Researchers from West Virginia University in Morgantown analyzed discharge data from patients who had been hospitalized in the United States from 2000 to 2014 and found that those with psoriasis and psoriatic arthritis had a related increase in irritable bowel disease (IBD), including Crohn’s disease. The scientists published their findings on September 23, 2020, in Wiener Klinische Wochenschrift. The link between Crohn’s disease and psoriatic arthritis is particularly strong, which may not be surprising given that both conditions are related to inflammation. They also share a number of genetic mutations, meaning that the same genes that make someone prone to psoriatic disease can also increase their vulnerability to gut disorders. Often, the psoriasis or psoriatic arthritis comes first and the Crohn’s later, according to Abrar Qureshi, MD, MPH, the chair of dermatology at the Warren Alpert Medical School at Brown University in Providence, Rhode Island, who was not involved with the new research. That’s not always the case, however. “Based on genetic risk, it could go either way,” Dr. Qureshi says. “When you’re dealing with systemic inflammation, any organ could develop problems first, then another.” Not every patient with psoriatic arthritis is at risk for Crohn’s disease. “There is a subset of people who have that risk,” says Qureshi. Though clues to the association have emerged in recent studies, Qureshi says, “we don’t yet know why some people get it and others don’t.”
A Team Approach to Treating Psoriatic Arthritis
As it becomes more evident that the skin and joint symptoms of PsA and the intestinal symptoms of Crohn’s are related — and connected to inflammation — doctors from different fields are starting to collaborate more in treating patients, with more beneficial results. Dermatologists, says Qureshi, once took a skin-only approach to patients with psoriasis. “We didn’t ask about anything else,” he says. “But psoriasis is more associated with systemic inflammation; it doesn’t only affect the skin.” Patients, too, need to understand that these conditions — Crohn’s, PsA — and their symptoms can be interrelated. “Back when I started practicing, more than 15 years ago, patients never connected their arthritis to the skin,” says Qureshi. While that perception has changed, “Most still don’t connect it to bowel problems they may be having,” Qureshi says. But it’s all part of the same picture.
Finding the Right Medications for Psoriatic Arthritis and Crohn’s
The good news is that there are medications that treat inflammation and also work to control the symptoms of psoriatic arthritis, Crohn’s, and other gut disorders. These include anti-TNF (tumor necrosis factor) drugs such as Humira (adalimubab) and Remicade (infliximab). The U.S. Food and Drug Administration (FDA) has approved the biologic drug Stelara (ustekinumab) for both psoriatic arthritis and Crohn’s. Yet that doesn’t mean there is a one-size-fits-all treatment for any of these conditions. Your doctor will consider a number of criteria when choosing a therapy, such as other illnesses you might have and your preference for oral or injectable medications. A caveat: Some physicians have expressed concern that certain drugs for psoriatic arthritis may worsen symptoms of Crohn’s. Experts in the field are investigating that connection, in the hope of finding alternatives that might ease one condition without exacerbating the other. For instance, a study published in April 2019 in Annals of the Rheumatic Diseases of more than 7,350 patients with psoriasis and psoriatic arthritis who took at least one dose of Cosentyx (secukinumab) showed that few experienced IBD symptoms from the medication. And a report in Drug Safety from June 2019 found that ustekinumab was safe for patients with plaque psoriasis, active psoriatic arthritis, and moderate to severe Crohn’s disease. There are alternatives on the horizon, too. “This remains an active area of research, with ongoing trials of new medications along with new trials for older drugs that have been previously approved for different inflammatory diseases,” says Kelly Weselman, MD, a rheumatologist with WellStar Medical Group in Smyrna, Georgia. The goal: To find medications that work for both conditions or, at least, do not worsen one while treating the other.
Losing Weight Can Ease Symptoms of Psoriatic Arthritis and Crohn’s
If you have both psoriatic arthritis and Crohn’s, getting the right medications is paramount, but adopting healthy habits is also crucial. That includes a diet low in saturated fat, cholesterol, and, particularly, simple sugars: A review published in April 2020 in the journal Rheumatology and Therapy found that people who have psoriatic arthritis are significantly more likely to have type 2 diabetes than the population at large, possibly because inflammation of the skin and joints may affect glucose metabolism. Obese patients with gut disorders like Crohn’s also don’t seem to respond to medication as vigorously as nonobese patients, and the drugs may lose their effectiveness more quickly. “Weight can dramatically affect inflammatory disease,” Qureshi affirms. The conundrum is that people with gut disorders and PsA may be more prone to obesity in the first place, whether because they are taking steroids (which can promote weight gain) or other factors. Some studies suggest that up to 45 percent of people with PsA are obese; a report published in 2019 in Medicine found that about 28 percent of participants with PsA were obese, as well as suffering from weight-related conditions such as high blood pressure, diabetes, and high cholesterol. Yet losing just 5 percent of weight can make a difference in managing these conditions. “Losing weight,” says Qureshi, “can have more of an impact than being on a drug.” Of course, dropping pounds isn’t easy. But these tips, many from the National Psoriasis Foundation, can help:
Write it down. If you jot down everything you eat and even how you feel when you’re eating, you’ll have an easier time seeing if you’re inadvertently consuming too much, or eating because of emotions. Apps like MyFitnessPal can make it easier to keep track.Eat more of the good stuff. A plant-based diet can help decrease inflammation levels, which may reduce psoriatic arthritis symptoms. Some experts recommend the Mediterranean diet, which is rich in anti-inflammatory omega-3 fatty acids and includes two to three servings of fruit and veggies, plus legumes, nuts, and seafood several times a week.Stay hydrated. Sometimes it’s easy to mistake thirst for hunger, which can lead to overeating — so drink up.
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Exercise Is Vital
Regular exercise is also critical if you have both psoriatic arthritis and Crohn’s, to boost muscle tone, promote joint and cardiovascular health, and maintain an ideal body weight. Resistance training, including weight lifting and body-weight exercises, such as squats, can be especially effective when it comes to weight loss, not to mention overall fitness. A small study published in February 2018 in the journal Clinical Rheumatology found that people with psoriatic arthritis who did resistance training twice a week for 12 weeks reduced their disease activity and pain and improved their quality of life. Your plan should also include stretching, as well as exercises to improve posture. Water workouts and aerobic exercise like brisk walking or swimming — really, anything that makes you breathe harder than normal — can help ease symptoms of psoriatic arthritis and Crohn’s as well, according to Crohn’s & Colitis UK. You’ll also want to learn coping methods that can help you put a lid on stress, according to the Crohn’s and Colitis Foundation. Mind-body techniques like meditation as well as psychotherapy can help. RELATED: Jump-Starting an Exercise Routine During the Pandemic And don’t underestimate the importance of sleep. “An adequate sleep regimen coupled with relaxation techniques can help minimize the effect of stress on your body,” Dr. Weselman says. You may already know this, but if you smoke, it’s time to quit. A study published in April 2020 in Scientific Reports found that smoking worsens inflammation. Ultimately, a holistic approach, one that includes the right medication, diet, and exercise plan as well as a medical team that works together, can make a huge difference in managing symptoms of psoriatic arthritis and gut disorders such as Crohn’s. “If dermatologists, rheumatologists, and gastroenterologists coordinate care, patients end up taking fewer medications, experience fewer side effects — and it’s less expensive for patients, too,” says Qureshi. “You can really fine-tune therapy and get optimal results in all three areas: the skin, the gut, and the arthritis.” Additional reporting by Beth W. Orenstein.
