Some psoriasis medications, such as steroid creams and retinoids, can cause skin irritation that’s difficult to deal with, according to the Mayo Clinic. While doctors generally recommend that you give these medications some time to take effect, Dr. Bierman says it’s best to immediately talk to your doctor if your skin becomes much worse, like if you develop a distinct skin rash, severe itchiness, or swollen skin. “You might have hypersensitivity to a particular component or ingredient,” she says.Other psoriasis medications can potentially cause diarrhea, Dr. Leger says. If you’re constantly running to the bathroom—and it doesn’t let up—let your doctor know. While it’s entirely possible that your diarrhea could be due to something else, like a stomach bug, it could also be a side effect of your medication.5. You’re planning to become pregnant.Talking to your doctor about having kids might not be one of your first thoughts during your psoriasis appointments. However, some psoriasis medications may increase the risk of fetal birth defects in people who are pregnant, so it’s important to check with your doctor to see if your medication is safe to take if you’re trying to conceive.“You need to talk to your dermatologist about what the right decision is for you,” Dr. Zeichner says. This includes people of all gender identities, because some medications can be found in sperm and cause birth defects when a partner becomes pregnant, according to the Mayo Clinic. If you’re trying to start a family, your doctor can recommend effective medications to treat your psoriasis that are also safe to use while trying to conceive.6. Infusion medication doesn’t work with your schedule.Some biologics are given through an intravenous (IV) infusion, which means you’d need to either go to a medical care center to receive it or pay for a home nurse to come to you and deliver it. That can be tough to make time for if you have a busy schedule. If your circumstances have changed and you’re always rescheduling your infusion visits, then it’s possible your treatment may not align with your lifestyle anymore.Luckily, Dr. Rodney says there are a lot of biologics that come in injectable form, which means you give yourself a shot at home. “There are very effective injectable biologic medications for psoriasis,” she says. “If you’ve been on an infusion regimen, you can definitely switch to an injectable.”7. You’re starting to feel joint pain.About 30% of people with psoriasis will develop psoriatic arthritis at some point, and unfortunately, this can happen at any time, according to the Cleveland Clinic.“Even if your skin psoriasis is well-controlled on your current medication, you may also experience pain and swelling in your joints,” Dr. Rodney says. So, if your wrists start hurting when you do ordinary activities, like making dinner or brushing your hair, or if you start having really severe knee or ankle pain and can’t walk for an unexplained reason, then you should talk to your doctor. Even if you just have minor pain that’s unusual or bothersome, it’s really important to flag that to your doctor because treating psoriatic arthritis early can help prevent long-lasting joint damage.If you do have psoriatic arthritis, which is diagnosed via a physical exam and imaging tests like an MRI, then you may need to switch up your medication. “Some injectable medications are better at treating both skin and joint psoriasis than others,” Dr. Rodney says. Your doctor can read through the research on psoriasis and psoriatic arthritis medications to recommend ones that may work best for you.Overall, it’s important to work closely with your doctor if you feel like your psoriasis treatment just isn’t working for you.It is totally possible to find relief from your symptoms—they’re not something you should just have to put up with because your current medication isn’t cutting it. “I’m always shocked when patients say they have a relative who is suffering from psoriasis,” Dr. Leger says. “We have so many great treatment options available. That should not be the case.”Sources:Institute for Quality and Efficiency in Health Care, Topical Treatments for PsoriasisRelated Stories:
Being diagnosed with psoriatic arthritis can drastically change the way you live your life and how you feel in your mind and body. The chronic health condition leads to really stiff, painful joints, so whether you’ve dealt with the symptoms for years or recently received a diagnosis, simply taking care of yourself can feel like a constant struggle.Although your health care team can give you valuable advice on how to manage your pain, only people who have psoriatic arthritis can truly understand the nuances of the condition—after all, they’ve already experienced the ups and downs of managing flare-ups and learned valuable lessons along the way.So, SELF spoke to four people who have psoriatic arthritis to dig into the most important things they’ve learned since their initial diagnosis. Keep reading for their insight on pain management, coping with mental health struggles, and embracing change.1. Slow down when you need to.Trying to do seemingly mindless tasks, like gripping a zipper or brushing your teeth, can be more difficult than you expect when your joints are especially stiff and painful. Jocelyn Hall, 36, who was diagnosed with psoriatic arthritis eight years ago, says she’s learned to give herself extra time in bed to mentally and physically prepare for the day. And she encourages anyone else with the condition to allow themselves that grace if their schedule allows for it.Hall says her psoriatic arthritis symptoms usually feel the worst during the first 10 minutes after she wakes up. “It’s like walking through mud or like you’re running in water,” she tells SELF.That’s why she welcomes a slower pace. “I’ll sit up and read the news, and hopefully my boyfriend will bring me coffee,” Hall says. “I give myself those extra minutes in bed to rest and to get my mind going.” Once she’s ready to start her day, she takes a shower to help relax her stiff muscles.2. Give yourself permission to set new goals.It’s not always easy to live your life exactly as you did before a psoriatic arthritis diagnosis—but sometimes navigating all the new changes opens doors you’d never even consider.Ashley Krivohlavek, 37, who was diagnosed with psoriatic arthritis in 2013, originally wanted to use her master’s degree in museum studies to work on exhibitions. However, her symptoms can get in the way when it comes to hands-on work. “When you are working in a museum, sometimes you do have to lift heavy things—and that is not something that could be in my job description,” Krivohlavek tells SELF.While Krivohlavek tried to come to terms with what this meant for her future, she found valuable information and support through CreakyJoints, an advocacy organization for people with arthritis and rheumatic disease. She began volunteering with the group and sharing her own psoriatic arthritis story through the website. Through her experience, Krivohlavek found a new passion for health advocacy and decided to go back to school to study population health.
Once the medication took effect, Ingram was able to trade food delivery apps for recipes again. Actions she once did regularly became major markers of progress. “I was able to start chopping up vegetables again,” Ingram recalls. “That was exciting—to be able to grip the knife and repetitively chop up and down.”It wasn’t just the familiar flavors and motions that Ingram was happy to get back. “When I was at my lowest on my sickest days, and I wasn’t able to cook for myself, it felt like a loss of independence,” she says. Regaining the ability to do something as seemingly simple as lift up a pot or stir soup has made her feel more in control.Ingram still deals with joint pain and stiffness sometimes, but now she can just rest for an afternoon and feel better. Before her treatment, Ingram wouldn’t be able to move for days when the pain became unbearable. “I wouldn’t say that you always get your whole life back to the way it was,” she says. However, she adds that treatment “definitely improves the quality of your day-to-day life.”3. “I’m training for my first bodybuilding contest.”Lauren Scholl, 33, views exercise as her me time. Long-distance running and dancing used to be her favorite ways to unwind and zone out. In fact, she was once a competitive dancer, but that career came to a halt when she developed psoriatic arthritis around five years ago.“I’ve been through about six or seven different drugs that unfortunately did not work for me,” Scholl tells SELF. She says joining CreakyJoints, an organization for people with arthritis and rheumatic disease, gave her a lot of support during the process. “Knowing that you’re not alone and you’re not the only one going through this made a huge impact on my life,” she says.Her sons, now five and eight years old, were also very young at the time of her diagnosis. Scholl says changing their diapers, preparing their bottles, and generally just trying to keep up with their energy was physically overwhelming with her joint pain. She remembers waking up dreading the physical toll it took on her body.Eventually, though, Scholl found a medication that worked. She receives a biologic infusion once a month. It makes her mood a bit low for about 48 hours, but she says that side effect is worth it: “I get almost a full month of feeling like myself.”Being able to run around and go to the park with her sons without having to grit her teeth through the pain has been life-changing. “My symptoms have curbed enough that I’m able to enjoy things like playing with my kids now that they’re older,” she says.Now, as a personal trainer, being able to work out is the second-best change in her life. “I feel like I can give so much more to my clients,” she says. Scholl also started bodybuilding and structured her routine so she isn’t always strengthening the same muscles. “Instead of running every single day, which is constant training on your feet, this has allowed me to give my biggest problem areas, like my knees and my feet, enough time to recover and not trigger inflammation,” she explains.Being able to see her own progress is a big mental boost—and she’s set to compete in her first bikini competition in April 2022. Her sons are impressed too. “I’ve got my five-year-old practicing his deadlift with a broomstick, and my eight-year-old can be found flexing around the house!” Scholl says. “They think it’s pretty cool.”Related:
Enthesitis can be asymptomatic or it can cause swelling and pain around the affected area.8 Your doctor may want to do an MRI to look for tendon or ligament enlargement and thickening (which are signs of enthesitis) when assessing whether you might have psoriatic arthritis.Plantar fasciitisWhen psoriatic arthritis involves the feet, the pain can seem like plantar fasciitis, which feels like a stabbing pain10 along the bottom of your foot near the hell. It can be easy to assume something like this is the cause of your foot pain, but if you have ongoing symptoms, exhibit other signs of psoriatic arthritis, and have a family history of psoriatic arthritis, then you may want to talk to your doctor about psoriatic arthritis screening.Psoriatic arthritis ankleAnyone with psoriatic arthritis can experience pain, tenderness, stiffness, and swelling in their ankles. Ankle pain is often related to inflammation of the enthesis11 (that area we mentioned above where the tendons and ligaments meet the bone and help us move our joints). Generally, psoriatic arthritis ankle stiffness and swelling can be worse in the mornings and improve when you are active. Some people may have a hard time walking at all during a particularly painful flare-up. If you can, doing some range of motion exercises first to warm up can help alleviate your pain and stiffness.Psoriatic arthritis toesAbout 50% of people with psoriatic arthritis experience dactylitis, a condition that’s also referred to as “sausage digits.”12 As the nickname implies, your toes can become very swollen and painful due to inflammation in the toe joints and connective tissue around your toes and ligaments. Dactylitis can be present in all toes, and the swelling can be acute or chronic.13 It is important to treat and manage dactylitis because your pain and swelling can become worse. Having swollen toes doesn’t automatically mean you have psoriatic arthritis—dactylitis is also associated with a few other conditions, like gout, tuberculosis, and sarcoidosis (an inflammatory condition that is associated with granulomata, or inflammation that is caused by growths in your organs). However, dactylitis is a strong indicator of psoriatic arthritis, so if you experience toe swelling, be sure to bring it up to your doctor who can take this into consideration when diagnosing you.Psoriatic arthritis nailsPsoriatic arthritis nail symptoms are common and roughly 80% of people with psoriatic arthritis14 have nail lesions, according to a 2017 paper published in Reumatologia. These changes aren’t the direct result of psoriatic arthritis but instead happen when you develop nail psoriasis. As a result, you may experience issues like pitting, deformity, nail plate thickening, and separation of the nail from the nail bed15 (just to name a few). If you have foot or ankle pain, toe swelling, and changes in your toenails, then you might want to talk to your doctor about whether you could have nail psoriasis and psoriatic arthritis. If you are already diagnosed with psoriatic arthritis and notice any nail changes as we described, then it’s a good idea to talk to your doctor about whether your condition is progressing.Morning stiffnessThere are various reasons that your feet may feel stiff in the morning, including going on a new hike. However, morning stiffness is a common symptom among people with psoriatic arthritis, especially during a flare. In the morning, your feet may feel extra stiff and sore, which occurs because your joints can stiffen up from lack of movement16 when you sleep. Generally, light movement can help mobility, so going for a short walk if you are able to might alleviate some of your discomfort.GoutGout is a painful type of inflammatory arthritis that initially affects just one joint17 (usually the big toe) but later it may affect other joints, even at the same time, such as the ankles, knees, elbows, wrists, and fingers. However, it can also affect the ankles, knees, elbows, wrists, and fingers. Similar to psoriatic arthritis, gout symptoms include pain and swelling and may flare and subside. If your toes become very painful and swollen, then you may wonder whether it’s related to gout or psoriatic arthritis. There is no single test to confirm psoriatic arthritis or gout, but x-rays, lab tests, physical exams, and patient histories can help physicians differentiate between the two. And it’s important to get an accurate diagnosis because gout and psoriatic arthritis are two very different diseases with different treatments.
She then switched to a biologic that was released to treat psoriatic arthritis, but she experienced an allergic reaction to the medication and had to stop taking it. Eventually, she was able to take part in a clinical trial for a biologic that was approved by the Food and Drug Administration to treat psoriatic arthritis and similar conditions in 2003. She’s been taking that same medication for nearly 20 years.“I noticed a difference within a few weeks,” Roberts says. “At the time, I was mostly in a wheelchair and using a walker. I went to a cane within a matter of a few weeks. Then, within three to four weeks, I was walking without a cane. I was able to walk unassisted pretty quickly and I got my life back.”Roberts says the medication was so pivotal for her, because it allowed her to have independence. “I was so young when the disease really set in,” she explains. “I had to have people help me bathe, get dressed, and do my hair and my makeup. I couldn’t go to the mall and hang out with friends because the walking was too much.” But once her condition improved, Roberts was able to do the things she wanted to. “My hands worked, my knees bent. I could sit in a chair and actually hold down an office job. I could go grocery shopping—all by myself —for the first time in a long time.”5. “Walking unassisted in D.C. was huge for me.”Jaime Holland, 40, was diagnosed with psoriatic arthritis in her early 30s, and started a biologic infusion in 2013. Holland, who also has Crohn’s disease and psoriasis, says that her skin started to improve, but her arthritis and Crohn’s symptoms only improved for a week or so before going back to where they were. “Walking felt like I was stepping on broken glass, and my fingers were numb and swollen to the point I could barely make a fist or grip anything,” she tells SELF. Her doctor tweaked the dosage of that medication and her symptoms improved, but Holland developed an allergic reaction to the treatment after a year. She had to change her medication a few more times due to allergic reactions until she finally landed on the right medication for her, which she’s still taking. “All in all, it took close to four years to cycle through meds until we found one that worked best,” she says.“My current medication, a biologic, had an almost immediate impact on my psoriatic arthritis symptoms,” she says. “I felt great in the weeks that followed. Over the course of the next eight weeks, my symptoms did return but they were not nearly as bad as they were prior to that first dose. When I had the second dose via an injection, I noticed improvements again.”After her first dose, Holland says she was able to travel to Washington, D.C. on her own and speak at a congressional hearing. “Walking unassisted in D.C. was huge for me,” she says. “A year prior, I had collapsed in agony on the sidewalk after walking a block from my hotel. It felt so defeating having to hail a cab just to get a few blocks down the road.” Now, Holland says, she’s thrilled to be able to travel and wear shoes. “You don’t realize how easy it is to take something for granted, like the ability to wear a pair of shoes at all, let alone comfortably, until your feet from toes to ankles are swollen beyond recognition.”6. “My new medication has allowed me to be mobile enough to retain my full-time job.”Alan Simmons, 48, was diagnosed with psoriasis when he was just 7 years old and with psoriatic arthritis when he was 35. “In my 30s, I started using a biologic medication for my psoriasis and that kept my arthritis from becoming too bad,” Simmons tells SELF. “When I was officially diagnosed with psoriatic arthritis, I was well-managed for a long time with that same medication for my skin,” he explains.After seven years on his medication, Simmons says he started to notice that he was waking up with stiff joints and that it took him a long time to move comfortably. “Over the span of another six months, I noticed this was getting worse,” he says. “It took longer to get going in the morning and eventually I got to the point where my joints were stiff and started causing more pain all day long.”Since then, Simmons has been through four different medications and is now taking a biologic that works well for him. “I still have good and bad days. But I can do most of the things I enjoy,” he says. That includes volunteering with the National Psoriasis Foundation. “I love to volunteer, participate in community events, and travel,” Simmons says. “When my arthritis is really bad, those activities can be painful physically, and not being able to participate is painful emotionally.”Sources:Psoriatic Arthritis, Mayo ClinicPsoriasis, Centers for Disease Control and PreventionRelated: