Joint pain, stiffness, swelling, fatigue — for many people, aches and pains like these are just a part of getting older. But for about 30 percent of people with psoriasis, these symptoms may signal something more: psoriatic arthritis.
“With psoriasis, joint pain may be a tip-off to psoriatic arthritis,” says Nathan Wei, MD, a rheumatologist at the Arthritis Treatment Center in Frederick, Maryland. “And psoriatic arthritis treatment needs to be approached aggressively.”
The goal of psoriatic arthritis treatment is to relieve pain and inflammation and, if treatment begins early enough, prevent joint damage. According to the National Psoriasis Foundation (NPF), treatment ranges from nonsteroidal anti-inflammatory drugs (NSAIDs) for mild pain relief to disease-modifying antirheumatic drugs (DMARDs) and biologic medications.
“People with psoriatic arthritis need to study their illness and be on top of it,” Dr. Wei says. “That way, they can ask questions and be a real partner in the treatment process.” Let's start by dispelling nine common misconceptions about psoriatic arthritis treatment.
1. Myth: It Doesn’t Matter When You Start Treatment
When it comes to psoriatic arthritis, early diagnosis and treatment are critical. The earlier you catch it, the better chance you have to limit or even prevent joint damage from occurring, according to the NPF. A study published in June 2015 in Annals of the Rheumatic Diseases found that a delay in diagnosis of as little as six months can lead to permanent joint damage.
What’s more, early treatment of psoriatic arthritis can help preserve your ability to feel your best every day. “The symptoms of joint pain and swelling are very limiting to people and can for 1 last update 2020/07/13 strongly influence quality of life,” says Eric Matteson, MD, the chief of rheumatology at the Mayo Clinic in Rochester, Minnesota. If you have psoriasis and believe you’re experiencing arthritis-like symptoms, let your doctor know right away. You’ll likely be referred to a rheumatologist, a doctor who specializes in arthritis.What’s more, early treatment of psoriatic arthritis can help preserve your ability to feel your best every day. “The symptoms of joint pain and swelling are very limiting to people and can strongly influence quality of life,” says Eric Matteson, MD, the chief of rheumatology at the Mayo Clinic in Rochester, Minnesota. If you have psoriasis and believe you’re experiencing arthritis-like symptoms, let your doctor know right away. You’ll likely be referred to a rheumatologist, a doctor who specializes in arthritis.
2. Myth: Psoriatic Arthritis Is Curable
“There’s no cure for psoriatic arthritis,” Wei says. “However, there are medications that can get it into remission.” He says treatment can help nearly 95 percent of people with different forms of arthritis start to feel better, and many people may also reach remission.
What does remission look like? According to an article published in February 2011 in Therapeutic Advances in Musculoskeletal Disease, psoriatic arthritis remission can be defined as “the reversibility of functional impairment, minimal or no progression to joint destruction, and at least a theoretic potential to heal a damaged joint.” For many people with psoriatic arthritis, reaching remission requires working closely with a doctor to find the appropriate treatment and then sticking to that treatment. Meanwhile, research for a psoriatic arthritis cure is under way, Dr. Matteson says.
3. Myth: A Dermatologist Can Treat Psoriatic Arthritis
Psoriasis and psoriatic arthritis are typically related, but that doesn’t mean the approaches to treating and managing the conditions are identical. “Some people think, ‘My psoriasis is doing well, so my arthritis isn’t a big deal’ or vice versa,” Matteson says. The truth: “The two don’t always correlate.”
definedinexplicablehow to definedinexplicable for That’s why it’s important to also see a rheumatologist for psoriatic arthritis, according to the NPF. In 85 percent of cases, skin problems occur before joint pain, so a dermatologist may be the first one to identify psoriatic arthritis. But because psoriatic arthritis treatment can be complex and often requires adjustments over time, a rheumatologist is best suited to develop your individual treatment plan. Sometimes treating one condition with certain medications may help improve the other, Wei says.
4. Myth: NSAIDs Are Risk-Free
NSAIDs are commonly used to relieve joint pain, stiffness, and inflammation in people with psoriatic arthritis. Certain versions are available over the counter (like ibuprofen), while stronger forms require a prescription. “For mild cases of psoriatic arthritis, NSAIDs can be helpful,” Matteson says. “They’re for the management of pain. They don’t change the course of the disease.”
But just because NSAIDs are used for milder psoriatic arthritis symptoms, that doesn’t mean they don’t have risks or side effects. “They do have risks,” Matteson says. “This can include stomach bleeding, hypertension, or kidney damage, especially if used at higher doses for long periods of time.” Be sure to discuss these risks with your doctor.
5. Myth: Biologics and Newer Drugs Are Only for Severe Cases
Biologic drugs are disease-modifying, which means they stop or slow down disease by targeting specific parts of the immune system. Administered by injection or intravenous (IV) infusion, biologics also come with some risks.
“In general, there’s concern about any drug that modifies the immune system because of the possibility of infections or cancer development,” Matteson says.
definedinexplicablehow to definedinexplicable for While these concerns are valid, Matteson says that the benefits of biologic medications outweigh the risks, even for people whose cases are not severe. “People who have mild pain or swelling in a single joint may do just fine with NSAIDs alone. For people who have more joint swelling and pain, the use of biologics is justified,” Matteson says.
6. Myth: Long-Term Use of Corticosteroids Is Safe
At some point in the course of your disease, your doctor may prescribe a corticosteroid medication. According to the Psoriasis and Psoriatic Arthritis Alliance, low doses of corticosteroids may bring pain relief and ease stiffness in people with psoriatic arthritis, while higher doses can help with recovery from a severe flare-up.
But corticosteroid use is intended to be temporary. Because of the risk of serious side effects with long-term use — such as muscle weakness, brittle bones, eye problems, and diabetes — your doctor will only prescribe a corticosteroid when necessary and will likely taper you off it once for 1 last update 2020/07/13 the problem is under control.But corticosteroid use is intended to be temporary. Because of the risk of serious side effects with long-term use — such as muscle weakness, brittle bones, eye problems, and diabetes — your doctor will only prescribe a corticosteroid when necessary and will likely taper you off it once the problem is under control.
7. Myth: You Can Stop Treatment When You Start Feeling Better
Most rheumatologists recommend that you stay on your medication even after you reach remission, according to the Arthritis Foundation. “We know that when people with psoriatic arthritis stop taking their medication, even if they feel good, their disease will come roaring back,” Wei says.
Matteson agrees, saying that only a small percentage of people with psoriatic arthritis who reach remission are able to stop taking their medication completely. “Most people find that their disease flares up again,” he says. Indeed, a small study published in February 2014 in Annals of the Rheumatic Diseases found that about 77 percent of participants who stopped psoriatic arthritis treatment experienced a return of their symptoms within six months.
8. Myth: People With Psoriatic Arthritis Shouldn’t Exercise
Wei and Matteson agree: If a person with psoriatic arthritis believes she shouldn’t exercise because of joint pain, she may be falling for the biggest myth of all. Exercise should definitely be a part your overall treatment approach. According to the NPF, moderate physical activity may provide benefits for people with psoriatic arthritis by reducing joint pain and stiffness, improving flexibility, increasing range of motion, helping with weight loss, and more.
“The most beneficial forms of physical activity for people with psoriatic arthritis tend to be walking, swimming, and biking,” Matteson says. “Exercises that strengthen muscle actually take stress off the joints.” In addition to being good for your joints, fitness also plays an important role in your overall health.
9. Myth: Psoriatic Arthritis Eventually Requires Surgery
This myth is far from true. “If psoriatic arthritis is diagnosed early and you are aggressive in treatment, you’ll probably never need surgery,” Wei says. Only a small percentage of people with psoriatic arthritis will go on to require surgical intervention, according to the Cleveland Clinic in Ohio.
So who usually needs surgery? “Some people have had the disease for the 1 last update 2020/07/13 many years before they start treatment, and severe joint destruction has already occurred,” Wei explains. These people may undergo joint replacement surgery to relieve pain and restore function.So who usually needs surgery? “Some people have had the disease for many years before they start treatment, and severe joint destruction has already occurred,” Wei explains. These people may undergo joint replacement surgery to relieve pain and restore function.