Just Diagnosed With Psoriatic Arthritis?
Those first few months after a chronic-illness diagnosis can be confusing—especially when it comes as a surprise. Tracy Davenport, 58, of Centreville, MD, knows this feeling all too well. Years ago, she mysteriously started dropping her coffee cups. “I was lucky I had a very astute general practitioner. He knew I had psoriasis and told me he suspected psoriatic arthritis,” Davenport says. She had never heard of psoriatic arthritis (PsA) before she received her diagnosis. Sound familiar? We've got your next best steps after a PsA diagnosis.
Get a Second Opinion if You Have Doubts
“I generally recommend, if there’s any doubt whatsoever in the diagnosis, that the patient be seen by a rheumatologist,” says Stephen Stone, M.D., dermatology professor at Southern Illinois University School of Medicine in Springfield. A rheumatologist specializes in systemic autoimmune conditons, like PsA. Dr. Stone notes that not all PsA patients have obvious psoriasis—the itchy skin rash that often accompanies PsA and is a visual cue that it's not another inflammatory condition such as rheumatoid arthritis. Those case can be trickier to spot by non-specialists.
Learn About the Condition
Now that you know you have PsA, it’s time to educate yourself! PsA is a chronic inflammatory autoimmune condition that affects your skin, nails, and joints. If left untreated, it can lead to permanent joint damage, gastrointestinal issues, and heart problems—which is why it’s important to get treated ASAP. PsA flares are characterized by swollen joints (especially fingers and toes), excessive fatigue, morning stiffness, and changes in the nails (crumbling, discoloration, or ridges). It can cause pain in the joint tendons and sometimes redness in the eyes.
Assemble Your Treatment Team
“If left untreated, over 50% of joints can develop permanent destruction within six months of early diagnosis,” says Alan Menter, M.D., dermatologist and psoriasis specialist at Texas Dermatology Associates in Dallas. If your skin and joints are both bothering you, work with multiple doctors to address these issues. Your rheumatologist and dermatologist can ideally partner up to come up with a plan for treatment. This will involve some combination of medication and lifestyle changes to ease symptoms and slow disease progression.
Start a Medication
You’ve got options! PsA meds range from over-the-counter pain relievers, like ibuprofen, to prescription biologic drugs and disease-modifying anti-rheumatic drugs, or DMARDs. “Most patients will respond and do very well with the medicines that are available now,” notes Dr. Stone. If your symptoms are mild, you may be given a medication to treat your pain and inflammation (OTC pain relievers). But if progression continues, you’ll likely start a DMARD or biologic drug to target your immune system and slow tissue damage.
Prepare for Flares
Even with the right medication and treatment plan, sometimes you’ll wake up with morning stiffness. It happens, and it’s no fun—so it’s smart to be prepared with supplies to help you cope. Braces or canes can help support your joints on difficult days (ask your doctor where to purchase them). It also helps to get moving: Do some finger exercises, have your partner massage your hands, or go for a short walk if you can. This will get blood flowing and help you feel relief.
Improve Your Health Habits
PsA doesn’t always exist on its own. “Psoriasis of the skin and joints is associated with a number of comorbidities,” notes Dr. Stone, including metabolic syndrome and heart disease. If you’re struggling with other health issues, improving your habits can also help you manage your PSA. Focus on one thing at a time—an extra hour of sleep, 20-minute daily walk, or morning meditation practice. (PS: If you’re a smoker, it’s time to call it quits for good. “Giving up smoking is probably the single most important non-medical thing you can do,” Dr. Stone suggests.)
Be Proactive With Your Follow-Ups
“It’s important to develop that good relationship with your rheumatologist or your dermatologist, because there is so much that can be done,” Stone urges. Too often, he sees patients who don’t seek the treatment they need for their joint problems—which can lead to permanent damage that causes excessive stiffness and pain. Dr. Menter notes that with appropriate medical treatment, PsA patients can expect a significant increase in mobility within just a couple of months.
Don't Give Up on Your Treatment
Looking back, Davenport wonders if she could have prevented earlier athletic injuries if she had gotten her PsA diagnosed years before. “Hindsight is always 20/20,” she says, but that hasn’t stopped her from getting the treatment she needs now. Sadly, if your PsA wasn’t diagnosed early, you could have tissue damage that requires more serious intervention, like joint replacement surgery. This takes weeks to heal and requires physical therapy afterwards, but it can significantly improve your range of motion and quality of life.
Figure Out a New Normal
Your symptoms won’t magically be cured tomorrow, and that’s OK. “At least for me, this has been a journey,” Davenport says. “None of it is a quick fix. I always tell people about managing my PsA, ‘It's not a job, it's more like a campaign.’” She still experiences flares, but she has her doctor to turn to when she needs to switch medications (which she has done five times in the last two years). It’s all about knowing your body and your condition, and being prepared with the right experts at your side.