From healthcentral.com
From weather to medication interactions, learn all the ways this condition can be triggered
Psoriatic arthritis (PsA), an autoimmune disease that leads to joint pain and skin rashes, can be unpredictable and change over time. If you have PsA, you know how hard it can be to pinpoint what’s causing your symptoms to worsen. There are multiple internal and external factors that impact the immune system, and figuring out which ones might set off a flare with psoriatic arthritis isn’t easy. What’s more, these factors, known as triggers, can vary from person to person. We asked the experts about some of the common psoriatic arthritis triggers and how to shield yourself from worsening symptoms.
Stress
“Stress is one of the biggest triggers for flares,” says Waseem Mir, M.D., a rheumatologist at Northwell Lenox Hill Hospital in New York City. Stress often occurs after an unpleasant life circumstance, new demands, an event like a death in the family. Stress could also result from an overall ongoing and challenging life experience such as poverty or marital dissatisfaction.
Short-term stress can help you respond to life’s challenges, but if the stress-inducing event goes on and on, your reaction can become more long-term, also known as chronic stress. According to an article in Frontiers in Human Neuroscience, large bodies of evidence show that chronic stress can activate inflammation in the brain and the body.
The relationship between stress and inflammation becomes clear with psoriatic disease. In one study, patients with psoriasis in 31% to 88% of cases reported stress as a trigger for their psoriasis and a higher incidence of psoriasis occurred in those with a stressful event in the previous 12 months.
Illness
A variety of infections have been reported as triggers of psoriatic disease. According to a 2024 review, both bacterial and viral infections have been responsible for the onset or recurrence of psoriatic disease. Bacterial infections include Streptococci pyogenes (strep throat), Staphylococcus aureus (staph infection), Porphyromonas gingivalis (periodontal disease). Viral infections related to psoriatic disease include human immunodeficiency virus (HIV), hepatitis C virus, and COVID-19.
Lack of Sleep
“Lack of sleep may contribute to psoriatic arthritis flares, but we need more research in this area,” says Melanie H. Smith, M.D., Ph.D., a rheumatologist at Hospital for Special Surgery in New York City, adding that the cause and effect may not be a straightforward relationship. “With sleep, maybe it’s not necessarily about being a trigger for psoriatic arthritis, but when we get less sleep, we feel more pain.” Given that people with psoriatic arthritis are more likely to have trouble sleeping, often from symptoms of the condition, exacerbation of pain is a real problem. According to the Arthritis Foundation, all the more reason to keep your psoriatic arthritis symptoms in check through proactive treatment.
Skin Trauma
If you have psoriasis along with your psoriatic arthritis, skin trauma or injury can be a flare of your symptoms, known as the Koebner phenomenon. According to the National Psoriasis Foundation, psoriasis can appear in the areas of the skin that have been harmed as a result of scratches, sunburns, bug bites, and vaccinations. The exact reason this occurs remains unclear without enough evidence to support any one theory.
Medication Disruptions
“Another trigger can be changing or discontinuing medication,” says Dr. Smith. That’s because a different mechanism of action might not work as well—or not work at all if you suddenly stop taking your medication. All of this can lead to worse symptoms, she explains. And in the world of psoriatic disease, medication changes happen quite frequently, according to the National Psoriasis Foundation.
Dr. Smith says that sometimes you will need to take the lead in shortening the time you are without treatment. “Sometimes it’s about making sure the doctor’s prior authorization is not running out anytime soon or if it is, letting the doctor know,” she explains. “I’m never upset about a patient advocating for themselves.”
Changing Physiology
There are other times related to your medication where you could experience a psoriatic arthritis flare, but it may not be the fault of your medication. “Sometimes people will blame their medications for flares, reporting that their medications have stopped working,” Dr. Mir says. Usually, though, it is more complicated than that. “Sometimes it is about your body becoming weaker when you have a flare, not the medication stopping working,” he says. “Our physiology changes over time—especially as we grow older.”
“Maybe the medication was working for you five years ago, but now you are five years older and your body has changed,” Dr. Mir adds. These changes in your body as you age can sometimes trigger a PsA flare.
Alcohol and Cigarettes
A complex relationship has been discovered between psoriatic disease and alcohol. People living with psoriasis tend to consume more alcohol than the general population, according to the National Psoriasis Foundation. Whether that’s because the discomfort of the disease drives people to self-medicate, if the goal of drinking is to help treat the symptoms of the disease, the opposite is true. Drinking alcohol can cause dehydration and nutritional issues, and also create oxidative stress and inflammation.
Smoking should also be avoided if you have psoriatic arthritis. Smoking is an independent risk factor for psoriatic disease. Why? One of the reasons is that nicotine stimulates immune cells by releasing inflammatory cytokines, according to a 2024 article in Cell Communication and Signaling. And if you are already genetically predisposed to psoriatic disease, it seems that smoking can turn up the volume. Smoking upregulates the expression of psoriasis-associated genes.
Diet
Because everyone reacts differently to food, there is no one recommended diet for people with psoriatic arthritis, but Dr. Smith says that following a nutritious meal plan can help shield people from psoriatic arthritis symptom triggers.
In particular, foods with anti-inflammatory properties may help ease PsA symptoms: There is some evidence to support eating a Mediterranean diet if you have psoriatic disease. This diet emphasis is on plant-based foods, fruits, vegetables, whole grains, beans and legumes, fatty fish and olive oil.
A healthy diet is not just about what you eat, but also about what you leave off your plate, explains Dr. Smith. Because processed food may cause psoriatic arthritis symptoms to flare, limiting consumption of it can be helpful for keeping the disease in check.
Weight Gain
On average, people with PsA have a higher mean body mass index (BMI) than those with psoriasis, rheumatoid arthritis, or the general population, according to a study in Rheumatology; up to 45% of people with psoriatic arthritis are obese. Adipose (fat) tissue can act as an active organ in our bodies, secreting proinflammatory cytokines. As a result, obesity has the potential to activate many of the known immune-inflammatory pathways, causing a flare in symptoms to occur.
Additionally, carrying weight may also prevent your treatment from working as well as it should. According to the Arthritis Foundation, a number of studies have shown that for people with psoriatic arthritis, being obese raises the chances of not improving with certain types of medications.
Cold and Dry Weather
Dr. Mir said that weather changes can be a trigger for PsA symptoms. “I just spoke to a patient who was flaring with foot and hand pain and it seemed possible that it was from a weather change,” he says.
Dr. Smith agrees that weather changes seem to frequently be reported as a trigger of psoriatic arthritis symptoms. “Some patients say that their skin and joints get worse,” she says. The research supports the impact of weather exposure and variations. For example, a 2022 study reported that patients with psoriasis who had occupations with more sunlight exposure were less likely to report aggravation of psoriasis in autumn/winter. On the other hand, smoking and hyperlipidaemia (elevated lipids) were positively associated with the seasonal aggravation of symptoms.
Shielding Yourself From Potential Triggers
While you probably won’t be able to avoid all the potential psoriatic arthritis triggers, there are ways to reduce their impact. “Exercise does seem to help shield people from some of the triggers,” says Dr. Smith.
Keeping on top of your treatment can also impact the power of the triggers. “If your medication is barely covering your disease and you get an extra blow to the system, you are going to feel it,” says Dr. Mir. “On the other hand, if your treatment is covering your condition really well, then if you have a small hit from a trigger, the medication may cover it.”
https://www.healthcentral.com/condition/psoriatic-arthritis/psa-psoriatic-arthritis-triggers
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