Triggers for Rheumatoid Arthritis Flares

From everydayhealth.com

People with rheumatoid arthritis (RA) often cycle between times when their symptoms are relatively well controlled and when pain, stiffness, swelling, and fatigue suddenly worsen. These episodes, known as flares, can last for days or weeks and may interfere with daily life.

While flares can seemingly come out of nowhere, certain factors may increase the likelihood of symptoms worsening. Identifying your personal triggers may help you avoid them, or at least reduce their frequency, severity, or duration.

Common Triggers to Look Out For

The exact cause of an RA flare isn't always clear. Over time, many people with RA notice that certain circumstances tend to precede a flare. Although triggers differ from one person to the next, experts have identified many common culprits.

Environmental Triggers

“One of the most common questions I get from patients with rheumatoid arthritis is whether certain environmental factors can trigger their symptoms,” says Priyanka Dongare, MD, a fellow in Stony Brook Medicine’s Division of Rheumatology in New York. “While environmental triggers don’t cause RA flares in every patient, many people notice patterns.” These triggers include:

• Weather Changes “Cold weather and sudden weather changes are probably the most frequently reported triggers,” says Dr. Dongare. But the weather may not have as much of an impact as patients may think. A meta-analysis found only that weather’s impact on RA symptoms appears to be minimal.
• Air Pollution Higher levels of air pollution have been linked to an increased risk of RA flares. One study found that exposure to pollutants including PM2.5, PM10, nitrogen dioxide, and ozone was associated with greater disease activity and higher levels of inflammation.
• Occupational Exposures Dust, fumes, and chemical irritants may aggravate symptoms in some people with RA. But most research has examined these exposures as risk factors for developing RA rather than triggers for flares.
• Cigarette Smoke and Secondhand Smoke Tobacco smoke causes whole-body inflammation, one of the main triggers for arthritis. “Multiple studies have demonstrated that smoking not only increases the risk of developing RA, particularly seropositive RA, but can also worsen disease activity and reduce response to treatment,” says Dr. Dongare. 

Physiological Triggers

Changes in the body, some of which you can manage through lifestyle modifications, can affect inflammation and increase your risk of a flare.

• Sleep Deprivation “Poor sleep is one of the most common triggers I see in clinical practice,” says Dr. Dongare. Research has shown that inadequate or disrupted sleep can increase inflammatory cytokines such as IL-6 and TNF-alpha, which are key drivers of RA inflammation. “Patients often say that after several nights of poor sleep, they experience increased pain, stiffness, and fatigue.”
• Physical Overexertion There’s a fine line between exercise and overdoing it. While regular movement is recommended for people with RA, pushing your body too hard can temporarily increase joint pain, stiffness, and fatigue. Repetitive motions, heavy lifting, or unusually strenuous activity may aggravate already sensitive joints, making flare symptoms feel worse.
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• Hormonal Shifts Hormones help regulate immune function. Sharp drops in oestrogen, such as after childbirth, around menstruation, and during menopause, may increase disease activity and trigger flares.

• Inconsistent Medication Skipping doses, delaying refills, or stopping medication because you think you feel fine can increase the risk of a flare. Disease-modifying antirheumatic drugs (DMARDs) and biologics help keep the immune system's inflammatory activity under control, and can worsen symptoms if not taken as prescribed.
• Added Sugars and Ultra-Processed Foods Diets that include these foods may promote inflammation and worsen RA symptoms over time. These foods have been linked to immune dysregulation and increased inflammatory signalling, which may contribute to greater disease activity.

Emotional Triggers

The state of your mental health can also affect your RA symptoms. 

• Stress “While stress doesn't directly cause RA, it can amplify inflammation and make symptoms feel significantly worse,” says Dongare. One long-term study found that those with greater perceived stress had worse pain, greater fatigue, and lower physical function.
• Grief Research suggests that intense grief is associated with higher levels of inflammation, and experts note that the emotional strain of losing a loved one may increase disease activity and flares.
• Anxiety A systematic review found that about 1 in 5 people with RA experience clinically significant anxiety symptoms. Research has linked anxiety to greater pain, fatigue, and disease burden.
• Depression Depression and RA have a bidirectional relationship. One review found depression is associated with higher disease activity and worse treatment outcomes in inflammatory arthritis, suggesting that depressive symptoms can make flares more difficult to manage.

Track Your Triggers

Because RA affects everyone differently, tracking your triggers and symptoms can help you identify patterns that may otherwise go unnoticed. Dongare suggests keeping a symptom diary or using a smartphone app to track these variables:

• Pain levels
• Stiffness
• Fatigue
• Sleep quality
• Stress
• Diet
• Exercise
• Environmental concerns

“Tracking can also help rheumatologists distinguish between inflammatory disease activity and other contributors to pain such as osteoarthritis, fibromyalgia, sleep disorders, or mood disorders,” says Dongare.

Tracking is a tool, not a diagnosis. She cautions against assuming that every flare has a clear cause, since RA symptoms can naturally fluctuate. If you consistently notice the same pattern, though, you should discuss it with your rheumatologist.

How to Avoid Your Trigger(s)

While you can't prevent every RA flare, addressing common triggers may help reduce their frequency and severity. The key, says Dongare, is to focus on factors you can control.

• Prioritize sleep. Poor sleep can worsen inflammation, pain, and fatigue, so maintaining good sleep habits may help keep symptoms in check. 
• Manage stress. "Stress management should be part of every patient’s treatment plan,” says Dongare. Meditation, counselling, exercise, and strong social support systems can help reduce the physical toll of chronic stress.
• Stay physically active. “Many patients worry that exercise will worsen their arthritis, but the evidence consistently shows the opposite,” she says.
• Follow a healthy eating pattern. Dongare says maintaining a healthy weight and following a Mediterranean-style diet may support overall health and help reduce systemic inflammation.
• Quit smoking. It’s not good for any part of your body — joints or otherwise.
• Take medications as prescribed. Skipping doses or stopping treatment can increase the risk of disease activity and flares.

“Avoiding triggers can help manage symptoms, but controlling the underlying inflammation with appropriate medical treatment remains the foundation of RA care,” she says. Keep up with regular rheumatology appointments and talk with your healthcare provider before making changes to your treatment plan.

Questions to Ask Your Doctor

If you notice possible RA flare triggers, share them with your healthcare professional. They can interpret symptoms, adjust treatment if needed, and keep your disease under control.

• What symptoms or patterns should I track to better identify my RA flares?
• Could my current medications or dosing schedule be adjusted to better prevent flares?
• Are there environmental or lifestyle triggers I should be most cautious about?
• How can I safely modify my diet, activity level, or daily routine without making my symptoms worse?
• Should I adjust or pre-plan treatment around known triggers like stress, illness, or travel?
• When should I contact you if I think I’m having a flare?

The Takeaway

• RA flares are periods of worsening pain, stiffness, swelling, and fatigue. While they can seem unpredictable, research suggests they’re often linked to environmental, physical, and emotional triggers that vary by person.
• Common triggers include weather changes, air pollution, smoking, workplace irritants, poor sleep, overexertion, hormonal shifts, missed medications, diet, and stress-related factors like anxiety or grief.
• Because triggers differ widely, tracking symptoms alongside daily habits can help identify personal patterns. Working with a healthcare provider can help confirm flare patterns and guide more effective treatment.

 https://www.everydayhealth.com/rheumatic-conditions/triggers-for-rheumatoid-arthritis-flares/

Can Psoriatic Arthritis Cause Hair Loss?

From everydayhealth.com

Psoriatic arthritis (PsA) is an autoimmune disease that causes inflammation of the joints, tendons, and nails. It usually occurs in people with psoriasis, an inflammatory condition causing rashes on the skin.

Symptoms can include joint pain, swelling, stiffness, and fatigue. Hair loss (alopecia) isn’t typically a sign of the disease, but it can affect some people with PsA in a roundabout way. 

“Psoriatic arthritis and hair loss are not directly linked,” explains Jennifer E. Yeh, MD, PhD, a clinical assistant professor of dermatology at Stanford University School of Medicine in California. “However, having psoriatic arthritis may predispose one to hair loss from psoriatic arthritis inflammation, from psoriatic arthritis treatment, or from an increased likelihood of having another type of autoimmune condition.” 

Physical or Psychological Stress Can Lead to Hair Loss

Psoriatic arthritis can significantly impact your emotional well-being, leading to anxiety, depression, diminished self-esteem — and particularly, stress. Chronic stress can worsen inflammation and immune dysregulation, leading to increased disease activity and more severe symptoms. Researchers note that stress may also disrupt neuroendocrine pathways, affecting cortisol levels and further dysregulating the immune system in PsA. According to the American Academy of Dermatology, stress is linked to hair loss and thinning hair.

Dr. Yeh says that both the physical and psychological stress associated with PsA can trigger a temporary type of hair loss called telogen effluvium. 

With telogen effluvium, more hairs than normal are forced into their resting phase. When this happens, they fall out at once. Most people lose about 100 strands of hair a day. But if you have telogen effluvium, you may lose up to 300 strands a day.

“While telogen effluvium is characterized by an increase in daily hair shedding, it usually reverses, and hair regrows once the underlying stressor is removed,” Yeh says.

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Medications for PsA May Cause Thinning Hair

Treatments for PsA can contribute to hair loss. Some common culprits are: 

• Methotrexate It stops cells from growing — including hair follicles. About 1 to 3 percent of people who use it experience hair loss.
• Leflunomide This medicine works like methotrexate and causes hair loss in about 10 percent of people.
• Anti-TNF Therapy Research has shown that “a sizable minority” of people on TNF inhibitors develop alopecia areata, the most common inflammatory hair loss disease, at a higher prevalence than the general population, though it’s not clear why this happens.

“Treatment-related alopecia typically improves with discontinuation of the offending medicine,” says Yeh.

Comorbid Psoriasis and Hair Loss

Most, but not all, people with PsA also have psoriasis. And, if you have psoriasis, you have a 45 to 56 percent chance of developing scalp psoriasis.

Scalp psoriasis causes a dry, itchy, and inflamed scalp. “Scalp psoriasis that is not controlled irritates the hair follicles, disrupting normal hair follicle function, and thereby causing hair shedding,” says Yeh. 

If you scratch or pick at the lesions, you can also damage hair follicles. This can result in additional hair loss.

The good news is that hair loss due to scalp psoriasis is usually temporary. “Most cases show complete hair regrowth after treatment,” says Yeh.

If you have severe psoriasis plaques, you should be aware that the oral medication acitretin, occasionally used to treat persistent psoriasis, can cause hair loss.

What to Do About Hair Loss

If you have PsA and experience hair loss, talk to your doctor. If you’re not already seeing a dermatologist to manage your condition, your rheumatologist can refer you to one who may be able to determine the underlying cause of your hair loss.

Getting your symptoms under control can also help preserve your hair. “Hair loss from uncontrolled PsA reverses once the inflammation is well-controlled,” says Yeh. “It’s critical to treat concomitant scalp psoriasis so that local inflammation surrounding hair follicles on the scalp does not contribute to increased hair shedding.”

Here are some ways you can help prevent hair loss caused by scalp psoriasis.

• Try not to touch, pick, or scratch your scalp.
• Keep your fingernails short.
• Be gentle when brushing, combing, washing, or drying your hair.
• Wear a hat when you’re outside.
• Use a medicated shampoo that contains salicylic acid and follow with a moisturizing conditioner. 
• Don’t take extremely hot showers.
• Ask your doctor about a prescription treatment that can help your symptoms.
• Avoid blow-drying your hair. If you do, use a low-heat setting.
• Try to keep stress levels low.
• Follow a healthy diet.
• Avoid heavy drinking.

While hair loss associated with PsA can be frustrating, the right treatments and lifestyle habits can help you minimize shedding — and protect the hair you have.

The Takeaway

• If you have psoriatic arthritis and you’re experiencing hair loss, consult your doctor to determine the underlying cause and effective treatment strategies.
• Medications such as methotrexate and leflunomide, commonly used to manage PsA, might contribute to hair thinning, so discuss potential side effects with your healthcare provider to explore any necessary adjustments.
• Emotional and physical stress linked to PsA can cause temporary hair loss; reducing stress levels and effectively managing the disease can lead to regrowth and a healthier scalp condition.
• If you’re dealing with scalp psoriasis, measures such as medicated shampoos and avoiding scalp irritation can prevent additional hair loss and support recovery.

https://www.everydayhealth.com/rheumatic-conditions/can-psoriatic-arthritis-cause-hair-loss/

Common Triggers for Psoriatic Arthritis

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.

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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

4 Psoriatic Arthritis Warriors Share Their Treatment Turning Points

From healthcentral.com

It’s not always easy living with PsA–but these stories prove that you can still live well this chronic condition 

Psoriatic Arthritis (PsA) is a type of arthritis that affects roughly 30% of the 125 million people worldwide living with psoriasis (PsO), an inflammatory autoimmune condition that triggers itchy plaques, rashes, and swollen, hot skin, according to the National Psoriasis Foundation (NPF).

Some people develop both conditions within a short timeframe, while others have PsO for years before developing PsA (or vice versa), per the NPF. The right treatment plan for PsA can manage both conditions and minimize disease-driven inflammation that can lead to related health concerns including heart attack, stroke, type 2 diabetes, high cholesterol, inflammatory bowel disease, depression, and anxiety.

Many people who have both PsA and PsO go through a trial-and-error phase to find the best medication (or combination of meds) for their specific symptoms—and the good news is, there are currently many effective treatment options available. Certain lifestyle changes, too, have been shown to help reduce PsA and PsO symptoms, including maintaining a healthy weight and minimising stress.

Even so, landing on the right, reliable treatment plan that controls your specific symptoms can be filled with ups and downs, both emotional and physical, especially right after a diagnosis or when psoriatic arthritis symptoms first flare. For been-there, done-that, “here’s-what-I-did” advice, we talked to four people with PsA about the turning point that helped them not just live with a chronic condition, but thrive with one.

A PsA Advocate Emerges 

Despite having psoriasis since childhood, it took Emily Kate Hertzberg, an art teacher in Long Island, NY, two years to get diagnosed with psoriatic arthritis after she developed joint pain. “I went to this orthopaedic doctor, and he was like, ‘You have tennis elbow … this is an injury from sports,’” she recalls. Hertzberg switched doctors when her symptoms continued to get worse—and was shocked to find out that she had PsA, a disease she’d never even heard of before. “It was really scary to be in my early twenties and not have any idea about this new condition that I was going to have for the rest of my life,” she says. Now 40, Hertzberg recalls researching PsA online, but not much information was available back then, nor were there many treatment options. In her quest for a medication that would treat her PsA, she was hospitalized for a “severe” allergic reaction to the biologic adalimumab after taking it for two years. After her first infusion of a tumour necrosis factor (TNF)-alpha blocker she had an allergic reaction and was treated with Benadryl. “The first couple of years were really, really hard,” she remembers.

Now 40, Hertzberg recalls researching PsA online, but not much information was available back then, nor were there many treatment options. In her quest for a medication that would treat her PsA, she was hospitalized for a “severe” allergic reaction to the biologic adalimumab after taking it for two years. After her first infusion of a tumour necrosis factor (TNF)-alpha blocker she had an allergic reaction and was treated with Benadryl. “The first couple of years were really, really hard,” she remembers.

PsA Turning Point

Hertzberg realized she was not happy with the care she was receiving, so she changed doctors. ”I found a rheumatologist [whom] I love, as well as treatments that started working for me,” she says. “I also found a phenomenal dermatologist for my psoriasis.” Around this time, she decided to become a PsA advocate and build her own community, Psoriatic Arthritis Warriors, on Instagram. “I had a kind of a-ha moment where I realized that I should really start sharing my journey and help people,” she says. “Starting my Instagram account not only inspired me to help others, it inspired me to stay positive and focused and just keep fighting.”

Attitude—Plus Regular Care—Is Everything

Hertzberg takes the biologic medication abatacept via injection once a month to treat her PsA, and she goes to her derm’s office weekly for phototherapy, in which the skin is exposed to UVA and UVB rays for five minutes per visit to help shrink PsO patches and prevent new ones from forming. She also says that her positive outlook is powerful medicine when it comes to managing her PsA and PsO. “The minute you give up and surrender, this disease is going to take over your mind and your body,” she says. “You have to have that positive self-talk, and mentally be in a good frame of mind the moment you wake up.”

PsA Words of Wisdom

“Be your own health advocate, seek out different treatment options, and ask all the right questions,” she says. Those include inquiring about a medication’s side effects before taking it, a physician’s availability during an emergency, and how much experience the doctor has treating PsA, Hertzberg suggests. “Sometimes telling these doctors what you need or want is more important than them telling you, because you know your body and what your body can and cannot handle,” she adds.

Managing Stress Made All The Difference

At first, Jude Avril Duncan’s PsA symptoms seemed to come out of nowhere. “One day, I woke up with back pain and it very quickly escalated into not being able to walk more than a few steps at a time without being in immense pain,” recalls the 31-year-old digital marketer, who lives in Glasgow, Scotland. “My skin was also really bad.” Looking back, however, Duncan says she believes her intensively stressful former job triggered this debilitating PsA flare. “I wasn’t able to realize how stressed I was until it was too late,” she adds. In fact, stress is one of the leading triggers of both PsO and PsA, according to The Cleveland Clinic.

PsA Turning Point

Duncan’s path to a PsA diagnosis was far smoother than Hertzberg’s: She got an appointment with a compassionate rheumatologist quickly on New Year’s Eve in 2018 due to a cancellation. She shared with her new doctor that she suspected PsA, and the physician agreed with her after performing an exam and asking about Duncan’s medical history. (Duncan also had an MRI to assess her level of joint damage). Thanks to her quick diagnosis, Duncan says she was able to get her disease under control right away. “The medication that I was put on worked really well for my skin and my arthritis,” she adds. “I was able to get back to the life I was living before very quickly.” Today, she sees a rheumatologist and a dermatologist who work in the same practice, so the doctors communicate about her condition, and both her PsA and PsO are well managed. “I’m very lucky,” she acknowledges.

Medication Access and Meditation Can Help

Duncan takes certolizumab pegol, a biologic via injection every two weeks that has worked well for her so far. She says getting free health care and prescriptions as a citizen of Scotland helps her maintain her good health, because she can try different treatments when necessary. “The reason I’m able to change my medication when I need to, is because I get it for free.” she says. “If I had to pay, I would not be able to afford it.” Beyond taking her medication as prescribed, Duncan manages her PsA symptoms by eating a healthful diet, exercising regularly, and meditating. “I still get aches and pains,” she adds, “but I’m very much able to live a ‘normal’ kind of life.”

PsA Words of Wisdom

“Make a flare kit,” advises Duncan, who offers skincare advice and PsA/PsO support on her Instagram channel. “When I was first diagnosed with psoriatic arthritis and I would have a flare, I’d be like, ‘Where did I put my heat pads? Where are my compression socks?’” she remembers. “I could never, ever find them because I would always put them in random places.” So, Duncan created what she calls a flare kit, an easy-to-find box with compression socks, heating pads, cooling pads, some kind of non-steroidal anti-inflammatory drug (NSAIDs), and a bar of chocolate (for a spirit-lifting treat)–everything she needs to feel better. “When you’re feeling bad the last thing you want is the stress of finding things,” she says.

Find a Support Group for PsA

Lorraine Boissoneault, a writer in Oak Park, IL, a suburb on the west side of Chicago, had her first experience with joint pain during a bout of food poisoning, which some studies suggest can trigger PsA. She eventually saw a rheumatologist in 2021, who screened her for both PsA and rheumatoid arthritis (RA), since both types of arthritis run in her family—but her diagnosis was unclear at the time. “I didn’t have any visible joint damage,” she says, “and I didn’t have any of the blood markers for RA.” Boissoneault also had no history of psoriasis.

When NSAIDs and a topical gel failed to relieve Boissoneault’s joint pain—which was particularly bad in her elbows, spine, and fingers, and she developed uveitis, a form of eye inflammation that’s common with PsA, multiple times—her doctor started her on a biologic. That medication cleared up her uveitis but her joint pain persisted. “I had to stop working at one point because I was too sick,” she remembers.

When Boissoneault developed PsO on her scalp in 2023, she was finally diagnosed with PsA. Ultrasound imaging around this time also showed inflammation known as enthesitis, in Boissoneault’s SI joint and left elbow.

PsA Turning Point

Boissoneault’s initial search for a rheumatologist led to incredibly negative experiences. “The first doctor was extremely rude and made me cry,” she says. “The other one was just like, ‘I don’t really know what’s going on with you. I don’t want to deal with it.’” Finally, Boissoneault found the doctor that would turn things around for her. “She was like, ‘We’re gonna figure this out,” Boissoneault remembers. “We’ll find a way to make you feel better one way or another.” Although it took a couple of years to get a confirmed diagnosis of PsA, Boissoneault says she remained hopeful because her doctor never gave up. “Having such a good doctor has been huge in making me feel supported,” she adds.

Community Matters, Along With PT

Boissoneault, now 34, has endured three joint surgeries, and she has had to switch medications various times, either because the biologic didn’t work, or her insurance stopped covering it. However, the biologic bimekizumab-bkzx, which she started taking recently, has dramatically improved her PsA symptoms. “Before starting my newest med, I had a terrible flare where my pain was constantly around 7 [on a scale of 10] and I was having trouble sleeping or doing much of anything,” she says. Now, she averages a pain level of 2 or 3, depending on the day.

Taking good care of herself, including writing in her journal regularly, and doing physical therapy and low-impact exercises such as Pilates and walking, also helps Boissoneault manage her condition. Additionally, she has a supportive partner and she belongs to a virtual support group, Rheum to Thrive, for people with all types of arthritis. “That’s been huge,” she says. “It’s nice to be able to talk about my psoriatic arthritis with people who understand what I’m going through.”

PsA Words of Wisdom

Take one day at a time. “It’s so overwhelming at first, but it will get better,” Boissoneault says. “Be patient with your mind and body.” And build a support network, so you’re not facing this chronic illness alone. “Find a community wherever you can, whether that’s a virtual support group or friends and family,” she adds.

Small Changes Can Make a Big Difference

Joni Kazantzis, 41, was diagnosed with PsO as a teenager and has been an advocate for others with the chronic skin condition since she launched her blog Just a Girl With Spots in 2012 and an Instagram channel by the same name in 2015. Then in 2020, Kazantzis, who now co-owns an advertising agency with her husband in Princeton Junction, NJ, developed pain that seemed to “come out of nowhere” in her fingers, toes, and feet. She didn’t immediately suspect PsA, despite knowing that she could possibly develop it, until she experienced a severe PsO flare. “My medication was probably masking the psoriatic arthritis, until it stopped working well,” she says. Kazantzis saw her doctor, who confirmed it was PsA. Still, she struggled for about a year to find a medication that worked for her. “It was pretty miserable,” she remembers.

PsA Turning Point

Kazantizis’ PsA symptoms erupted at the height of COVID-19, when she was working remotely up to 15 hours a day for an advertising agency, her husband was launching his own business, and they were trying to parent their daughters, who were then 3 and 5. “I was sitting in front of my laptop, or I would be on calls,” she remembers. “I was stressed all the time. I’m a stress eater, so I was eating potato chips and drinking a lot of wine, just living an unhealthy lifestyle.” Ultimately, Kazantizis says she realized she needed to take a step back from work and change how her whole family was living–and get her health back on track. “We were able to go for walks,” she says. “My kids were getting more attention, so they weren’t as stressed out and constantly fighting. We were able to spend more time cooking.”

Even Modified Movement Can Manage PsA Symptoms

Kazantizis was taking the biologic adalimumab for her PsO when she developed PsA. Next, she tried two other medications, the biologic ixekizumab and the disease-modifying antirheumatic drug (DMARD) apremilast—neither of which controlled her symptoms. Currently, she manages her PsA with the interleukin-23 blocker guselkumab, as well as eating a healthful diet and taking turmeric supplements (this golden orange spice has been shown in studies to reduce the swelling caused by PsA). She also exercises four or five days a week. Kazantizis has a particular fondness for Orangetheory classes–intervals of high intensity exercises that blend cardio and strength training–that she says help her manage her stress, as well as improve her physical health. She admits that PsA has taught her to accept her limitations, particularly on days when she isn’t feeling her best. “Maybe I can’t run, but I can walk,” she says. “Or maybe I can’t lift very heavy weights, but I can use the bands.”

PsA Words of Wisdom

The entrepreneur and former athlete says it was hard for her to slow down at first—but listening to her body and “doing what feels right” has been key to managing her PsA. “Give yourself some grace,” Kazantizis adds. “Be flexible with yourself.”

https://www.healthcentral.com/condition/psoriatic-arthritis/psoriatic-arthritis-treatment-turning-point