What Special Concerns Do Women With Psoriatic Arthritis Face?

Doctor examining woman's elbow.
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Men and women are equally affected by psoriatic arthritis, an inflammatory type of arthritis that is associated with the skin disease psoriasis. It is classified as one of the spondyloarthropathies, which includes ankylosing spondylitis and reactive arthritis as well. At first, psoriatic arthritis was considered a variation of seronegative rheumatoid arthritis, but it later was recognized as its own disease.

The prevalence of psoriatic arthritis is estimated to be one to two per 1000 in the general population. The estimated prevalence of psoriatic arthritis among people with psoriasis ranges from four to 30 percent.

Gender-Related Differences in Psoriatic Arthritis

Researchers have studied gender differences in the spondyloarthropathies. Certain gender-related differences have been discovered: men are more likely to develop axial (spine) involvement with psoriatic arthritis while women tend to develop peripheral polyarticular disease. Also, women tend to have less severe radiographic (x-ray) damage to their spine and peripheral joints compared to men. 

It has also been determined that, compared to men with psoriatic arthritis, women with psoriatic arthritis:

  • tend to discontinue treatment with TNF blockers sooner because of a less adequate response and more side effects.
  • tend to have worse quality of life.
  • tend to have more severe fatigue.
  • experience more work disability.

The differences may be connected to the effect of hormones, different gene expression, differences in occupational exposure, or differences in pain perception. It is yet to be fully understood.

Smoking and Alcohol Affect Risk in Women

A study that was published in the Annals of the Rheumatic Diseases (2011) concluded that smoking was associated with a higher risk of developing psoriatic arthritis in women.

Researchers studied the connection because previous studies had revealed an association between smoking and psoriasis, but the association remained undefined in psoriatic arthritis.

Similarly, a study that was published in the Journal of Rheumatology (2015) revealed that excessive alcohol intake was associated with a higher risk of psoriatic arthritis in US women. Researchers undertook this study because previous studies found an association between alcohol intake and psoriasis, but the association with psoriatic arthritis was not clear.

Psoriatic Arthritis and Other Conditions

Researchers have found an association between psoriasis, psoriatic arthritis, and certain other conditions. Some diseases and conditions tend to occur more frequently in people who have psoriasis and/or psoriatic arthritis. It has been determined that:

  • Temporomandibular disorders are more common in people with psoriatic arthritis than psoriasis, largely due to the arthritis aspect, according to study results published in 2015 in the International Journal of Medical Sciences. This is particularly true of women with psoriatic arthritis compared to men. 
  • A history of gallstones is associated with an increased risk of psoriatic arthritis and psoriasis in women, independent of obesity, according to study results published in 2015 in the British Journal of Dermatology.
  • Hypercholesterolemia (elevated level of cholesterol in the blood), a known cardiovascular risk factor, is associated with an elevated risk of psoriatic arthritis and psoriasis in women, according to a study published in 2013 in Arthritis & Rheumatism.  
  • Psoriasis, especially with existing psoriatic arthritis, is associated with an increased risk of Crohn's disease, according to results published in 2012 in the Annals of the Rheumatic Diseases. Genome-wide association studies (GWAS) have found common susceptibility genes between the conditions.
  • Women with psoriasis and psoriatic arthritis have a higher prevalence of fragility fractures (defined as any fracture caused by a fall from standing height or less) and a higher risk of metabolic syndrome, according to study results published in 2011 in Arthritis Research & Therapy. The higher prevalence of fractures was evident despite no major difference in spine and femur bone mineral density among those with psoriasis, psoriatic arthritis, or healthy controls.

Emotional Effects of Psoriasis and Psoriatic Arthritis on Women

A report from the National Psoriasis Foundation emphasized that the emotional and social impact of psoriasis and psoriatic arthritis on women is greater than it is on men. The conditions affect self-confidence, social relationships, and self-esteem.

If you're a woman with psoriatic arthritis, understandably, concern over appearance may be present—how you perceive yourself and how you are perceived by others. Additionally, you may be worried about pregnancy, dating, intimacy, and the stigma of having a visible condition on your skin. If you're feeling concerned or depressed, make sure to talk to a healthcare professional. There are countless resources available that address your specific concerns and provide tips and solutions for your specific situation.

Sources:

Clinical Manifestations and Diagnosis of Psoriatic Arthritis. Gladman and Ritchlin. UpToDate. Reviewed May 2016.
https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-psoriatic-arthritis

Gender-related Differences in Patients With Psoriatic Arthritis. Eder L. et al. International Journal of Clinical Rheumatology. December 2012.
http://www.futuremedicine.com/doi/full/10.2217/ijr.12.63

Clinical Differences Between Men and Women With Psoriatic Arthritis: Relevance of the Analysis of Genes and Polymorphisms in the Major Histocompatibility Complex Region and of the Age at Onset of Psoriasis. Queiro R. et al. Clinical and Developmental Immunology. April 2013.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652135/

Smoking and Risk of Incident Psoriatic Arthritis in US Women. Wenqling L. et al. Annals of the Rheumatic Diseases. November 2011.
http://ard.bmj.com/content/early/2011/11/07/annrheumdis-2011-200416.short

Alcohol Intake and Risk of Incident Psoriatic Arthritis in Women. Wu S. et al. The Journal of Rheumatology. April 1, 2015.
http://www.jrheum.org/content/early/2015/03/25/jrheum.140808.abstract

Temporomandibular Disorders in Psoriasis Patients With and Without Psoriatic Arthritis: An Observational Study. Crincoli V. et al. International Journal of Medical Sciences. 2015.
http://www.medsci.org/v12p0341.htm

Personal History of Gallstones and Risk of Incident Psoriasis and Psoriatic Arthritis in US Women. Tong LX et al. British Journal of Dermatology. May 2015.
http://onlinelibrary.wiley.com/doi/10.1111/bjd.13463/abstract

Hypercholesterolemia and Risk of Incident Psoriasis and Psoriatic Arthritis in US Women. Wu S. et al. Arthritis and Rheumatism. December 2013.
http://www.docguide.com/hypercholesterolemia-and-risk-incident-psoriasis-and-psoriatic-arthritis-us-women

Psoriasis, Psoriatic Arthritis and Increased Risk of Incident Crohn's Disease in US Women. Wen-Qing L. et al. Annaks of the Rheumatic Diseases. August 2012.
http://ard.bmj.com/content/early/2013/03/15/annrheumdis-2012-202143.short

Bone Mineral Density and Body Composition in Postmenopausal Women With Psoriasis and Psoriatic Arthritis. Pedreira PG et al. Arthritis Research & Therapy. February 2011.
http://arthritis-research.biomedcentral.com/articles/10.1186/ar3240

Women and Heavy Toll of Psoriasis. Amy Stork. National Psoriasis Foundation. 05/06/2015.
https://www.psoriasis.org/advance/women-and-psoriasis

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