When it comes to psoriatic arthritis (PsA), depression and anxiety can make managing the disease much more difficult.
Researchers found that people with psoriatic arthritis who also have depression and anxiety were about 70 percent less likely than those without these mental-health issues to achieve minimal disease activity (MDA), a state in which pain, tenderness, and swelling are drastically reduced.
“We all want our patients to get to remission or have minimal disease activity, but depression and anxiety are important factors that prevent that from happening,” says Vinod Chandran, MD, PhD, a rheumatologist and clinician-scientist at the University of Toronto, the co-director of the psoriatic arthritis program at the University Health Network, and a co-author of that study.
Depression and psoriatic arthritis have a complex relationship. While depression can be the psychological response to living with the pain and stress of a chronic condition like PsA, the systemic inflammation that causes PsA likely also plays a role in depression. Studies have shown that depression and psoriatic disease follow a similar inflammatory pattern.
The Toll on Emotional Well-Being in People With PsA
Mental health problems are all too common among individuals with psoriatic arthritis. It’s estimated that about one third of patients with this autoimmune condition struggle with depression and anxiety.
Research has shown that people with psoriasis and PsA are nearly 3 times more likely to have depression independent of other comorbidities than those without PsA. Among 73,447 people with psoriasis, those who developed major depressive disorder (MDD) were at a significantly increased risk of developing PsA compared with those who did not develop MDD.
“These issues should be addressed by clinicians when managing patients with psoriatic arthritis,” says Chandran.
How Depression and Anxiety May Fuel Psoriatic Arthritis Pain
Brett Smith, DO, a rheumatologist at Tennessee Direct Rheumatology in Knoxville, believes that clinicians could be more proactive about assessing their patients’ mental health, especially because psoriatic arthritis and depression seem to make each other worse.
Although no research has proved a cause-and-effect relationship between depression and psoriatic arthritis, PsA pain can heighten depression. Conversely, when a person is depressed, he or she may not take care of their health by exercising, for instance, which can make psoriatic arthritis symptoms worse.
“I tell people that depression and anxiety are not the only reason for their pain, but it’s like squirting [lighter] fluid on a campfire – it just makes the flame grow bigger,” Smith says.
Stanford Shoor, MD, a clinical professor of medicine and rheumatology at Stanford University in Palo Alto, California, explains that depression and anxiety can also lower a patient’s pain threshold.
“Pain is in the mind of the beholder,” he says, “and depression and anxiety can make the same amount of inflammation present in a joint feel worse. It’s very important to determine whether the discomfort a person feels is actually from the inflammation or if it’s more related to processing the pain – and depression and mood play a role in that.”
Recognizing Serious Mental Distress and Getting Help
Smith notes that he sometimes works with a psychologist who can provide specialized support for patients who are grappling with mental health or psychological issues.
“We have to address the patient as a whole person rather than just a handful of joints and some skin changes,” he says.
While Dr. Shoor emphasizes that psoriatic arthritis is “not just a body disease – the mind plays a role,” he points out that rheumatologists are not experts in the treatment of depression. If he believes a person needs mental help, Shoor may suggest they see a therapist or possibly a psychiatrist.
Patients who are proactive may also find emotional support among social groups of other psoriatic arthritis patients. The Centers for Disease Control and Prevention provides links to self-management education workshops that can help teach you how to cope with arthritis symptoms and maintain healthy behaviors.
For a patient, the first step in overcoming a mental health challenge may be recognizing the symptoms. Signs of depression may include the following:
Persistent sad, anxious, or empty mood
Feelings of hopelessness, pessimism
Loss of interest or pleasure in hobbies and activities
Lower energy, fatigue, feeling slowed down
Difficulty concentrating, remembering, or making decisions
Insomnia, early-morning awakening, or oversleeping
Decreased appetite and weight loss or overeating and weight gain
Restlessness or irritability
Including Mental Health as Part of Comprehensive Care
Chandran believes that clinicians need to not only focus on therapies that can suppress joint inflammation but also expand care to a more multidisciplinary approach.
“Comprehensive management of PsA should include measures for addressing anxiety and depression so that more patients achieve a state of MDA,” his study concludes.
A recent review of research emphasizes that “recognizing and addressing the psychosocial impact of PsA is paramount for comprehensive patient care” and requires a multidisciplinary approach involving rheumatologists, psychologists, and other healthcare professionals. Cognitive behavioral therapy, mindfulness-based stress reduction, and other psychological interventions can help with stress, anxiety, and depression; support groups can provide both emotional and practical help. Researchers add that “comprehensive disease management programs that address both physical and psychosocial needs could also be crucial for improving patient outcomes and overall quality of life.”
The Arthritis Foundation says that treating mental health conditions should be regarded as a fundamental part of managing arthritis symptoms. The organization offers advice on when to see a mental-health specialist as well as information on healthy lifestyle choices and self-care options that can help ease symptoms, especially when used alongside psychotherapy or medication.
Identifying and treating depression takes a multi-team approach working with your rheumatologist, primary care providers, as well as behavioral and mental health professionals.
The Takeaway
Depression and anxiety can worsen psoriatic arthritis symptoms, with research showing that people with these mental health issues are about 70 percent less likely to achieve minimal disease activity.
Mental health problems are common in people with psoriatic arthritis, affecting about one-third of patients, and the relationship appears to be bidirectional – depression can lower pain thresholds, while chronic pain can worsen depression.
If you’re experiencing persistent sadness, loss of interest in activities, fatigue, or difficulty concentrating alongside your PsA symptoms, talk to your rheumatologist and healthcare team about getting support from a mental health professional or joining a support group.
Treatment that addresses both the physical and psychological aspects of psoriatic arthritis through a multidisciplinary approach can improve your overall quality of life and help you better manage the condition.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
Wong A et al. Depression and Anxiety Reduce the Probability of Achieving a State of Sustained Minimal Disease Activity in Patients With Psoriatic Arthritis. Arthritis Care & Research. March 4, 2021.
Mathew AJ et al. Depression in Psoriatic Arthritis: Dimensional Aspects and Link with Systemic Inflammation. Rheumatology and Therapy. April 22, 2020.
Lubrano E et al. Psychological Health in the Management of Patients with Psoriatic Arthritis: An Intricate Relationship. Rheumatology and Therapy. March 25, 2025.
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Beth Biggee, MD
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Beth Biggee, MD, is owner and practitioner of Lifestyle and Integrative Rheumatology, a holistic direct specialty care practice in North Andover, Massachusetts. She offers whole-pe…
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