The word prognosis is just medical lingo for “prediction.” Like a weather forecast can’t absolutely guarantee a rainfall, it’s impossible to know exactly how your experience with psoriatic arthritis (PsA) will go.
While receiving a diagnosis for a chronic condition can be intimidating and scary, brushing up on the facts and learning as much as possible is a great first step toward taking control of your health. Way to go!
First, here’s a quick overview:
Psoriatic arthritis (PsA) is a chronic, inflammatory autoimmune condition that affects the joints and places where ligaments and tendons attach to the bone. Though much less common, PsA can occur without having psoriasis.
Around 30 percent of people with psoriasis will experience psoriatic arthritis. It typically shows between the ages of 30 to 50 and about 10 years after developing psoriasis.
The severity of psoriasis symptoms aren’t linked to PsA severity. So even if you have severe psoriasis symptoms, that doesn’t mean PsA will be more severe.
There’s no cure, but many treatments can help manage pain, preserve range of motion, and protect joints. Early diagnosis and treatment are essential for managing pain and preventing joint damage.
Studies indicate delaying treatment for even 6 months can result in joint damage.
Everyone with PsA experiences it differently. For some, it may develop slowly with mild symptoms, or it can develop quickly with severe symptoms.
Common early symptoms include:
- tender, swollen tendons
- swollen fingers and toes
- morning stiffness
- a reduced range of motion
- changes in nail bed health
- fatigue
- eye inflammation
Symptoms of PsA may come and go, and may even disappear for long periods of time — this is known as remission.
What you can expect will depend on several factors, including:
- the type of PsA you’re diagnosed with
- the stage of symptoms at diagnosis
- your personalized treatment plan
- your body’s response to treatment
Complications of PsA
Over time, the spaces between joints may begin to narrow, due to cartilage destruction, causing joint pain. Erosion of bone may also occur due to chronic inflammation.
When bone density decreases, osteoporosis may develop. With osteoporosis, the body reabsorbs more bone tissue and produces less bone tissue to replace it. The bones of people with osteoporosis are more porous and weak. This increases the risk for fractures, especially in fragile places like the hip, spine, and wrists.
Bone “spurs” may develop. These are small, smooth projections that extend from your bones, particularly where two bones meet in a joint. Some bone spurs are painless while others may require medical attention.
Will PsA get progressively worse?
Not necessarily. Early diagnosis followed by an effective treatment plan can usually prevent progressive damage from occurring, especially for those with mild symptoms.
If PsA symptoms follow a cycle of flare-ups and remission, or go untreated for a long time, damage is more likely to accumulate progressively.
Psoriatic arthritis itself isn’t life threatening, but PsA may increase the risk for conditions that could be, such as heart disease.
Medications can ease symptoms and prevent chronic inflammation, reducing the risk of comorbidity (related conditions that can develop alongside another condition).
Comorbid diseases and symptoms for PsA include:
- diabetes
- heart disease
- obesity
- high blood pressure
- uveitis (eye inflammation)
- lung disease
- liver disease
- kidney disease
- osteoporosis
- inflammatory bowel disease
- depression
- anxiety
Cancer risk
Some evidence suggests psoriatic disease increases the risk for some types of cancer. However, it’s not clear if the risk is related to psoriasis or other contributing factors, like smoking or diet.
A 2015 study examined biologic medications commonly used to treat PsA and psoriasis including adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade), finding no significant evidence to suggest these biologics increased the risk of cancer.
To reduce your risk for complications, try these lifestyle tips:
- maintain a healthy weight
- eat a healthy diet that includes fiber, fruit, and veggies
- avoid excessive alcohol use
- exercise regularly
- quit smoking
- use sunscreen while outdoors
- seek routine cancer screenings
- obtain routine vaccinations
Everyone’s different, so it’s impossible to know how your diagnosis will shape your daily life and future.
Depending on the severity of these symptoms, your daily activities could need modification:
- joint pain
- inflammation
- stiffness
- tiredness
- decreased range of motion
Over time, even mild symptoms can lead to frustration and a downturn in mood and energy.
Be gentle with yourself and take the time to identify tools and modifications that work for you.
What the research shows…
A Pharmacy and Therapeutics medical review evaluated 49 studies and compared quality of life outcomes of those with PsA to the general population. Those with PsA reported a decrease in physical function, increased risk of comorbidity (particularly in cardiovascular health), and an overall lower quality of life. Cost of care was considered a contributing factor in evaluating the burden of PsA on quality of life.
Having psoriasis in addition to PsA presents additional symptoms and self-esteem concerns that can further contribute to a decrease in quality of life.
Maintaining quality of life ultimately comes down to managing mental health and pain.
Managing pain
Try the following to help reduce pain:
- Try over-the-counter (OTC) NSAIDs like ibuprofen or naproxen for mild pain
- Stay as active as possible. Physical activity and light exercise can loosen up stiff joints, keeping muscles strong. Yoga, tai chi, swimming, and gentle stretching are good options if your joints are swollen. Ask your doctor for other ideas if your mobility is limited.
- Keep a pain journal. Note activities that make your pain worse and what helps relieve symptoms.
- Talk to your doctor regularly to discuss new research and treatment options. Bring your pain journal as this can help them personalize your treatment plan.
- Physical and occupational therapy can help relieve pain by improving strength and flexibility. Therapists can offer alternatives for performing daily activities if pain and stiffness are making tasks too difficult.
Mental health
The physical symptoms of PsA can affect your personal, social, and professional relationships, all of which can take a toll on your mental health. Such added mental strain can further worsen the symptoms of PsA.
If you’re struggling with depression, anxiety, or stress, there are ways your doctor can help.
Options include:
- medications
- counseling
- cognitive behavioral therapy
- support groups
- yoga, meditation, or tai chi (mild exercise, relaxation, and social connection can boost your mood)
When determining a treatment plan, your doctor will take into account your personality as well as the severity of your symptoms.
Treatment options for psoriatic arthritis include:
Tumor necrosis factor inhibitors
These are biologic drugs that can slow down the progression of the disease, reduce flare-ups, and reduce symptoms. These aren’t suitable for everyone, and they can have adverse effects.
When treatment using TNF inhibitors don’t work well, other biologics that might be tried are IL-17 and CTLA-4.
Disease-modifying antirheumatic drugs (DMARDs)
These drugs help slow joint damage caused by PsA. An example is tofacitnib (Xeljanz), an immunosuppressive drug, and also apremilast (Ortezla).
Corticosteroids
These can reduce pain and inflammation, but they aren’t suitable for long-term use. A doctor typically injects this medication into one or more affected joints to rapidly reduce the inflammation.
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs (such as Aleve) are used alone in milder cases or in combination with other medications. Benefits and risks should always be discussed with your healthcare provider.
It’s important to maintain open communication with your doctor and discuss the best options for your symptoms, severity, and lifestyle.
Psoriatic arthritis isn’t “one size fits all.” Symptoms can range from mild to severe, and may or may not worsen over time. Permanent joint damage and limited mobility are less likely with early diagnosis and proper treatment, so being proactive in pursuing treatment is the best thing you can do.
Symptoms like pain, inflammation, and emotional stress can be effectively managed with a variety of treatment options. Check in with your doctor frequently, as new treatments are always being investigated, and they can make sure your treatment plan is working as effectively as possible for you.