If you have psoriatic arthritis (PsA), an autoimmune disease that affects 30% of people with psoriasis, it's pretty common to experience what we like to call an Rx break-up. You know the feeling: Your meds were working for a while and then, suddenly, they lost their oomph, leaving you feeling stiff, uncomfortable and, frankly, annoyed.
Ask experts and they'll tell you that the reasons your treatment can stop working are as individual as you are. One big reason, however, is that your body is just plain resisting your meds.
"Many patients may respond to treatment initially but anywhere from months to years later, they develop active symptoms again," says Stuart D. Kaplan, M.D., chief of rheumatology at South Nassau Communities Hospital in Hewlett, NY.
So, assuming you're taking your meds as directed, here are some hints as to why your treatment plan isn't working as well as it once did:
#1: Your body has just stopped responding to the treatment.
Here's where the science comes in: Apparently, it's highly possible that your body has begun making antibodies against the med you're taking (this isn't uncommon with biologics), which can, in turn, neutralize what it's supposed to do to help you feel better. "In other cases, you may be blocking a particular protein pathway, but the body finds a way around it and produces the inflammatory protein via a different mechanism," Dr. Kaplan says. The good news is that you have options. You can switch to a different drug that targets the same protein, or your healthcare provider may recommend that you choose one in a different class, he adds.
The options don't end there: "Your doctor may discuss combinations of some of the older medications, even if you already tried them and failed on them in the past, as the combination may work in a different and better way than each of the drugs separately," says Anca D. Askanase, M.D., an associate professor of medicine in the division of rheumatology at Columbia University College of Physicians & Surgeons in New York City. "Additionally, there are drugs used in different diseases that can be re-purposed for PsA. For example, sulfasalazine which is used to treat inflammatory bowel disease can also be used to treat psoriatic arthritis. With all the research in this area there is hope."
However, since PsA can be accompanied by more subtle symptoms than psoriasis (where you can see when you're flaring), it's important to follow the exact dosing schedule for your medication. "The goal of treatment nowadays is to not only relieve symptoms but to suppress disease activity in order to prevent joint damage and deformity," Dr. Kaplan says.
#2: PsA isn't actually causing your joint symptoms.
While you may feel like your medication isn't working anymore, something else could actually be awry. "You could feel a pain in your thumb and think it's your PsA, but it's actually osteoarthritis,” says Lynn M. Ludmer, M.D., medical director of rheumatology at Mercy Medical Center in Baltimore. "If this is the case, we'll change therapies. Or it could be tendonitis that has nothing to do with your PsA. If your knee feels stiff, we can often drain it, put steroids in and get it back on track. There are lots of things we need to examine before concluding that this has to do with your PsA treatment."
In other words, you can have a flare in one joint even though the PsA is under control, notes Dr. Kaplan. "In fact, it is not uncommon to see acute gout attacks in people with active psoriasis and psoriatic arthritis."
#3: You're having a stress-related flare.
If you're having an acute flare but are otherwise doing well, your healthcare provider may recommend treating that flare with steroids while continuing your present medication. "This is particularly true if there's an obvious reason for the flare, such as a particular physical or emotional stress like surgery or the loss of a loved one," Dr. Kaplan says.
However, if there's no other apparent reason for your PsA to be acting up, talk to your healthcare provider right away. "You might want to consider switching meds or increasing the dose if it's not already at the maximum," Kaplan adds.
#4: You haven't given the treatment enough time.
Dont jump ship too soon. Patients can be on methotrexate—a pill or shot that interrupts the process that causes RA-related inflammation—for up to 40 years because it continues to work for them, Dr. Ludmer says. "Others will be on biologic medications for 10 to 15 years with no problems." To see if a psoriatic arthritis treatment is a good fit for you, it's important to try it for at least three to six months. "It won't work right away," Dr. Ludmer says.
There is one common denominator in all of these possibilities: You've got to be able to speak openly with your rheumatologist when managing PsA, especially if you think your medication has pooped out. "This sounds obvious, but many patients will stick with a treatment that's not working in the hopes that things will get better on their own," Dr. Kaplan says. "You don't want to let this go on for an extended period because there may be irreversible joint damage going on. Our goal is to help patients feel better, so we need you to reach out to us for help." Moral? No one needs to suffer in silence!