Features March 2018 Issue

Coping with Psoriatic Arthritis

Physical diseases can have psychological consequences. These need to be addressed as part of a complete approach to treatment.

A greater understanding of psoriatic arthritis and an increasing number of medications available to treat it have had a major impact on relieving pain and improving function. But less attention is paid to some of the conditions that often accompany psoriatic arthritis. If you have this form of arthritis and are experiencing fatigue, sleep problems or depression, you are not alone.

Cleveland Clinic rheumatologist Elaine Husni, MD, MPH, wants to shine a light on some of the psychosocial issues that many people with psoriatic arthritis face so they can be recognized and addressed in a timely manner.

What Is Psoriatic Arthritis?

Psoriatic arthritis is an inflammatory type of arthritis that affects up to one-third of people with the skin condition psoriasis. These are autoimmune diseases, in which the body’s immune system mistakenly attacks healthy tissue. Psoriasis causes patches of red skin with silvery scales. With psoriatic arthritis, the immune system attacks joints and the places where tendons and ligaments attach to bone, causing inflammation and pain.

Skin symptoms usually begin years before joint symptoms. But skin and joint symptoms may appear at the same time. Psoriatic arthritis strikes men and women equally, usually between the ages of 30 and 50, unlike rheumatoid arthritis, which affects more women than men.

“We understand the skin and joint changes with psoriatic arthritis, how to measure it, and how it responds to treatment,” says Dr. Husni. “Much less is understood about how the disease impacts other areas of life.”

More than Joints


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Psoriatic arthritis can cause nonjoint symptoms, including fatigue and sleep problems.

Living with any chronic disease presents challenges. Dr. Husni and her colleagues identified some issues that are particularly problematic for people with psoriatic arthritis. They published their findings from a search of the scientific literature in Seminars in Arthritis and Rheumatism (December 2017).

They discovered that people with psoriatic arthritis have a generally poorer quality of life than the general population. “The most common issues were sleep disorders, fatigue, low-level stress, mood disorders and reduced work productivity,” says Dr. Husni. Not everyone experiences these, but for those who do they should not be ignored.

Lack of sleep, low energy and depression can cause people to withdraw from activities they usually enjoy, which may lead to social isolation. Pain, fatigue and anxiety can contribute to lost days of work and lower productivity while at work.

Not only do these negatively impact quality of life, they can set up a vicious cycle. Fatigue and a desire to hide the skin rash of psoriasis may lead to less physical activity. But physical activity is an important part of treatment. In addition, it’s been shown that repeated nights of poor sleep can worsen pain, which further disrupts sleep.

Don’t Suffer in Silence

Increased pain may be treated by raising the dose of a medication or changing to a different one. But this may not be necessary if the other problems are addressed. “Once these issues are recognized they can be properly treated,” says Dr. Husni.

“I want patients to understand that mood disorders, poor sleep, fatigue and other psychosocial issues can negatively impact their disease, and they should discuss them with their rheumatologist, and also with their primary care doctor,” says Dr. Husni. Addressing these issues will improve the overall treatment of psoriatic arthritis.

It may require taking additional medications, such as antidepressants, or seeing other medical specialists in addition to your rheumatologist. A sleep specialist or mental health professional may be consulted.

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