Joint pain is often one of the first signs of psoriatic arthritis, according to Francis C. Luk, MD, a rheumatologist at Wake Forest Baptist Health in Winston-Salem, North Carolina. “Classically, it presents as a swelling and pain in the hands, but it can occur in pretty much any joint in the body,” he says. The goal of psoriatic arthritis treatment is to relieve pain and inflammation and, if initiated early enough, prevent joint damage. According to the National Psoriasis Foundation, options range from nonsteroidal anti-inflammatory drugs (NSAIDs) for mild pain relief to disease-modifying anti-rheumatic drugs (DMARDs) and biologic medications for moderate to severe disease. It’s important to seek out a rheumatologist (a doctor who specializes in immune system disorders that affect joints, bone, and muscles) for the appropriate treatment to achieve the best possible outcome, says Dr. Luk. “There are many medicines that can help with both psoriasis and psoriatic arthritis,” he says. To successfully manage psoriatic arthritis you need to know the facts about your disease and your treatment options — and to recognize the false beliefs getting in the way. Here are 9 common misconceptions, debunked.
Myth 1: It Doesn’t Matter When You Start Psoriatic Arthritis Treatment
When it comes to psoriatic arthritis, early diagnosis is critical. The earlier you treat the disease, the better chance you have to limit or even prevent joint damage, says Luk. A study published in Annals of the Rheumatic Diseases in 2015 found that a delay in diagnosis of as little as six months led to permanent joint damage. What’s more, early treatment of psoriatic arthritis can help preserve your ability to feel your best every day. “The symptoms of joint pain and swelling are very limiting to people and can strongly influence quality of life,” says Eric Matteson, MD, an emeritus professor in the rheumatology division of the department of internal medicine at the Mayo Clinic in Rochester, Minnesota. If you have psoriasis and believe you’re experiencing symptoms of psoriatic arthritis, let your doctor know right away. You’ll likely be referred to a rheumatologist. What does remission look like? According to the Arthritis Foundation, there isn’t a specified criteria for defining remission in psoriatic arthritis, and it can be difficult to know if you’ve achieved it. Typically, experts define remission as being in “a minimal disease activity state.” For many people with psoriatic arthritis, reaching remission requires working closely with a doctor to find the appropriate treatment and then sticking to that treatment. Meanwhile, scientists continue to search for a psoriatic arthritis cure, Dr. Matteson says.
Myth 3: A Dermatologist Can Treat Psoriatic Arthritis
Psoriasis and psoriatic arthritis are typically related autoimmune disorders, but that doesn’t mean the approaches to treating and managing the conditions are identical. “Some people think, ‘My psoriasis is doing well, so my arthritis isn’t a big deal’ or vice versa,” Matteson says. The truth: “The two don’t always correlate.” That’s why it’s important to also see a rheumatologist for psoriatic arthritis, according to the National Psoriasis Foundation. Per CreakyJoints, in 85 percent of cases, skin symptoms of psoriatic disease occur before joint pain, so a dermatologist may be the first one to identify psoriatic arthritis. But because psoriatic arthritis treatment can be complex and often requires adjustments over time, a rheumatologist is best suited to develop your individual treatment plan.
Myth 4: NSAIDs Are Risk-Free
NSAIDs are commonly used to relieve joint pain, stiffness, and inflammation in people with psoriatic arthritis. Certain versions are available over the counter, like ibuprofen, while stronger forms require a prescription. “For mild cases of psoriatic arthritis, NSAIDs can be helpful,” Matteson says. “They’re for the management of pain. They don’t change the course of the disease.” But though doctors prescribe NSAIDs for milder psoriatic arthritis symptoms, that doesn’t mean these drugs don’t have risks or side effects. “They do have risks,” Matteson says. “This can include stomach bleeding, hypertension, or kidney damage, especially if used at higher doses for long periods of time.” Be sure to discuss these risks with your physician.
Myth 5: Biologics and Newer Drugs Are Only for Severe Cases
Biologic drugs are disease-modifying, which means they stop or slow disease by calming specific parts of the immune system. “The immune system is pretty broad, and there are multiple cells and cytokines that lead to joint pain and joint swelling,” says Luk. By blocking some aspects of the immune system, he explains, biologics can ease psoriatic arthritis symptoms and even prevent bone damage and joint damage. These therapies have been used in the treatment of psoriasis for over 15 years, says the National Psoriasis Foundation, and most are administered by injection or intravenous (IV) infusion. Janus kinase (JAK) inhibitors have emerged as a new type of biologic treatment for psoriatic arthritis, and unlike most biologics, these drugs come in pill form. Biologics come with some risks, according to Matteson. “In general, there’s concern about any drug that modifies the immune system because of the possibility of infections or cancer development,” he says. While these concerns are valid, Matteson says that the benefits of biologic medications outweigh the risks, even for people whose cases are not severe. “People who have mild pain or swelling in a single joint may do just fine with NSAIDs alone. For people who have more joint swelling and pain, the use of biologics is justified,” Matteson says.
Myth 6: Long-Term Use of Corticosteroids Is Safe
At some point in the course of your disease, your doctor may prescribe a corticosteroid medication. According to the Psoriasis and Psoriatic Arthritis Alliance, low doses of corticosteroids may bring pain relief and ease stiffness in people with psoriatic arthritis, while higher doses can help with recovery from a severe flare-up. “Steroids can calm down the swelling and the pain,” says Luk. But corticosteroid use is intended to be temporary, says Luk. Because of the risk of serious side effects with long-term use — such as muscle weakness, brittle bones, eye problems, hypertension, and diabetes — your doctor will prescribe a corticosteroid only when necessary and will likely taper it off once the problem is under control.
Myth 7: You Can Stop Psoriatic Arthritis Treatment When You Start Feeling Better
Most rheumatologists recommend that you stay on your medication even after you reach remission, according to the Arthritis Foundation. “Unfortunately, if people stop taking their medicines, the psoriatic arthritis will probably come back,” says Luk. Matteson agrees, saying that only a small percentage of people with psoriatic arthritis who reach remission are able to stop taking their medication completely. “Most people find that their disease flares up again,” he says. A study published in 2017 in the Journal of Rheumatology found that rebound disease activity returned for 73 percent of people who stopped their tumor necrosis factor (TNF) inhibitor, the first-line biologic therapy for psoriatic arthritis. These findings support those of other, smaller studies.
Myth 8: People With Psoriatic Arthritis Shouldn’t Exercise
According to Matteson, if a person with psoriatic arthritis doesn’t think exercise is possible because of joint pain, they may be falling for the biggest myth of all. Moving your body should definitely be a part your overall treatment approach. The 2018 American College of Rheumatology guidelines recommend physical activity for people with active psoriatic arthritis because it may provide many benefits, including reducing joint pain and stiffness, improving flexibility, increasing range of motion, helping with weight loss, and more. In general, people with psoriatic arthritis tend to do better with low-impact exercises such as yoga, swimming, walking and biking instead of high-impact exercise like running. “Exercises that strengthen muscle actually take stress off the joints,” Matteson says. In addition to being good for your joints, fitness also plays an important role in your overall health. Talk with your doctor before deciding on what level and type of activity will be best for you. The good news is that most people with psoriatic arthritis won’t ever have to have surgery, according to the Cleveland Clinic in Ohio, and should be able to manage the disease through a combination of medications and lifestyle modifications. But if psoriatic arthritis has severely damaged your joints, your doctor may recommend surgery to relieve pain and restore function. Additional reporting by Becky Upham.
