Hugh Duckworth MD

Doctor of Medicine (M.D.) in 1984 from University of Tennessee School of Medicine

Sep 27, 2018 6 min read

PsA Management: How Do You Manage Psoriatic Arthritis?


Psoriatic Arthritis Overview

Psoriatic arthritis, rheumatoid arthritis  are the most common forms of arthritis.  Psoriatic arthritis has many of the same symptoms as osteoarthritis and rheumatoid arthritis; however, one distinguishing characteristic is the presence of psoriasis. In 85% of cases of psoriatic arthritis, individuals also experience psoriasis in addition to joint pain and inflammation. According to the National Psoriasis Foundation, 30% of individuals living with psoriasis will go on to develop psoriatic arthritis – with initial onset typically occurring in their 40s and 50s. The exact cause of psoriatic arthritis is as yet unknown; however, genetics and the environment are thought to play key factors. The majority of individuals diagnosed with psoriatic arthritis have a family member who has also been diagnosed with the disease, or who lives with psoriasis. Certain environmental conditions are thought to trigger the onset of the disease, such as viral or bacterial infections, or stress.

85% of People with Psoriatic Arthritis have Psoriasis


Psoriatic arthritis is an autoimmune disease, where the body’s immune system attacks its own healthy joints. The disease is chronic and progressive, and there are five major types of psoriatic arthritis:

  • Symmetric arthritis: Affecting the same joints on both sides of the body. This type of psoriatic arthritis has many overlapping symptoms with rheumatoid arthritis.


  • Asymmetric arthritis: Affecting different joints on both sides of the body. This is the most common type of psoriatic arthritis.


  • Distal interphalangeal predominant: Affecting the joints in the fingers and toes closest to the nails. This type of psoriatic arthritis mimics many of the same symptoms of osteoarthritis.


  • Spondylitis: Affecting the spinal column, this type of psoriatic arthritis causes inflammation in those joints. While many individuals living with psoriatic arthritis have symptoms occurring in the lower back and spine, only 5% of individuals have spondylitis.


  • Arthritis mutilans: The most severe form of psoriatc arthritis, representing less than 5% of cases. This form of psoriatic arthritis debilitates and deforms the joints of the hands and feet. Arthritis mutilans is very damaging and very progressive.


Ways Psoriatic Arthritis Can Affect your Health

Common symptoms of psoriatic arthritis include joint pain, inflammation, dactylitis (“sausage-like” fingers and toes), fatigue, heel pain, tendonitis, and back pain. However, the disease can also have an impact on your health in a secondary way. That is, a number of conditions can pop up and negatively impact your health, as a result of psoriatic arthritis.

  • Heart disease: The inflammation caused by psoriatic arthritis can also have a lasting impact on the coronary arteries. Controlling the inflammation caused by psoriatic arthritis can reduce the risk of developing cardiovascular disease.
cardiac operating room
  • Heart attack: Your risk of suffering from a heart attack is increased if you have psoriatic arthritis. Even after controlling for high blood pressure and diabetes, psoriatic arthritis patients still experience an elevated risk. Doctors attribute this to the presence of chronic inflammation.


  • Fibromyalgia: Pain and fatigue are common symptoms of psoriatic arthritis. However, psoriatic arthritis patients also experience pain and generalized fatigue beyond the affected joints, leading to this secondary condition.


  • Obesity: Being obese is a condition that affects psoriatic arthritis before it’s diagnosed and after it has been confirmed. Obesity is thought to be a potential trigger to the onset of the disease, as it plays a role in inflammation. After diagnosis, obesity can have a further impact on the disease, as it places additional stress on the joints, leading to more pain and damage.


  • Cancer: If you have psoriatic arthritis, you have an increased risk of developing certain cancers, such as skin cancer and lymphoma.
mental illness
  • Mental illness: Individuals living with psoriatic arthritis are also more prone to developing depression and anxiety. Drug therapy can help, but sometimes the medications used to treat psoriatic arthritis can also cause mental health issues.


Recognizing the Triggers

Individuals living with psoriatic arthritis typically experience “flares” – where symptoms of the disease come and go. One of the keys to managing psoriatic arthritis is to understand what triggers these flares in order to minimize the occurrence of symptoms.

  • Stress: Stress can be the number one contributing factor in triggering flares. And stress is thought to also play a role in the onset of psoriatic arthritis. Closely related is the sleep disruption associated with psoriasis and psoriatic arthritis.


  • Skin injuries: The Koebner Phenomenon is the explanation behind why basic cuts or a sunburn can case major flare-ups of psoriatic arthritis symptoms. Essentially what happens is when you have trauma affecting one part of your body (e.g., a cut on your leg) can trigger inflammation in a close-by area (e.g., your knee). The likely contributing factor to this phenomenon is that psoriatic arthritis is an autoimmune disease, causing abnormal inflammatory responses.
  • Medications: Certain medications used to treat other conditions (other than psoriatic arthritis) can trigger flare-ups of psoriatic arthritis. These drugs include psychiatric drugs (e.g., lithium), anti-malaria drugs (e.g., chloroquine), blood pressure medications (e.g., propranolol), prednisone, and quinidine (a heart medication).


  • Alcohol: Drinking alcohol can worsen the effects of psoriasis due to its pro-inflammatory effect on joints, causing a flare-up of psoriatic arthritis symptoms.


  • Diet: Certain foods can trigger psoriatic arthritis in individuals, including gluten, sugar, dairy, and tomatoes. Conversely, other foods might diminish the prevalence of flares, including, anti-inflammatory foods, such as fish, olive oil, walnuts, and flaxseed. Antioxidant-rich vegetables and fruits also contribute to a healthy eating pattern for individuals with psoriatic arthritis; these vegetables include kale, broccoli, carrots, spinach, blueberries, and strawberries.

To manage psoriatic arthritis symptoms and flares, individuals can avoid and/or minimize any of the abovementioned triggers to ward off pain and inflammation.


Lifestyle Changes to Manage Psoriatic Arthritis

Being knowledgeable about your symptoms, triggers, and treatments can help you successfully manage psoriatic arthritis. When flare-ups occur, keep track of what foods you ate, if you were under a lot of stress, whether you had a cut, whether you had a good night’s sleep, etc. Knowing what is triggering your symptoms and educating yourself is half the battle. The other half is managing it.

How can you take control of your symptoms?

  • Take the medications prescribed by your doctor regularly – don’t skip doses: Skipping or stopping doses of medications prescribed to treat the inflammation and pain associated with psoriatic arthritis may cause a flare-up of symptoms.


  • Be as proactive as you can about cuts and burns: If you’re going to be out in the sun, make sure to wear sunscreen to minimize the occurrence of any sunburns. While you can’t prevent cuts and scrapes from occurring in everyday life, you can minimize the probability of an accident by being mindful of your activities.  Slow down, don’t rush, take your time.
  • Get a good amount of sleep: Try to maintain a full 8 hours of sleep per night. Avoid stimulants that might keep you awake at night (e.g., caffeine, too much screen time). If you don’t get enough sleep at night, try to plan a good nap to counter the effects of losing sleep.


  • Practice stress management: If you know your stressors, avoid them.  Educate yourself.  If you can’t avoid the stressors, do what you can to manage them and take part in activities that can lower your stress levels. For example, practice yoga or meditation to quiet your mind.


  • Exercise regularly: Regular exercise has many benefits.  It can help you to maintain a positive attitude, increase your joint range of mobility, and help to ease your joint stiffness, and pain. Exercise can also boost moods and relieve stress.  Exercise is a key factor in helping to maintain an optimal weight for joint health.  Consider participating in exercises that are less stressful to the joints, such as swimming and biking.
bike ride
  • Take things slower: Because fatigue is a common symptom of psoriatic arthritis, take rest breaks often. Break activities into multiple part. Don’t overexert yourself.


Summing it all Up

In summary, there is as yet no cure for psoriatic arthritis, but there are excellent treatment and management options to reign in symptoms and flares. Keep track of your triggers. Educate yourself.  Follow your doctor’s recommendations for medications and lifestyle changes. Stay active.  A person today, diagnosed with and treated for psoriatic arthritis can manage the disease with every expectation for a normal quality of life.  ,