The Bottom Line on PsA Treatment During COVID
Yes, we’re still dealing with a pandemic, but now is no time to quit seeing your doc.
In the world of diseases, psoriatic arthritis is a double-edged sword. On one end you have the inflammation, joint pain, stiffness, and swelling that comes courtesy of arthritis. On the other end are the hallmark red, itchy, scaly patches of skin that psoriasis brings (consider yourself doubly blessed). According to the National Psoriasis Foundation, psoriatic arthritis affects about one million people in the United States. Most people with the disease develop psoriasis first and arthritis later. And it doesn’t take much for one disease to turn into the other—especially in the way of the psoriasis. “When I think someone has psoriatic arthritis, I'll go on a rash hunt, and a lot of times, the only thing I’ll find is a little patch of psoriasis behind the ears,” says Martin Bergman, M.D., chief of the division of rheumatology at Taylor Hospital in Ridley Park, PA and clinical professor of medicine at Drexel University College of Medicine.
Finding that telltale patch is critical to helping your doctor correctly diagnose PsA, and the sooner the better since research shows that patients fare far better when their condition is treated early and consistently. Which takes us to our next point: Managing your PsA requires regular treatments and evaluations, and that means seeing your doc—yes, even during COVID.
Taking COVID Into Account
When you have a chronic, inflammatory disease like PsA, consistent, regular care and medication are key to managing the condition so you can live a normal, discomfort-free life. That said, lately, thanks to COVID concerns, more and more people are postponing regular doctors’ appointments. According to a study by the Kaiser Family Foundation, nearly half (48%) of adults say someone in their household has postponed or skipped medical care because of the coronavirus outbreak, and what’s worse, 11% of adults overall said their family member’s condition got worse as a result of postponing or skipping medical care due to coronavirus.
The thing is, a chronic condition like PsA is with you for a lifetime, so, like a stage-five clinger, it’s always going to be there even when you're feeling well, and still has the ability to cause inflammation, Dr. Bergman says. What this also means is: You cannot stop treatment. “If you stop your medicine, it’s going to take longer to get it back under control, and every time you do that, you have inflammation,” he says. “And inflammation causes damage.” Worst-case scenario? “PsA can destroy joints and lead to deformity and dysfunction. You can get to a point where you can't make a fist, you can't bend your wrist, and you have difficulty walking.” Not to mention, long gaps between restarting your medicine can cause your body to build up resistance. “You can make an otherwise effective medicine ineffective,” Dr. Bergman says.
Why Regular Care Is Key
If you’re taking your meds on the regular and following your doctor’s orders, chances are, you’ve got the condition under control and you're feeling good. But, if you are experiencing a flare, which usually looks like increased joint pain, stiffness, swelling, tenderness, and fatigue, you need to see your doctor for an in-person checkup—stat.
The reason this is so crucial is because having a flareup tells your doctor that your medication isn’t working, Dr. Bergman says. “I need to figure out why. Is it because I have you on the wrong medicine or dosing schedule? Are you not taking the medication the way I wanted you to? It's important to have flares followed because it may mean you need to adjust, change, or stop and restart a new medicine,” he said.
And the problem with telemedicine are the subtleties. “I can't pick up a slight change in the swelling of a joint of your wrist; I have to feel it," he says. "This is why I like to see my patients every three months.”
While you may be apprehensive to step inside your doctor’s office, there is no research to suggest having PsA increases your risk for COVID or make your symptoms worse, Dr. Bergman says. In addition, guidelines published in Arthritis & Rheumatology by the American College of Rheumatology state there is no compelling evidence those with rheumatic disease are at a greater risk of COVID‐19 complications.
Still need extra reassurance to feel secure seeing you doc? Practices have more safety protocols in place than ever before:
Distanced waiting room seating (or no waiting room altogether)
Screenings and paperwork ahead of time
Serious room sanitization
Bottom line: Avoiding your doctor's office will have virtually no effect on whether or not you get COVID, but it most certainly will effect how well you're able to manage your psoriatic arthritis. Moral of the story? Don’t put off your appointments.
PsA Basics: Rheumatic Disease Clinics of North America.(2015). “The Epidemiology Psoriatic Arthritis.”
COVID Concerns & Medical Care: HCA Healthcare Journal of Medicine. (2020). “Fear-Based Barriers to Care in the COVID-19 Pandemic.” scholarlycommons.hcahealthcare.com/cgi/viewcontent.cgi?article=1215&context=hcahealthcarejournal
PsA Care During COVID: Arthritis & Rheumatology: (2020). “American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID‐19 Pandemic: Version 3.” onlinelibrary.wiley.com/doi/full/10.1002/art.41596