Psoriatic arthritis (PsA) doesn’t hit you like a truck blowing through a red light. It tends to advance in stages -- though the disease isn’t officially “staged” the way cancer is. And not everybody with PsA goes through all the possible stages, or phases.
For example, some people have mild PsA and quickly achieve remission. Others have aggressive disease that damages their joints while they search for an effective treatment. Some people enjoy long-term remission. Others stop medications and quickly find themselves battling another round of painful symptoms.
Pre-PsA
In some cases, psoriasis is the first sign of what’s to come. According to one estimate, three in 10 people with psoriasis may eventually go on to get psoriatic arthritis.
People with PsA don’t always have psoriasis first. But there’s a silver lining when they do. Existing psoriasis makes it easier for doctors to diagnose PsA, which can mimic other health conditions.
Early Stages
PsA tends to develop about 5 to 12 years after psoriasis starts. There are plenty of exceptions, though: You might get PsA earlier, get psoriasis and PsA at roughly the same time, or not have skin symptoms until after arthritis starts.
Whenever PsA sets in, symptoms are similar:
- Swollen, inflamed, sore joints, especially in the fingers and toes.
- Early psoriatic arthritis can affect other joints, too, including shoulders, knees, and joints up and down your back and neck.
- PsA can also cause so much swelling in a finger or toe that they look like a sausage -- a condition called dactylitis.
Long-Term, Active Disease
Over time, PsA may cause permanent damage to joints. In small joints, such as fingers and toes, you can clearly see the joint deformity from chronic inflammation.
Joint damage can put a hard limit on activities you once enjoyed. That’s not just upsetting; it’s a recipe for even more pain. When you don’t get enough physical activity, your joints can become stiff and your muscles weak.
Joint problems aren’t the only concern. PsA also makes you more likely to have other conditions, including:
- Anemia (low red blood cell count)
- High blood pressure
- High cholesterol
- Obesity
Remission
Some people with PsA never know the pain and embarrassment of damaged and deformed joints, thanks to powerful medications designed to control the disease. These include:
- Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate and sulfasalazine
- Immunosuppressants, such as azathioprine and cyclosporine
- TNF-alpha inhibitors, such as adalimumab (Humira) etanercept (Enbrel)
- Newer drugs for plaque psoriasis, such as apremilast (Otezla) and secukinumab (Cosentyx)
You may find a drug that works for you right away, or you may need to try a few before symptoms start to improve. Once you’re on an effective treatment, you can likely expect major improvement within a year. In fact, some research suggests that up to 60% of patients with PsA can have “minimal disease activity” -- a.k.a. remission -- after taking biologic drugs for a year.
Keep in mind that achieving remission doesn’t mean you’ve cured the disease. Your doctor will still encourage you to take at least some medications for the long haul. Research shows that people with PsA who stop taking disease-modifying drugs during remission tend to have their symptoms relapse within a few months.
How Lifestyle Changes Help
In addition to drugs that slow down the march of psoriatic arthritis, you can change your lifestyle to ease the pain, stiffness, and fatigue that come with the disease:
Simplify tasks. Why strain your joints when there are products to make twisting, turning, pushing, and pulling easier? Look for arthritis-friendly products to suit your needs, large and small -- from gardening tools to walk-in bathtubs. You can also change the way you do everyday things. For example: Use your body, not your hands, to push open doors; lift cookware with two hands instead of one.
Slim down. Losing weight is hard, whether you’re trying to shed 10 or 100 pounds. But achieving a healthy weight can make a difference in your PsA. It lightens the load on your joints, which means less pain, more energy, and better mobility. Plus, being overweight can make some PsA medications less effective.
Master your stress. Like fanning a flame, stress causes your body to release chemicals that aggravate PsA. (Stress triggers inflammation, and inflammation makes symptoms worse.) Consider a therapist or support group for PsA, as well as these proven ways to manage stress:
- Deep breathing
- Meditation
- Progressive muscle relaxation
- Yoga
- Tai chi
- Walking
Rest often. Pain, inflammation, and even medications for your arthritis can drain your energy. That doesn’t mean they have to drain the fun from your life. The trick to being active with PsA, whether that means a jog or a family picnic, is to take rest breaks when you start to feel tired -- not once you’re already wiped out.