WTF Should I Do If My Psoriatic Arthritis Starts Getting Worse?

Psoriatic arthritis (PsA) is an autoimmune condition that affects your skin and joints (mostly). Your immune system goes into overdrive, creating too many skin cells and causing inflammation in the tissues of your joints.

The inflammation results in spots of dry, dead skin or patches of redness or discoloration. You can also experience stiffness, tenderness, and pain in your joints. There’s currently no cure (and no one really knows yet why PsA happens), but a variety of treatments are available.

If your symptoms get worse, it’s best to work closely with your rheumatologist for solutions. You may need to try different treatments or combinations of treatments before you find one that works for you. The condition can go into remission intermittently, and many people may live their lives with relatively few symptoms.

Some conditions work progressively, meaning they start out not-so-good and get worse. PsA is a little trickier. If left untreated, it may result in progressive damage to your bones and joints.

But if you’re treating your PsA, the condition can work more like a roller coaster than a steady incline. You may feel like you’re in remission for weeks and then suddenly you might have a flare-up(s).

Remember. Even if you’re doing everything right, you may occasionally get flare-ups. But flare-ups are typical.

If you’re monitoring your triggers, taking your medication, and talking with your doctor regularly, there’s a good chance the flare-up(s) will be temporary and you can go back to business as usual.

Since symptoms can come and go, it can be hard to tell when the condition is getting worse. Here are a few things you can do to better monitor your PsA.

Keep a symptom journal

When you have symptoms or flare-ups, write them down. Include what the symptoms feel like, whether you did anything unusual that day, and anything notable that happened before the symptoms started.

Keep a trigger journal

Your symptom journal will help you figure out what your triggers are. Then, write down all your potential triggers so you know what to avoid (when possible).

For example, if you get a flare-up every time you have a stressful day at work, then stress is one of your triggers. Maybe you have a flare-up after a night at the bar? Now you know alcohol may be a trigger.

Different foods, stresses, and events will trigger people differently, so it’s a good idea to focus on what makes PsA worse for you.

Keep a flare-up journal

This can be a much shorter entry. Just note your flare-ups and give your symptoms a rating from 1 to 10.

Sure, you might fill up a bunch of journals, but all this information is incredibly helpful. This way, you won’t have to guess if your pain is getting worse or better — you’ll know!

Plus, your doctor will be able to give you more targeted treatment when you have evidence of PsA’s progression.

First of all, make sure to talk with your doctor before engaging in any self-care activity. Even if your symptoms are generally mild, it’s best to regularly seek medical advice about your PsA, just to make sure the activities you’re choosing are good options for you.

If you’re in communication with your doctor and you feel like your PsA is getting a little worse, there are some at-home treatments you can try before you go on medication or try a new prescription.

Try not to stress

Stress is the biggest trigger and the most likely source of your worsening symptoms. So, try your best to avoid stressing. Ta-da — everything’s fixed! (Just kidding.)

OK, obviously it’s not that simple, but managing stress can really help reduce your symptoms. Meditation, for example, is an excellent way to relax, reduce your heart rate and blood pressure, and maybe even help your PsA.

Meditation can be a challenge at first, but give it a try. According to the American Psychological Association meditation can help reduce stress and improve other brain processes — plus, it’s free and doesn’t cause any side effects.

If meditation isn’t your thing, try to give yourself a few minutes of quiet every day. Spend more time on hobbies that relax you and less time on your phone.

If you can, avoid stressful situations. If you know you have to do something stressful, be sure you give yourself extra time afterward to rest and recover.

Eat a balanced diet

It’s boring advice, but it’s true: A nutrient-dense diet will make you feel better. Since PsA is an inflammatory condition, it’s a good idea to avoid foods that cause inflammation, including processed snack foods, foods that are high in fats and fried, alcohol, and sugar.

Try to eat mostly vegetables, fruits, whole grains, and lean protein. This may also help you lose weight, which puts less stress on your joints.

Get moving

Another boring tip that works: Exercise is wonderful for arthritis symptoms. Exercise might be the last thing you want to do during a flare-up(s), but it can help reduce inflammation, increase mobility, and even lighten your mood.

A 2011 research review showed that exercise can improve mobility and overall function, though this research also focused on people with rheumatoid arthritis.

Research experts recommend starting slowly and working up to 20 to 30 minutes of exercise per day, 3 to 5 days per week. Try low impact activities like walking, swimming, biking, or light resistance training.

The Centers for Disease Control and Prevention (CDC) recommends starting out slowly and modifying activities as needed to accommodate any pain.

In addition to improving arthritis symptoms, exercise can reduce your risk of other conditions, such as heart disease, diabetes, and depression.

Sometimes, flare-ups happen because of a lack of exercise or an imbalanced diet, so addressing those concerns can help flare-ups subside and maybe even prevent recurrences.

Even if a fun workout doesn’t make all the pain go away, getting into the habit of exercise is highly recommended to avoid long-term PsA concerns.

See the light

For psoriasis symptoms, light therapy may help. UVB rays can slow the overgrowth of skin cells and help manage dry, red, or discolored patches. It’s best to use an at-home UVB light for a doctor-approved amount of time.

The best part is that it can also help your mood and stress. More research is needed on this topic, but a 2005 research review showed that light therapy also helps with depression, which could reduce stress, and in turn, PsA triggers.

If you don’t have a UVB light, you can substitute regular sunlight, but be careful. A sunburn will cause greater damage, and psoriasis doesn’t always respond to natural light.

Try a quick walk in the sunshine, but be sure to protect your skin if you’re exposed to the sun for any significant amount of time.

Take an NSAID

If you haven’t tried over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, take one. They may help reduce inflammation and might relieve your pain.

NSAIDs may not reduce severe pain and inflammation, but they can help with mild symptoms. They have minimal side effects but can cause stomach conditions, ulcers, and kidney conditions with prolonged use. Keep your doctor informed about your NSAID use so you can make sure there aren’t any concerns.

If your symptoms don’t respond to at-home treatments and are getting worse, it’s best talk with your doctor about trying a new medication.

Though there has been rapid growth in PsA treatments, none of them are 100 percent effective for 100 percent of people.

One research review showed that in many trials, only half of the participants experienced a 20 percent improvement in symptoms with treatment. This doesn’t mean treatment won’t work for you, but it may take a few tries before you find the right strategy.

Treat-to-target

If your pain is moderate to severe, you may want to go with the treat-to-target strategy. In this approach, instead of having appointments with your doctor every 8 to 12 weeks, you have them every 4 weeks.

You target a specific outcome, and at each appointment you find out whether the new treatment is bringing you closer to (or farther away from) that goal. This strategy allows your doctor to change your medication or dosage quickly and hopefully get results faster.

If you aren’t currently taking any medication, your doctor may first try methotrexate. Methotrexate is a disease-modifying antirheumatic drug (DMARD) that blocks a specific chemical that causes inflammation. You take it orally as a weekly dose.

The most common side effects of methotrexate are nausea and vomiting, but taking a folic acid supplement may help you avoid those effects. Methotrexate is also available as an injection if taking it orally doesn’t work for you.

Traditional DMARDs like methotrexate are the most commonly prescribed drugs for PsA. But if your PsA isn’t responding to it or your symptoms are getting worse, your doctor might move you to a biologic.

Biologics

Biologics are a genetically engineered type of DMARDs that block the actions of some cells and proteins to reduce inflammation. Regular DMARDs target the whole immune system, while biologics target very specific points in the cascade of inflammation.

Biologics may be administered via injection or intravenous (IV).

Types of biologics include:

• Tumor necrosis factor-alpha (TNF-alpha) inhibitors. Some people with PsA have an excess of the protein TNF-alpha, which causes joint pain and rapid skin turnover. The TNF-alpha inhibitor does just that — inhibits the production of the inflammatory protein. Cimzia, Enbrel, Humira, Remicade, Simponi, and Simponi Aria are all TNF-alpha inhibitors.
• Interleukin 12 and 23 (IL-12/23) inhibitors. IL-12/23 are proteins associated with the specific inflammation of psoriasis, and these drugs block those proteins. Stelara is an IL-12/23 inhibitor.
• T-cell inhibitors. Some white blood cells evolve into T-cells, and those T-cells are involved in PsA inflammation. T-cell inhibitors block these white blood cells from attacking your tissues. Orencia is a T-cell inhibitor.
• Interleukin 23 (IL-23) inhibitors. IL-23 is a cytokine (like a protein) that’s involved in some PsA inflammation. These drugs block that cytokine and help slow the progression of the condition. Ilumya, Skyrizi, and Tremfya are IL-23 inhibitors.

There are a lot of proteins to inhibit! This is another reason why there isn’t a one-size-fits-all treatment for PsA. One protein may be more active than another in your pain, so you’ll need to work with your doctor to find out which treatment works best for you.

A research review found that switching biologic treatments was an effective way to find the best medication for PsA. That way, you can try different treatments, focus on exactly what works for you, and reduce overall flare-ups.

One side effect of biologics is that they suppress your immune system. Unlike generalized immunosuppressants, which basically shut down the whole immune system, biologics target specific parts of the immune system.

But that still means part of your immune system is affected and you may be more susceptible to infections.

As you work with your doctor, you’ll find a mixture of at-home and medical treatments that works for you. Even if you find the perfect treatment, it’s important to be aware of triggers and maintain a balanced diet and exercise routine.

Also, be sure to continue your treatment even when your symptoms go away. It’s tempting to stop taking medication when you’re feeling better, but most people have flare-ups anywhere from 1 month to 6 months after stopping treatment.

If you stay symptom-free for a while, your doctor may reduce your medication. Don’t stop taking your meds or change doses without talking with your doctor first.

Psoriatic arthritis might feel overwhelming at times, but by knowing your triggers, maintaining a healthy lifestyle, and staying in contact with your doctor, you can manage the condition.

You may need to try a few different treatments to find what works for you, and you may have occasional flare-ups even after trying a variety of treatments.

With patience and the help of a rheumatologist you trust, you can find a way to live well with PsA while keeping the condition from progressing.