From healthcentral.com
Ease the ache with expert-approved tips for managing pain and stiffness
Psoriatic arthritis (PsA) pain is driven by inflammation that can affect joints and tendons. Inflammation may start where tendons attach to bone, known as enthesitis, leading to discomfort in areas like the shoulders, elbows and knees, says Bret Sohn, M.D., a rheumatologist at Stamford Health in Stamford, CT. As inflammation spreads into the joints, the immune system attacks synovial cells that produce joint-lubricating fluid, causing red, swollen joints and stiffness—often worse after rest or inactivity. The good news? There are effective ways to manage PsA pain, starting with the strategies here.
Heat Therapy: When Warmth Works Best
Heat helps chronic psoriatic arthritis pain by reducing stiffness, improving function, and suppressing inflammatory mediators. Try morning hot showers, apply heating pads before workouts, experiment with warm pool exercises, or explore paraffin wax treatments. However, avoid heat on new, acute pain—it can worsen inflammation during a PsA flare. Also, “any topical use of heat should be discussed with your physician,” says Julius Birnbaum, M.D., an associate professor of rheumatology at University of Pittsburgh Medical Center in Pennsylvania.
Cold Therapy Brings Relief
For acute arthritis pain and swelling—like after exercise, during a flare-up, or in the initial few days after an injury—applying a cool compress can help. “Cold therapy can reduce inflammatory proteins in a joint and provide modest pain relief in these situations,” says Dr. Sohn. Cold also constricts blood vessels, which reduces blood flow to the area to relieve swelling, and it interrupts pain signals as they travel across nerve fibres. Press an ice pack (or a bag of frozen veggies in a pinch) to the sore area for 15 minutes a few times a day.
Topical Relief Options
Topical pain relievers may irritate psoriasis plaques, experienced by one in three people with PsA. “Topical treatments aren’t typically recommended for PsA joint pain,” says Dr. Sohn. However, many people with psoriatic arthritis also have osteoarthritis, which can contribute to symptoms. In those cases, topical NSAIDs such as diclofenac or ketoprofen may help, particularly for knee or hand pain. These creams contain the same active ingredients as oral NSAIDs but with lower gastrointestinal, cardiovascular, and kidney risks because they aren’t absorbed through the digestive system.
Gentle Movement Reduces Pain Over Time
When you’re uncomfortable, you might feel inclined to take it easy and avoid strenuous activity. But regular, consistent movement actually helps calm inflammation. And strengthening your muscles eases the burden on your joints. “In general, exercise and physical activity can reduce pain and improve overall function for people with psoriatic arthritis,” says Dr. Sohn. “Studies demonstrate that physical activity correlates inversely with disease activity, meaning that more activity is associated with less pain and inflammation.” Consider low-impact workouts like yoga, tai chi, swimming, cycling, or walking.
Pacing Your Activities Protects Joints
The benefits of movement outweigh the risks, but it’s important to avoid overdoing it. “Excessive mechanical stress, especially at the spots where tendons attach to bone, may trigger or worsen the inflammatory process in people with psoriatic arthritis. There’s no clear threshold where beneficial exercise ends and harmful overloading begins,” says Dr. Sohn. That’s why it’s important to start slow and ramp while listening to your body: Be consistent with your exercise routine, but don’t push through pain. Break workouts or strenuous tasks into shorter intervals with regular breaks and rest days in between.
Easing Morning Stiffness
People with psoriatic arthritis often experience “gelling,” a type of stiffness after rest that can last more than 30 minutes, says Birnbaum. Medications and gentle movement help, but small routine changes can also make mornings easier. The Arthritis Foundation suggests using heat overnight or setting an electric blanket to warm up before waking. Keep topical or oral NSAIDs by your bed. When your alarm goes off, take or apply medication, then do gentle stretches in bed to get your joints moving before standing. A brief warm shower can also help loosen stiff muscles and joints.
Supportive Tools and Daily-Life Modifications
Assistive devices can make everyday tasks easier when you have sore joints or lower range of motion. An occupational therapist can help you identify tools that suit your specific needs. “Examples include splints or braces, adaptive footwear, or a TENS (transcutaneous electrical nerve stimulation) unit to relieve pain,” says Dr. Sohn. You can also adapt your home environment with modifications like safety grips and grab bars in the bathroom, an electric jar opener or toothbrush, a sock puller, a grabber tool for out-of-reach items, or a voice-to-text function on your computer or phone.
Pain Management During a Flare
During a psoriatic arthritis flare, staying in close contact with your rheumatologist is key. An individualized plan may include a short course of NSAIDs or steroids, or adjustments to your current medications, says Dr. Sohn. Rest is also essential, since added physical stress can prolong recovery. Avoid heat on painful areas, which may worsen swelling; use ice packs or topical NSAIDs instead. Finally, note what was happening before the flare—such as stress, injury, or dietary changes—to help identify triggers and reduce the risk of future flare-ups.
