Psoriatic Arthritis: Need a Treatment Change?
First comes a diagnosis, then comes treatment. For psoriatic arthritis (PsA), an inflammatory form of arthritis that affects 30% of people with psoriasis, a growing range of medicines available can help slow disease progression, minimize pain, and protect joints. “With today's treatment options, the probability of getting your disease under control has increased exponentially,” says Anand A. Kumthekar, M.D., assistant professor of rheumatology at the Albert Einstein College of Medicine. “Different medications use different pathways. If one doesn’t work, we can try another one."
Flare or Failed Treatment?
Even with treatment, periodic flares, or times when your PsA symptoms worsen, will still happen. So how do you decide if an increase in pain and stiffness is part of a flare or a sign you need to revamp your treatment? That’s something you’ll ultimately figure out with your physician, says Ana-Maria Orbai, M.D., director of the Psoriatic Arthritis Program at Johns Hopkins Arthritis Center. But there are some red flags that suggest your treatment isn’t working the way it should. Here’s how to tell when it’s time to talk to your doctor about potentially switching things up.
Symptoms Haven’t Improved After 3 Months
If you’re starting a new treatment, patience is the name of the game. “Most medications take at least three months to act,” says Dr. Kumthekar. “After that, we can decide whether it’s working or not.” Some drugs can even take four or five months to start working, says Stanford Shoor, M.D., a rheumatologist at Stanford Health Care. The exact time frame will vary depending on the medication, so don’t get discouraged if you’re not getting results in the first few weeks. Give it three months minimum before talking with your doc about other options.
You Failed the 6-Month Test
If psoriasis still covers more than 1% of your body after six months of treatment, it could be time to try something new, says Dr. Orbai. (After three months of treatment, patients should have psoriasis on less than 3% of their body surface area.) One percent sounds like nothing, but for a visual, you’re looking for a patch about the size of the palm of your hand. More than that after months of treatment and your meds probably aren’t working as well as they should. Trying a different approach could help.
Side Effects Are Worse Than the Disease
An unfortunate truth: Even drugs that work well can cause unwanted side effects. These can be physically uncomfortable, like nausea, or something potentially dangerous that’s revealed in your bloodwork, like too-low white blood cell counts. When it comes to PsA medication, “it isn’t just whether a patient responds to the treatment, but whether they can tolerate it,” says Dr. Shoor. Only you know how much your medication is affecting your life, so be honest about how you feel, mentally and physically, with your doctor. Remember, if this one makes you feel lousy, there are other options.
You Feel Depressed
Look, we get it. Having PsA isn’t exactly cause for joy. “Anyone who has chronic pain at any level will inevitably experience changes in their mood and to some degree, their outlook on life,” says Dr. Shoor. Still, the right PsA treatment will help you maintain your quality of life, and that should give your mood a lift. If you’re feeling down because of your pain, it’s a sign you may need a different treatment to manage the disease more effectively. You might not reach cheerleader status, but you shouldn’t be scowling alone in the corner.
You’re Not Sleeping Well
If the pain of aching joints or discomfort from sensitive skin is keeping you up at night, that’s your cue to try new meds. The good news is that improving your sleep may not always require a complete treatment overhaul. “Your doctor may be able to suggest medication specifically to help you sleep better,” says Karmela Kim Chan, M.D., a rheumatologist at the Hospital for Special Surgery in New York City. Sleep matters more than you might think—it lowers stress levels, a big trigger for many people with PsA.
No pain, no gain does not apply when it comes to joint stiffness so severe that even basic walking is excruciating. The irony? Regular exercise is an important part of staying on top of PsA. Physical activity helps maintain muscle mass, which in turn supports your joints. If your joints are so inflamed that you can’t exercise consistently (meaning the pain lasts longer than a week or happens during the majority of your workouts), you might try switching up your meds.
Taking Your Meds Is Hard
To state the obvious, medication doesn’t work if you don’t take it. So if the way your treatment is administered or its frequency makes it hard for you to keep up, it’s smart to consider other options. Most doctors know that sticking to a schedule can be an issue and will ask patients if they’re taking their treatment as prescribed, says Dr. Shoor. If you’re having a tough time, be honest about it and explain why. That way, your doctor can help figure out a plan that better suits your lifestyle and preferences.
Your Quality of Life Is Suffering
The goal of PsA meds is to reduce pain and improve quality of life. To a certain degree, that’s a subjective measurement: The bar set by a very active 40-year-old is likely different than the expectations of a more sedentary 65-year-old. “Treatment should be personalized to patient preferences and life impact,” says Dr. Orbai. If you’re not happy with how you feel, talk to your doctor about trying another approach. It might take some trial and error, but ultimately, with so many different treatment options available, you’re bound to find one that helps you live life the way you want.
PsA affects about 30 percent of people with psoriasis. National Psoriasis Foundation: About Psoriatic Arthritis. (2019). psoriasis.org/about-psoriatic-arthritis
Managing Patients with Psoriatic Disease: The Diagnosis and Pharmacologic Treatment of Psoriatic Arthritis in Patients with Psoriasis. Drugs. (2014). ncbi.nlm.nih.gov/pmc/articles/PMC3958815/
From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis. Journal of the American Academy of Dermatology. (2017). jaad.org/article/S0190-9622(16)30909-4/fulltext
DMARDs: Side Effects and Solutions. Arthritis Foundation. arthritis.org/living-with-arthritis/treatments/medication/drug-types/disease-modifying-drugs/dmards-side-effects.php
Factors Influencing Sleep Difficulty and Sleep Quantity in the Citizen Pscientist Psoriatic Cohort. Dermatology and Therapy. (2019). ncbi.nlm.nih.gov/pubmed/31177381