in Patients With Moderate-To-Severe Psoriasis as Detected by Transient Elastography. Metabolic syndrome and female sex are associated with the development of significant liver fibrosis in patients with psoriasis. PubMed, Indian J Dermatol Venereol Leprol, 07/08/2020.

Depression and suicidality in psoriasis and clinical studies of brodalumab: a narrative review. Clinicians are urged to evaluate patients with psoriasis for psychiatric risk factors regardless of their therapy. PubMed, Cutis, 2019 Dec;104(6):361-365. (Also see Depression and Suicide Prevention)

Association Between Psoriasis with Arthritis (PsA) and Hearing Impairment (HI) in US Adults: Data from the National Health and Nutrition Examination Survey. PsA is independently associated with a significantly increased risk of HI, which partially mediates an association with worsened psychiatric outcomes. PubMed, J Rheumatol, 2019 Jun;46(6):587-594.

Association of Psoriasis With Inflammatory Bowel Disease: A Systematic Review and Meta–analysis. These findings suggest that psoriasis is significantly associated with IBD and gastroenterology consultation may be indicated when patients with psoriasis present with bowel symptoms. PubMed, JAMA Dermatol, 10/24/2018. (Also see Inflammatory Bowel Disease)

Increased Prevalence of Metabolic Syndrome (MetS) and Adipocytokine Levels in a Psoriatic Arthritis(PsA) Cohort. Clinicians caring for PsA patients ought to be aware of the increased risk of MetS in PsA patients, confirmed in different regions worldwide. PubMed, J Clin Rheumatol, 2018 Sep;24(6):302-307.

Risk of type 2 diabetes (T2D) and cardiovascular disease in an incident cohort of people with psoriatic arthritis (PsA): A population–based cohort study. The development of T2D in an incident population of PsA is significantly higher than in psoriasis alone, whereas the increased risk of cardiovascular disease in PsA and psoriasis is similar. PubMed, Rheumatology (Oxford), 2019 Jan 1;58(1):144-148. (Also see Symptoms and Complications of Diabetes)

Comorbidity in psoriatic arthritis (PsA) and rheumatoid arthritis (RA). High rates of comorbidity were found and the prevalence of depression, cardiovascular risk factors and other comorbidities were higher in PsA than RA participants. PubMed, Intern Med J, 07/26/2018. (Also see Rheumatoid Arthritis in Overlap)

Risk of incident liver disease in patients with psoriasis (PsO), psoriatic arthritis (PsA) and rheumatoid arthritis (RA): a population–based study. More so than RA, PsO and PsA are associated with liver disease, particularly non-alcoholic fatty liver disease and cirrhosis, and this was true even among patients without systemic therapy exposure. PubMed, J Invest Dermatol, 2018 Apr;138(4):760-767. (Also see Symptoms and Complications of Rheumatoid Arthritis)

Psoriasis and arthritis sufferers have a higher risk of heart attacks and strokes, study finds. People with inflammatory arthritis and psoriasis should be closely monitored and given extra support to help prevent heart attack and strokes. Mail Online, 04/23/2018.

Subclinical impairment of myocardial and endothelial functionality in very early psoriatic (PsA) and rheumatoid arthritis patients: Association with vitamin D and inflammation. Disease activity was the main predictor of myocardial strain impairment and myocardial function was altered and associated with carotid intima-media thickness. Atherosclerosis, 03/06/2018. (Also see Symptoms and Complications of Rheumatoid Arthritis)

Prevalence and type II diabetes–associated factors in psoriatic arthritis. Results suggested that diabetes was notably related to late–onset psoriasis and hypertension and the risk of diabetes ought to be evaluated carefully in subjects whose psoriasis begins after 40 years. PubMed, Clin Rheumatol, 02/22/2018. (Also see Symptoms and Complications of Diabetes)

Risk of uveitis and inflammatory bowel disease in people with psoriatic arthritis (PsA): a population–based cohort study. In a primary care–based incidence cohort of patients with PsA, there were substantial risks of developing uveitis and/or Crohn's disease, but not ulcerative colitis, when compared with the general population and psoriasis controls. PubMed, Ann Rheum Dis, 2018 Feb;77(2):277-280. (Also see Inflammatory Bowel Disease)

Metabolic syndrome (MetS) in psoriatic arthritis (PsA): the interplay with cutaneous involvement. Evidences from literature and a recent cross–sectional study. In our study, the occurrence of MetS and mean levels of serum uric acid were higher in PsA patients with clinical evident psoriasis compared to sine psoriasis PsA. PubMed, Clin Rheumatol, 01/08/2018.

Psoriasis and concomitant fibrosing disorders: Lichen sclerosus, morphea, and systemic sclerosis. In this population, a predisposition toward autoimmunity is seen as 38.5% of patients had a personal history of a third concomitant autoimmune disease, in addition to psoriasis and fibrosing disorder, whereas 42.3% reported a history of a first-degree relative with an autoimmune disease. Journal of the American Academy of Dermatology. (Also see Lichen Sclerosus, Morphea, Systemic Sclerosis, and Multiple Autoimmune Syndrome)


Role of joint damage, malalignment and inflammation in articular tenderness in rheumatoid arthritis, psoriatic arthritis and osteoarthritis. While tenderness in early arthritis may be more related to inflammation, established disease is better explained by joint damage and malalignment. PubMed, Ann Rheum Dis, 2021 Jan 12;annrheumdis-2020-218744. (Also see Symptoms and Complications of Rheumatoid Arthritis)

Interleukin-17A biomarker as a predictor for detection of early axial spondyloarthritis (SpA) changes in patients with psoriasis. Our study can imply that IL-17A is a valuable, useful and low–cost biomarker in detecting early axial SpA changes in asymptomatic and nonradiographic axial SpA psoriatic patients. PubMed, Int J Rheum Dis, 10/05/2020. (Also see Interleukins)

miR-183-3p Suppresses Proliferation and Migration of Keratinocyte (HaCaT) in Psoriasis by Inhibiting GAB1. MiR-183-3p exhibited inhibition property in the proliferation and migration of HaCaT cells via down-regulation of GAB1, suggesting the potential therapeutic strategy for psoriasis. PubMed, Hereditas, 2020 Jul 10;157(1):28.

Unbalanced Sphingolipid Metabolism and Its Implications for the Pathogenesis of Psoriasis. The significance of SLs as structural and signalling molecules and their actions in inflammation are discussed. PubMed, Molecules, 2020 Mar 3;25(5).

The role of epigenetics and immunological imbalance in the etiopathogenesis of psoriasis (Ps) and psoriatic arthritis (PsA). Besides well-known genetic susceptibility loci, epigenetic DNA modifications, which are associated with Ps development, have been characterized recently. PubMed, Ther Adv Musculoskelet Dis, 2019 Nov 6;11:1759720X19886505.

Evidence for a role of autoinflammation in early-phase psoriasis. IL-1β overexpression in combination with low expression of cytokines that are predominant in late-phase plaque psoriasis may support the role of autoinflammation in early-phase disease. PubMed, Clin Exp Immunol, 09/11/2019.

Musculoskeletal ultrasound can improve referrals from dermatology to rheumatology for patients with psoriasis. Due to the high frequency of non-specific pain in psoriasis, it is not possible for every psoriasis patient with joint pain to be assessed by a rheumatologist. PubMed, Br J Dermatol, 09/10/2019.

Differential synovial tissue (ST) biomarkers among psoriatic arthritis and rheumatoid factor/anti–citrulline antibody–negative rheumatoid arthritis. Histological analysis of ST may help to solve the clinical overlap between the two diseases and provides prognostic data about the therapy success. PubMed, Arthritis Res Ther, 2019 May 9;21(1):116. (Also see Diagnosis of Rheumatoid Arthritis)

Amplifying the concept of psoriatic arthritis: The role of autoimmunity in systemic psoriatic disease. The purpose of this review is to describe the new pathogenetic mechanisms and the different clinical pictures of Systemic Psoriatic Disease. PubMed, Autoimmun Rev, 04/05/2019.

Genetic variation at the glycosaminoglycan metabolism pathway contributes to the risk of psoriatic arthritis (PsA) but not psoriasis. These findings provide insights into the biological mechanisms that are specific for PsA and could contribute to develop more effective therapies. PubMed, Ann Rheum Dis, 2019 Mar;78(3).

Potential Role of Cytochrome c and Tryptase in Psoriasis and Psoriatic Arthritis Pathogenesis: Focus on Resistance to Apoptosis and Oxidative Stress. The cytochrome c release into the extracellular space and tryptase may have a role in skin and joint inflammation. PubMed, Front Immunol, 2018 Oct 30;9:2363. (Also see Oxidative Stress)

The pathogenesis of psoriatic arthritis. Improving our understanding of psoriatic arthritis pathogenesis could help to establish validated biomarkers for diagnosis. PubMed, Lancet, 2018 Jun 2;391(10136):2273-2284.

Mortality and Prognosis

Residual Disease Activity (RDA) and Associated Factors in Psoriatic Arthritis (PsA). RDA can be recognized in patients with PsA and very low disease activity seems to be the most stringent composite index to identify patients in the absence of RDA. PubMed, J Rheumatol, 2020 Oct 1;47(10):1490-1495.

Remission in psoriatic arthritis: Definition and predictors. The use of biologic agents increased not only the chance of remission, but also the chance of sustained remission for at least 12 months. Seminars in Arthritis and Rheumatism, 02/03/2020. (Also see Biologic Agents)

Identification of Novel Autoantibodies Associated with Psoriatic Arthritis. Our findings suggest that these autoantibodies may be useful biomarkers and indicative of therapeutic targets of psoriasis and psoriatic arthritis. PubMed, Arthritis Rheumatol, 01/07/2019.

Smoking and delay to diagnosis are associated with poorer functional outcome in psoriatic arthritis (PsA). Smoking, delay to diagnosis, older age at diagnosis, female sex and a history of anti-tumor necrosis factor (TNF) treatment are associated with worse physical function in established PsA. Ann Rheum Dis.

Research for Psoriasis

Overview of the molecular determinants contributing to the expression of Psoriasis and Psoriatic Arthritis phenotypes. This review highlights how the knowledge of patients' clinical and (epi)genomic make-up could be helpful for improving the available therapeutic strategies for psoriasis and psoriatic arthritis treatment. PubMed, J Cell Mol Med, 2020 Oct 31;24(23):13554-13563.

Pathogenesis of psoriasis in the "omic" era. Part IV. Epidemiology, genetics, immunopathogenesis, clinical manifestation and treatment of psoriatic arthritis. The joint damage starts early in the course of the disease, thus early recognition and treatment with modern biological treatments is essential for the patient long-term outcome. PubMed, Postepy Dermatol Alergol, 2020 Oct;37(5):625-634.

Treatments for Psoriasis

The Risk of COVID-19 Pandemic in Patients with Moderate to Severe Plaque Psoriasis Receiving Systemic Treatments. Several case reports described full recovery from COVID-19 with favorable outcomes in psoriasis patients who were being treated with synthetics or biologicals. PubMed, Vaccines (Basel), 2020 Dec 2;8(4):E728.

Unmet needs in patients with moderate-to-severe plaque psoriasis treated with methotrexate (MTX) in real world practice: FirST study. The study identified unmet needs in moderate-to-severe plaque psoriasis patients treated with MTX. PubMed, J Dermatolog Treat, 2020 Sep 8;1-10.

Comparative Persistence of Methotrexate (MTX) and Tumor Necrosis Factor Inhibitors (TNFi) in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis. Concomitant use of MTX with a TNFi, however, is associated with improved TNFi persistence in all 3 diseases. PubMed, J Rheumatol, 2020 Jun 1;47(6):826-834. (Also see Treatments for Rheumatoid Arthritis, Ankylosing Spondylitis and Immunosuppressants)

Interleukin-36 family dysregulation drives joint inflammation and therapy response in psoriatic arthritis. Exogenous replacement of IL-36 antagonists may be a novel promising therapeutic target for PsA patients. PubMed, Rheumatology (Oxford), 09/03/2019.

Effect of disease-modifying anti-rheumatic drugs (DMARDs) on bone structure and strength in psoriatic arthritis (PsA) patients. Despite longer disease duration, bDMARD-treated PsA patients benefit from higher bone mass and better bone strength than PsA patients receiving methotrexate or no DMARDs. PubMed, Arthritis Res Ther, 2019 Jul 3;21(1):162. (Also see Disease-Modifying Anti_Rheumatic Drugs)

Case Report: Efficacy and Metabolic Effect on Serum Lipids of Apremilast in Psoriatic Arthritis (PsA). Our observations suggest that apremilast is effective in controlling mild skin and joint involvement and suggest a potentially advantageous metabolic effect in patients with PsA. PubMed, J Clin Med.

The Effect of Pregnancy on Disease Activity in Patients with Psoriatic Arthritis. Continuation of biologics therapy was associated with a low level of disease activity and a low probability of flare during pregnancy. PubMed, J Rheumatol, 2018 Dec;45(12):1651-1655. (Also see Biologic Agents)

Improved patient–reported outcomes (PROs) in patients with psoriatic arthritis (PsA) treated with abatacept: results from a phase 3 trial. Abatacept treatment improved PROs in patients with PsA versus placebo, with better results in elevated baseline C-reactive protein and tumour necrosis factor inhibitor– na´ve subpopulations. BMC Journals, Arthritis Research & Therapy, 12/06/2018. (Also see Biologic Agents)

Naturally derived Heme-Oxygenase 1 inducers attenuate inflammatory responses in human dendritic cells and T cells: relevance for psoriasis treatment. This study supports reports highlighting the therapeutic potential of curcumin in psoriasis by providing insight into its immunological effects. PubMed, Sci Rep, 2018 Jul 6;8(1):10287.

Drug Utilization Patterns and Adherence in Patients on Systemic Medications for the Treatment of Psoriasis: A Retrospective Comparative Cohort Study. We report greater adherence in new users of biologics when compared to methotrexate. PubMed, J Am Acad Dermatol, 07/04/2018. (Also see Biologic Agents)

Low Doses of Etanercept (ETN) Can Be Effective to Maintain Remission in Psoriatic Arthritis (PsA) Patients. The main reasons that hinder the dosing interval increase in ETN in PsA patients are peripheral polyarthritis pattern and exacerbation of cutaneous manifestations. PubMed, J Clin Rheumatol, 2018 Apr;24(3):127-131. (Also see Biologic Agents)

Precision medicine using different biological DMARDs based on characteristic phenotypes of peripheral T helper cells in psoriatic arthritis. Strategic treatment in which different bDMARDs were selected according to phenotypic differences in helper T cells showed significantly higher efficacy. PubMed, Rheumatology (Oxford), 04/02/2018. (Also see Biologic Agents)

Use of Curcumin in Psoriasis. Curcumin has been proposed as a valid and safe therapeutic option for psoriasis. PubMed, Open Access Maced J Med Sci, 2018 Jan 21;6(1):218-220. (Also see Supplement Guide)

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