And then there’s psoriasis—the chronic skin condition that almost always occurs alongside psoriatic arthritis. As SELF previously reported, skin conditions can have a real psychological impact. “People become socially isolated and embarrassed, and there can be a level of disability that comes from skin itching and pain,” Dr. Gupta says. At the same time, any health condition that interferes with your ability to do the things you love to do can lead to feelings of guilt, loss, and frustration.
Jen Douglas, PhD, a licensed psychologist in San Francisco and a clinical assistant professor at Stanford School of Medicine, tells SELF that there is a “bidirectional relationship between mental health and physical health.” Meaning that often, when one suffers, so does the other. “This is often referred to as the mind-body connection.”
The intriguing role of inflammation
While it’s not shocking that the experience of living with psoriatic arthritis can exacerbate mental health conditions, there may also be a biological explanation for this association. Experts are investigating the role that inflammation plays in the higher rates of depression among people with chronic inflammatory conditions.
“Once we control the inflammation with psoriatic arthritis medication, the patient’s depression often also improves,” Dr. Gupta says. “It’s an association, and we can’t say there’s direct causation,” he notes. While it’s possible this could be a result of symptom improvement, there is growing interest in the role of inflammation in depression. In fact, experts think it could be a two-way street.
“We have also found that depression drives skin and joint disease,” Dr. Gupta says. A 2019 research review published in the journal Current Opinion in Rheumatology2 looked at the connection between depression and rheumatoid arthritis, an inflammatory arthritis similar to psoriatic arthritis, and found that depression increases the risk of flares and decreases rates of remission. Similarly, the 2020 Clinical Rheumatology review mentioned earlier found that people with psoriatic arthritis who also had anxiety and/or depression reported greater psoriatic arthritis disease activity.
To add to the complexities, living with a mental health condition alongside an autoimmune condition like psoriatic arthritis can make managing either illness even more challenging. “If patients are depressed and anxious, sometimes they are not compliant with medication, making treatment less successful,” Dr. Gupta says.
A holistic approach to care
There’s a strong case for working mental health care into your treatment plan for psoriatic arthritis. Many people with the condition already see both a dermatologist and rheumatologist—sometimes even within the same practice, as is the case in Dr. Gupta’s clinic. Adding mental health care into that collaborative, one-stop-shop model would be great, but it’s not something you see very often.
Instead, most rheumatologists will refer a patient to their primary care provider or a mental health professional if mental health concerns come up during an appointment. Social anxiety is a big one that Dr. Gupta’s patients mention. “I also always encourage them to get involved in social support groups, because social isolation is one of the big factors that is going to feed depression and anxiety,” he says.