What PsA Remission Really Means—and How to Get There
Experience fewer flares (and a better quality of life) with the right psoriatic arthritis treatment plan.
Swollen fingers and toes. Pain and stiffness in your joints that makes it tough to get out of bed in the morning. Mobility challenges, plus reduced range of motion. Eye problems, plus the crushing fatigue that so often comes with it all.
If you have psoriatic arthritis (PsA), an autoimmune disorder that causes damaging inflammation (and other complications) in many parts of the body, you likely dream about never having another flare. You want the freedom remission brings—and you want it right now.
“Psoriatic arthritis is an inflammatory musculoskeletal disease associated with psoriasis,” says Joseph Martinez, M.D. a rheumatologist at Texas Orthopedics in Austin. Thirty percent of people with psoriasis go on to develop PsA sometime in their lives, usually between the ages of 30 and 50. “There is a genetic component, although environmental factors likely contribute, as well,” Dr. Martinez explains.
All that discomfort can cause a lot of stress and emotional upheaval, which can chip away at your quality of life. So, it’s no wonder people with PsA often report symptoms of depression and anxiety among their many symptoms, according to research. To regain a sense of well-being, aim for remission with a PsA treatment plan in place that works to get—and keep—you at the lowest disease activity level possible.
The Fallout of a PsA Flare
No one really knows why PsA symptoms can come and go—but experts say that inflammation rears its ugly head when the immune system mistakenly attacks healthy cells and tissues in the joints and skin. Inflammatory triggers include skin trauma or injury, stress, alcohol, excess weight, smoking, and common infections that can all cause a surge in immune system activity.
“The degree of inflammation one has determines how long a flare can last," explains Minna J. Kohler, M.D., director of the Rheumatology Musculoskeletal Ultrasound Program at Massachusetts General Hospital and Harvard Medical School in Cambridge, MA. "The length of a flare related to PsA can vary from days to weeks.”
If a flare remains uncontrolled, it can eventually translate into permanent damage to the joints and soft tissues, leading to bone loss, cartilage damage, and tendon tears. Eye inflammation, known as uveitis, can present, or be worsened, by a flare.
“Adequate, early treatment of inflammation should be a goal in treatment of PsA to prevent permanent joint and tendon damage,” Dr. Kohler advises.
Tame Inflammation with Targeted Treatment
Although flares can be tough on your body, it’s important to know that periods of remission are possible—and these welcome periods of calm can vary in duration, too. While there is no known cure for PsA, Dr. Martinez says that current treatment options can provide long-term respite from disease activity.
So, that’s the goal—and it’s achievable. But to get there, you'll need a plan.
Think back to when you first started experiencing PsA symptoms. You may have bounced around from doctor to doctor, with each specialist attempting to treat every ailment individually, as if they weren’t at all connected. Your eventual diagnosis was likely a big “a-ha moment” for you—and now it’s time for another one. Talk to a rheumatologist about developing the right “treat-to-target” plan to up your odds of living symptom-free.
“It is important to be evaluated by a rheumatologist, who can offer multiple medication treatment options to control symptoms, slow down progression of the disease, and prevent accelerated joint damage,” Dr. Kohler says.
Treat-to-target therapy (T2T) aims to achieve long-lasting remission. Originally a strategy for managing diabetes and heart disease, it involves regular monitoring by your doctor (usually monthly or every three months) to see if your PsA medications are effective. If they're not working as well as you'd hoped, your doctor may increase your dosage, or even swap meds, in hopes that you’ll achieve remission (or get as close to it as possible).
This approach combines your doctor's assessment of your symptoms, physical exam, and sometimes blood tests with your input (usually through questionnaires, with your answers being incorporated into what's known as your remission score) to deterime whether or not you've actually achieved remission.
In other words, T2T takes your specific symptoms into account to deliver the right mix and dosages of medications to decrease flares. And, the sooner you make an appointment, the better your outcome likely will be, Dr. Kohler says. “If the appropriate treatment is started early, symptoms can be put into remission,” she adds.
Common PsA Treatments
So, what’s the first line of action to put PsA in its place?
“The inflammation associated with psoriatic arthritis can be treated most effectively with current pharmacologic treatments, including non-steroidals, disease modifying anti-rheumatic drugs [DMARDs], and biologic therapies," Dr. Kohler says. These treatments work to alter immune system signals that are known to play a role in psoriatic arthritis." And, she adds that “targeted corticosteroid injections for acute flares of specific problematic joints can also be provided.”
Biologic therapies are particularly promising, in Dr. Kohler's view. “There has been a boon of disease-modifying biologic treatment options for both psoriatic arthritis and psoriasis." These include Remicade (infliximab) and Humira (adalimumab).
In addition, Dr. Martinez cites recent drug trials that have shown great success of an oral medication called Xeljanz (tofacitinib) in treating PsA, which is a non-biologic that belongs to a class of drugs called Janus kinase inhibitors (JAK) that work to reduce inflammation in the body.
With any kind of immunosuppressive therapy, there's a chance you may not have to stay on it indefinitely. “Some patients who achieve excellent control of inflammation for longer duration can consider tapering down, or off, immunosuppressive therapy,” Dr. Kohler explains. “However, the majority of patients with PsA do stay on treatment long-term.”
Why Remission Is the Goal
It can take some trial and error to discover the unique cocktail of medical interventions and lifestyle changes that can lead to remission from PsA. This is the very essence of T2T therapy, which has been proven to be quite effective. According to a study on this treatment approach cited by the Arthritis Foundation, 206 patients were seen every 12 weeks to tweak their meds, with minimal disease activity as the eventual goal. The study showed how those with skin and joint symptoms had “improved significantly”—something that just might be music to your ears.
And, while every person’s remission is unique, Dr. Martinez says that “a patient with psoriatic arthritis can remain in remission for many years.”
Dr. Kohler agrees, but also doesn’t want to overpromise for every individual with PsA, since people and their symptoms are so variable. “The nature of inflammatory arthritis is unpredictable, and some patients may have milder symptoms that are well-managed with medications, whereas other patients may develop more moderate to severe disease and experience more flare ups despite an overall attempt to achieve systemic inflammatory control.”
Still, the point is that for many people, long-term remission remains a real possibility. And there are many reasons to aim for it (besides the obvious ones of experiencing less immediate discomfort): “The goal of remission provides many benefits, such as prevention of joint and soft tissue damage,” says Dr. Martinez. “There may be a reduction in cardiovascular disease as well.”
Support Remission With Lifestyle Changes
Medications are certainly the go-to when it comes to PsA treatments, but experts say that lifestyle tweaks can make a difference, as well.
Some non-pharmacologic approaches recommended by doctors include a healthy diet (such as Mediterranean and gluten-free diets, which can help decrease PsA inflammation, according to research); physical therapy; weight loss (even 5% of your body weight can help, per one study ); reducing stress levels (try journaling, taking up a relaxing hobby, or managing tough emotions through therapy); and regular exercise (the Mayo Clinic says to get at least 150 minutes of moderate aerobic activity, or 75 minutes of vigorous aerobic activity each week).
But what if you’re still experiencing pain or mobility issues? Don’t throw in the towel just yet! Tai chi, yoga, and swimming are all super-gentle on the body and may even alleviate symptoms. Having a low-pain day? Hit the gym for strength training, or sweat it out on the elliptical machine or stationary bike. Just be sure to speak with your doctor first before starting any exercise regimen, especially if you’re in the middle of a flare.
Also, Dr. Kohler says you can increase your chances of a long-lasting period of remission by remembering to take your medication regularly, and consistently going in for follow-up appointments with your rheumatologist.
Even if you’re flaring and feeling lousy right this moment, rest assured, with the right approach, remission can be a reality for you. Dr. Martinez has seen it firsthand. “Patients with psoriatic arthritis generally can be treated effectively and reach remission and lead a high quality of life.”
Number of Psoriasis Sufferers with PsA: National Psoriasis Foundation. (n.d.). “About Psoriatic Arthritis.” psoriasis.org/about-psoriatic-arthritis/
Depression and Anxiety: Arthritis Care & Research. (2012). “Anxiety and depressive symptoms and illness perceptions in psoriatic arthritis and associations with physical health‐related quality of life.” onlinelibrary.wiley.com/doi/full/10.1002/acr.21725
Treat-to-Target Outcomes: Arthritis Foundation. (2015). “Using Treat-to-Target for PsA.” arthritis.org/diseases/more-about/using-treat-to-target-for-psa
Efficacy of Tofacitinib: Rheumatology and Therapy. (2018). “Efficacy of Tofacitinib for the Treatment of Psoriatic Arthritis: Pooled Analysis of Two Phase 3 Studies.” pubmed.ncbi.nlm.nih.gov/30414064/
Weight Loss and PsA: Annals of the Rheumatic Diseases. (2013). “Weight loss and achievement of minimal disease activity in patients with psoriatic arthritis starting treatment with tumour necrosis factor α blockers.” ard.bmj.com/content/73/6/1157