Because symptoms such as joint pain and stiffness are part of living with psoriatic arthritis, it can sometimes be hard to know how well your condition is controlled. “There’s a lot of variation in psoriatic arthritis from individual to individual,” says Ana-Maria Orbai, MD, MHS, director of the psoriatic arthritis program and assistant professor of medicine at Johns Hopkins University of Medicine in Baltimore. Indeed, while one person may have heavily swollen hands when they are diagnosed, another may only have a swollen knee. And if you also have skin symptoms, the severity of your psoriasis may not match the severity of the arthritis. “People may also react differently to treatment, depending on how well it matches their own disease and progression,” Dr. Orbai says. “Therefore, people will look very different before and during the course of their treatment.”
Psoriatic Arthritis Red Flags
With that said, there are some signs that your psoriatic arthritis management plan could use a tune-up, according to Orbai, including:
1. Your symptoms make it hard to do your daily activities.
According to the National Psoriasis Foundation, swollen fingers and toes, pain and stiffness in other joints, morning stiffness and tiredness, and less range of motion are just some of the psoriatic arthritis symptoms that can make it difficult to carry out your daily tasks at home and at work. If your symptoms greatly impact your quality of life or ability to do everyday tasks, talk to your doctor. With the right treatment, you should be able to get your psoriatic arthritis back into remission.
2. You have joint pain and swelling that won’t quit.
While some people with mild psoriatic arthritis have only occasional joint pain and swelling, others with more severe disease notice it all the time — and because this can lead to joint damage, it’s important to treat these symptoms. If your joint pain and swelling aren’t letting up, Orbai says, “that’s even more reason to check in with your doctor.”
3. You feel exhausted all the time.
If psoriatic arthritis has you feeling relentlessly worn out, there’s actually a lot more going on — psoriatic arthritis-related fatigue is driven by inflammation, chronic pain, and how long you’ve lived with the condition, according to a study published in July 2019 in the Journal of Rheumatology. Fatigue can be a major indication your psoriatic arthritis isn’t well controlled. Unchecked pain and inflammation can contribute to fatigue, so a key step to getting your energy back is to get disease activity under control, according to the Arthritis Foundation.
4. You feel depressed.
While psoriatic arthritis doesn’t necessarily cause depression, emotional struggles like anxiety and depression are more common in those with the condition, according to a meta-analysis of studies published in December 2020 in the journal Seminars in Arthritis and Rheumatism. “It’s like a vicious circle,” says Orbai. “If you don’t feel good because [your] psoriatic arthritis isn’t controlled, then how can you be happy?”
5. You have changes in your vision.
If you suddenly experience redness, blurred vision, and pain in your eye, it may be due to inflammation in the central part of the eye — a condition called uveitis. Uveitis is more common in people with inflammatory conditions such as psoriatic arthritis, although it may not necessarily mean your symptoms are acting up. “Another frequent association of psoriatic arthritis is dry eye, which can cause blurry vision and sensitivity to light,” Orbai adds. If you experience vision changes, get them treated by an eye doctor, and check with your doctor to see if your psoriatic arthritis management needs to be tweaked, she advises. If left untreated, uveitis can cause permanent vision loss, Orbai says.
6. Your flares get more frequent and intense.
Because psoriatic arthritis is unpredictable, having a flare in itself doesn’t always mean your treatment should change, according to Orbai. “So the question is, what’s the intensity of these flares? What’s the frequency, and how impairing are they?” says Orbai. If things are ramping up — including if you have a recurrence of old symptoms that were previously under control — it’s time to check in with your doctor.
See Your Doctor Regularly
All of these factors highlight the value of regular check-ins with your doctor to monitor your progress over time. If you feel your psoriatic arthritis isn’t well-controlled, communicate with your doctor. He or she can help adjust your treatment plan and make sure there aren’t other factors contributing to your symptoms. This could mean increasing the dose of a drug you’re taking, adding an additional treatment, or stopping one that isn’t working. And don’t wait until pain or other symptoms start interfering with your life. “I think follow-up is so important to be able to untangle these things,” says Orbai. “It’s about, what is the pattern for you? How do you look when you’re doing well, and how do we recognize when things aren’t going well?” By keeping your doctor in the loop, you can get closer to the answers.
