Psoriatic Arthritis and Bone Damage

About one out of every three people with psoriasis, a condition that causes patches of itchy, scaly skin, will develop psoriatic arthritis as well. Psoriatic arthritis is a form of inflammatory arthritis and can lead to swollen, stiff, and painful joints in areas such as the fingers, toes, heels, and lower back. Over time, psoriatic arthritis may also result in damage to the bones themselves.

If you have psoriatic arthritis, it’s helpful to be aware of how it can affect your bones and what you can do to maximize your bone health.

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Bone erosion refers to bone loss in localized areas and is one type of damage frequently associated with psoriatic arthritis. Though bone erosion can occur in healthy individuals due to damage caused by normal wear and tear, the process is often amplified in people with psoriatic arthritis. This is because psoriatic arthritis is an autoimmune disease, causing your immune system to mistakenly attack your own tissues, like your skin and joints. Certain proteins and cells involved with this faulty immune response speed up the process of bone erosion, especially as you get older.

Abnormal bone growth may also occur with psoriatic arthritis. Bony projections called enthesophytes can develop in areas where your tendons attach to bones. These bony projections can cause pain and swelling and interfere with movement and function. The amount of abnormal bone growth present often increases the longer you’ve had psoriatic arthritis.

Additionally, psoriatic arthritis is associated with an increased risk of osteoporosis and fractures. However, this may be due to secondary factors, such as steroid use or being overweight, rather than the condition itself.

There isn’t a cure for psoriatic arthritis, but early diagnosis and proper treatment can reduce or slow the progression of bone damage. The key is to break the cycle of inflammation. Common treatments for psoriatic arthritis include:

• nonsteroidal anti-inflammatory drugs (NSAIDs): such as ibuprofen (Advil, Motrin) and naproxen sodium (Aleve)
• disease-modifying antirheumatic drugs (DMARDs): such as methotrexate (Trexall, Otrexup)
• biologic medications: such as adalimumab (Humira), secukinumab (Cosentyx), etanercept (Enbrel), and ixekizumab (Taltz)

A recent study found treatment with biologics, in particular, was associated with better bone density and function. By targeting specific parts of the immune response, biologics may effectively halt inflammation and damage to your joints.  

Consider incorporating these lifestyle modifications to support your bone health:

• Move your body. Physical activity can improve your flexibility and strength. Weight-bearing exercises can improve bone density, but always talk to your doctor about what kind of exercise is appropriate for you.
• Lose weight if needed. Excess weight puts additional stress on your bones and joints. Being overweight may also limit the effectiveness of some psoriatic arthritis medications.
• Stop smoking and limit alcohol. Tobacco and alcohol use can decrease your bone density.
• Eat a healthy diet. Several nutrients, including calcium, vitamin D, vitamin K, and magnesium, are important for strong bones. Aim to get your nutrients from whole foods, instead of supplements, when possible.

It’s always best to be proactive versus reactive when it comes to managing your psoriatic arthritis. If you’re having more flare-ups of your symptoms or your current treatment isn’t working for you, be sure to let your doctor know. Learning how to control your disease can help you avoid long-term bone damage.