Can traumatic injury trigger psoriatic arthritis? A review of the literature

Clin Rheumatol. 2014 May;33(5):601-8. doi: 10.1007/s10067-013-2436-7. Epub 2013 Nov 19.


Traumatic injury as a trigger for the subsequent development of psoriatic arthritis (PsA) has been implicated by several case reports and case series. However, it is still unclear whether trauma is the inciting event or just an incidental finding. It is thought that the interplay of genetic, immunologic, and environmental factors, such as trauma, may trigger the development of PsA. At least two hypotheses of how trauma may be linked to the development of PsA have surfaced and involve a "deep Koebner effect," the concept of a synovio-entheseal complex and activation of the innate immune system by biomechanical factors. The role of neuropeptides such as substance P and vasoactive intestinal peptide has been highlighted in the synovium after trauma. Better understanding of this phenomenon would shed light into the pathophysiology of Psa and help the development of preventive and therapeutic strategies.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Arthritis, Psoriatic / complications*
  • Arthritis, Psoriatic / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuropeptides / chemistry
  • Neuropeptides / physiology
  • Research Design
  • Substance P / physiology
  • Synovial Membrane / physiopathology
  • Vasoactive Intestinal Peptide / physiology
  • Wounds and Injuries / complications*
  • Wounds and Injuries / diagnosis*
  • Young Adult


  • Neuropeptides
  • Substance P
  • Vasoactive Intestinal Peptide