Psoriatic arthritis (PsA) is a joint condition that often occurs alongside psoriasis, a skin disease. Psoriatic arthritis is an autoimmune disorder where the immune system attacks healthy tissues. PsA mainly affects the joints, but sometimes also the skin, eyes, and nails. Studies suggest that people with hidradenitis suppurativa (HS) may also have a higher risk of developing PsA and psoriasis.

Both HS and PsA can be hard to diagnose. A healthcare professional may need to run several tests to rule out other conditions before finding the cause of your symptoms and your best treatment options.

While managing HS and PsA together can be challenging, it’s important to know about the increased risk of comorbidities (co-occurring health conditions). Hearing from others who are dealing with both HS and PsA can help you feel less alone.

Is It Common To Have HS and PsA?

One study found that people with HS have a three times higher incidence of some form of inflammatory arthritis, such as rheumatoid arthritis or PsA. Usually, HS lesions come first. An arthritis diagnosis may not happen until 20 years after HS is diagnosed.

One myHSteam member shared, “I have been dealing with HS since I was 18, and now I’m 41. I also have psoriasis and psoriatic arthritis, so my skin is all kinds of a mess!”

Researchers aren’t sure why people with HS have a higher chance of PsA compared to the general population. They think it might be due to environmental or genetic factors. Both conditions also involve problems with the immune system.

Do HS and PsA Share Risk Factors?

Several factors can increase the chances of developing HS or PsA. Some risk factors overlap, while others differ.

Family History

Both HS and PsA run in families, suggesting there are probably some genetic links.

Age, Sex, and Race

According to Mayo Clinic, women are three times more likely to develop HS. The condition also tends to start after puberty, more often before age 40. Black people are more likely to develop HS than people of other racial backgrounds, according to Mayo Clinic.

PsA usually develops a little later in life, between ages 30 and 55. The biggest risk factor for PsA is having psoriasis. However, some people develop PsA first or without showing signs of psoriasis on the skin at all. According to the National Psoriasis Foundation, psoriasis is more common in Caucasians (3.6 percent) than than in African Americans (1.5 percent). Psoriasis may be underdiagnosed in people with darker skin, partly because the condition presents differently on darker skin than on lighter skin, which may make it more difficult to recognize by doctors and people who have it.

Body Mass and Smoking

HS is more common and severe in people who smoke and in those who are diagnosed with obesity. Obesity is determined based on a person’s body mass index (BMI), which measures the relationship between weight and height.

Both smoking and obesity are also risk factors for psoriatic arthritis.

Other Factors

Some health experts think that trauma — like a physical injury or a bacterial or viral infection — may trigger PsA in people who are genetically predisposed to it.

Do HS and PsA Share Symptoms?

HS and PsA are both chronic diseases with symptoms that typically come and go. They share some symptoms, like swelling, pain, and changes in how your body looks and feels. However, specific symptoms, like lesions and abscesses in HS or swollen fingers and toes in PsA, do not overlap.

Comorbidities

While HS and PsA don’t share many symptoms, they do share several comorbidities. These include:

• Psoriasis
• Diabetes
• Inflammatory bowel disease
• Hypertension (high blood pressure)
• Obesity
• Anxiety and depression

How Is PsA Diagnosed?

Since HS increases the risk of inflammatory arthritis, it’s important to watch for early signs of joint problems. Tell your healthcare provider right away if you notice symptoms like lower back pain, stiffness in the morning, and pain in the peripheral joints (like fingers and toes).

One member of myHSteam wrote, “I talked to my doctor not too long ago about having swelling and pain in my joints. I asked if it was connected to HS, and she said yes, because HS causes inflammation.”

If your doctor suspects you might have PsA or another form of inflammatory arthritis, they may refer you to a rheumatologist for diagnosis. This specialist will perform a physical exam and order tests, like blood work and imaging, to confirm a diagnosis.

How Are HS and PsA Treated?

There’s no known cure for HS or PsA, but both conditions can be managed with healthy habits, medications, and sometimes surgery.

HS and PsA share some treatment options, though they may be applied differently depending on the condition.

Oral and Injected Medications

Doctors often prescribe biologics to reduce inflammation in both HS and PsA. Some biologic therapies can treat both conditions.

Non-steroidal anti-inflammatory drugs (NSAIDs) can help with pain and inflammation from HS or PsA.

In addition, steroid injections may be given to reduce pain and swelling in HS or PsA. For HS, steroids are injected into skin lesions. For PsA, they’re injected into joints.

HS-specific treatments include hormone therapy, retinoids, and antibiotics. PsA-specific treatments may include additional oral medications, such as a variety of disease-modifying antirheumatic drugs (DMARDs), like methotrexate (available as a pill or intramuscular injection).

Surgery

For HS, surgical interventions may involve draining or removing affected areas of skin. For PsA, surgery can replace damaged joints with artificial ones. Surgery is usually a last resort for both conditions.

Lifestyle

Maintaining a healthy body weight can help lower inflammation, which is good for both HS and PsA. However, it’s not a cure for either condition. Quitting smoking is also important for managing HS and PsA, as it may improve symptoms and reduce the risk of other health problems.

For people with PsA, physical therapy, occupational therapy, and massage therapy can also help manage symptoms. Ultimately, the best treatment plan is one that addresses all your health needs and helps you feel your best.

Talk With Others Who Understand

On myHSteam, the social network for people and their loved ones living with hidradenitis suppurativa, more than 46,000 members come together to ask questions, give advice, and share their stories with others who understand life with this challenging skin condition.

Have you talked to your dermatologist about the risk of psoriatic arthritis? If you’ve been diagnosed with PsA after HS, how do you manage treatment for both conditions? Share your experience in the comments below or start a conversation by posting on your Activities page.