Psoriatic arthritis (PsA) is a chronic and inflammatory arthritis, often occurring in people with psoriasis. Estimates show that 15-30% of people with psoriasis have PsA.¹

Some of the main symptoms experienced by those with PsA include significant pain, nail changes, fatigue, morning stiffness, impaired sleep, impaired physical function, and severe itch.¹ Those experiencing skin psoriasis are further burdened by psychological distress due to negative body image, poor self-esteem, anxiety, and depression.¹ 

The symptoms experienced by those living with PsA can interfere with all aspects of their lives, such as family relationships, relationships with friends, and romantic relationships, including sexual intimacy.

What are the physical effects of psoriatic arthritis on intimacy and relationships?

It is easy to understand why PsA may influence the physical relationships of those living with the condition. When physical symptoms like pain and extreme fatigue are combined with emotional symptoms like depression, anxiety, and poor body image, it is not surprising that intimacy can be affected. If you have ever found yourself feeling guilty or blaming yourself for how your PsA affects your physical relationship with your partner, take a step back! Remember to be kind to yourself and reframe your thoughts. These are experiences shared by many individuals with chronic illnesses, including PsA. Having a positive outlook can go a long way in bringing forth self-acceptance.

People have reported refraining from being intimate with their partners due to the physical pain associated with the joint manifestations and mental impact of their PsA.²^,³ This is especially true for those living with PsA and psoriasis.³ They experience additional physical and visible symptoms such as itchy, scaly skin. These individuals report impaired sexual experience during sexual activity, worsening of symptoms after sexual activity, decreased frequency of sexual activity, avoidance of sexual relationships, and reduced sexual desire.⁴ In fact, recent studies found that men and women with PsA were more likely to experience sexual dysfunction.^5,6

Despite how common these experiences are for people with PsA, many can feel unsupported by their healthcare professionals. As many as 43% of people with psoriasis and PsA feel that their clinicians' efforts to address sexual health are insufficient.⁴ If you experience this, make sure to bring up the conversation with your healthcare team to explore how they can support you.

What are the emotional effects of psoriatic arthritis on relationships?

The issues with sexual function seen with PsA are not only associated with organic causes; but self-acceptance, anxiety, and body image also play a role. People with PsA are at an increased risk for depression, which appears to be greater than for those with psoriasis without PsA.⁷ The consequences of living with PsA – namely the pain, fatigue and ongoing management – can evoke negative emotional responses. These negative emotions often include low mood, depression, anger and frustration. Many individuals report a perceived lack of understanding and unrealistic expectations concerning their PsA, which strains their relationship with their partner.⁸ Feeling understood and appreciated are core human desires. When this is missing in a relationship, it can result in a massive amount of emotional distress and dissatisfaction. It is essential to recognize if you are experiencing any of these emotions towards your partner and build a better understanding of your PsA together.

For those living with both PsA and psoriasis, the presence of visible symptoms can often bring about feelings of embarrassment and shame. Compounded with the physical symptoms associated with PsA, people report fearing rejection and stigmatization due to their disease. They are also more likely to feel shameful and guilty.⁹ These symptoms can be even more pronounced for individuals who experience sexual dysfunction or have genital psoriasis.^9,10 All of this can impact individuals' comfort levels and ability to participate in healthy emotional relationships with their partners.

PsA is more than just a joint condition. The emotional impacts can be debilitating and significantly impact the quality of life of those affected. If you feel like your quality of life is diminished because of your PsA, you are not alone. What is most important is recognizing when you are having those feelings and working towards developing healthy emotional responses. Some common strategies include keeping a journal where you can jot down your emotions to clear your mind, talking it out with a trusted family member or friend who you know will actively listen, joining a support group of individuals with PsA to feel less alone, and seeking medical advice if the emotions become too much to bear! If you feel depressed or unlike yourself, it is important to discuss these feelings with your doctor and get the help that you need.

Factors to consider during intimacy and sex

The daily battle with a chronic illness can make it challenging to have a healthy and satisfying sex life. Often, it can be hard to feel beautiful or sexy on days when your symptoms are harmful or bothersome. In these times, it is essential to be kind to yourself and recognize that you are doing the very best that you can. Work towards building a healthy relationship with yourself and your body, which can ultimately help you feel more comfortable in your day-to-day life and intimate relationships. 

If you are self-conscious about the impact that your PsA symptoms may have during sex, then consider brainstorming strategies that can help. These strategies could include taking it slow with your partner when it comes to intimacy. For instance, if your joints are tender and lack flexibility, make sure your partner is aware by communicating when you feel pain or discomfort. If you are feeling insecure because of your skin, talk to your partner about those concerns. Perhaps you can share what areas are good to touch and others that might make you feel uncomfortable or be painful. Explaining how it makes you feel, including any fears or anxiety, can help them understand why you sometimes appear uncomfortable. Your partner might feel as though they are doing something wrong. This openness can lead to good sexual health and a closer, more satisfying relationship.

If you are experiencing difficulties with sexual function, it could be reversible and related to treatments you are receiving for other conditions. For instance, anti-depressants can be associated with sexual dysfunction! Consider speaking to your doctor if you struggle to feel arousal during times of intimacy. 

Being the partner of someone with PsA

Having empathy and understanding for your partner with PsA helps encourage them to maintain open communication and emotional and physical connection during a relationship. It is important to recognize that the symptoms they experience can result in significant distress and affect sexual function. 

When living or interacting with your partner who has PsA, consider that: 

• Your partner may be unable to participate in activities due to their physical symptoms. Having to justify their need to do things differently can be exhausting. Be understanding and encourage them to openly communicate how they feel without making them feel guilty for having to ask or not participating. 
• They may be experiencing depression or anxiety related to their condition. Please do your best to support and encourage your partner to seek help.

References

1. Esteve E, Maccari F, Delavierre D, et al. Preliminary development of a questionnaire assessing the impact of psoriasis and psoriatic arthritis on patient's perception of sexuality. Medicine2018;97(42):12807. 
2. Haugeberg G, Michelsen B, Østensen M,Kavanaugh A. Perceived influence of health status on sexual activity in patients with psoriatic arthritis,Scand J of Rheumatol 2020;49:6, 468-475.
3. Sumpton D, Kelly A, Tunnicliffe DJ, et al. Patients’ perspectives and experience of psoriasis and psoriatic arthritis: a systematic review and thematic synthesis of qualitative studies. Arthritis Care Res (Hoboken) 2020;72(5):711–22.
4. Kurizky PS, Mota LM. Sexual dysfunction in patients with psoriasis and psoriatic arthritis − a systematic review. Rev Bras Reumatol 2012;52(6):938-948.
5. Wilton K, Achenbach S, Karmacharya P, et al. Erectile Dysfunction in Men With Psoriatic Arthritis: A Population-based Cohort Study. J Rheumatol 2020;48(4), 527-532.
6. Boone D, Ronson A, Karsh J. Comparison of Female Sexual Function Index in patients with psoriatic and rheumatoid arthritis and healthy controls. Musculoskeletal Care 2019;17(3), 226-230. 
7. McDonough E, Ayearst R, Eder L, et al. Depression and anxiety in psoriatic disease: prevalence and associated factors J Rheumatol, 2014;41:887-896.
8. Dures E, Hewlett S, Lord J, et al. Important Treatment Outcomes for Patients with Psoriatic Arthritis: A Multisite Qualitative Study. Patient 2017;10:455–462. 
9. Lee S, Mendelsohn A, Sarnes E. The burden of psoriatic arthritis: a literature review from a global health systems perspective. PT 2010;35(12):680-9. 
10. Feldman S, Malakouti M, Koo J. Social impact of the burden of psoriasis: effects on patients and practice. Dermatology Online J 2014;20(8).