By Anca Askanase, MD, as told to Camille Noe Pagán
If you have psoriatic arthritis (PsA), odds are you’ll probably have symptoms for months and maybe years before you're told that you have it. It’s understandable because if your joint pain isn’t constant -- and PsA pain often isn’t -- you might think it’s just a sign of aging or wear and tear caused by exercise.
Like all chronic diseases, though, the earlier you start treating your PsA, the less damage you’re likely to have. So when I see someone with psoriasis who also has joint pain, fatigue, nail issues, or other signs that it could be PsA, my goal is to find out what’s going on and get them started on a treatment plan.
Diagnosis isn’t always straightforward. Unlike rheumatoid arthritis, for example, psoriatic arthritis doesn’t show up on blood tests. Because of that, doctors make a diagnosis mostly based on symptoms like joint pain and stiffness that are worse in the mornings and get better after you move around a little.
I think it’s important to know that if you have psoriasis, joint pain isn’t automatically a sign that you have psoriatic arthritis. Only about 30% of people with psoriasis will get PsA. I’ve treated people who have psoriasis and lupus, for example, or inflammatory osteoarthritis. Their symptoms were similar to psoriatic arthritis, but it wasn’t that.
Work With Your Team
After you get your diagnosis, it’s important to work closely with your medical team to manage your condition. I think it’s beneficial to see a specialist like a rheumatologist. Someone who regularly sees people with PsA is more likely to understand all of your treatment options.
You also want to make sure that different members of your health care team -- for example, your rheumatologist, dermatologist, and family doctor -- work together on your treatment plan. PsA ups your chances of things like heart disease and diabetes. That’s why all members of your health care team should be monitoring you.
Unfortunately, we still don’t have a cure for psoriatic arthritis. What we do have are many good treatment options that we didn’t have even 10 years ago. There are a lot of new medications for psoriasis and psoriatic arthritis that can limit damage to your joints, which can help you feel better and stay active longer.
Biologics, which change the way your immune system works, are especially promising. But they don’t work for everyone, which is why researchers are still looking for treatments. The reality is, 50% of the treatments we have make about 50% of people better.
Not enough people are in remission, and that’s the goal.
If You Feel Something, Say Something
I wish more people knew that they don’t have to settle. If you don’t like the side effects of a treatment or aren’t seeing the results you want, you should let your doctor know. There are usually more things to try. And in some cases, you may need to combine treatments to get to a place where your skin is clear and you’re feeling good.
Just don’t wait to see your doctor. I can’t stress this enough: The earlier you start on medication, the more likely you are to get to a place with few or no symptoms.
Many times, I only have 15 to 20 minutes to spend with each person I see. There’s a lot I have to pack in during that time. But that doesn’t mean I don’t want people to ask questions and bring up concerns! Learning more about your condition and how to manage it will make things better.
Regular checkups do, too. Don’t just come in when your symptoms are bad. I may see someone as often as every 2 weeks during a flare. But if you’re stable, I still want to see you a couple times a year to monitor for changes and to make sure your treatment plan is still working.
Managing psoriasis takes a team approach -- and that means working together through the bad and the good.
Anca Askanase, MD is the founder and clinical director of the Lupus Center at Columbia University Irving Medical Center in New York. She's also their director of rheumatology clinical trials.