For younger adults, the diagnosis often comes as a surprise. “I’ve had patients in their twenties tell me, ‘I thought arthritis only happens to old people,’” she says. For many young adults, a psoriatic arthritis diagnosis can also be hard to accept. On top of having to deal with the skin rashes this condition can bring, painful and swollen joints can make everyday tasks and activities difficult. Most of us take our ability to wake up and do things without having joint pain or stiffness for granted, notes Dr. Snyder. “And when you’re in your twenties and that starts to happen, it can be quite a shock,” she explains. When a young person gets a diagnosis like psoriatic arthritis, they no longer have that completely carefree, “I don’t even need to think about my body” experience that many people in their twenties have, points out Eleanor Anderson, MD, an assistant professor of clinical psychiatry at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. “Accepting that can be hard and emotionally painful,” she says. Plus, your twenties are the time in life when you’re just starting to carve out your work situation, your career, establishing romantic relationships, and maybe thinking of starting a family, notes Dr. Anderson. “Getting a diagnosis of a chronic disease like psoriatic arthritis can negatively impact that developmental arc,” she explains. RELATED: What Not to Say to Someone With Psoriatic Arthritis
You May Rethink Your Career Choices After a Psoriatic Arthritis Diagnosis
For Paige Meleney, 29, a small animal veterinarian in Cleveland who learned she had psoriatic arthritis in elementary school, living with this condition meant rethinking the career she had always envisioned for herself. “My goal was to do musical theater and to sing on Broadway someday, and I performed throughout middle school, high school, and college,” explains Meleney, who chronicles life with her condition on Instagram. “I remember when I finally had to have the big conversation with my parents.” She knew a career in musical theater would not only be physically demanding, requiring a lot of dancing and late nights, but could also be financially unstable. “Although there was a chance that I could have fulfilled that dream, the reality was because of my arthritis I needed to pursue a career where I could have health insurance to maintain my disease and pay my bills,” she explains. Accepting a new vision of yourself and (if necessary) reinventing your dreams can help build your resilience and open the door to new possibilities. While Meleney decided to pursue a degree in biology instead of musical theater, she looked for a way to keep pursuing the things she loves. “I ended up finding an a cappella group in college that I loved and sang with 24/7. That kept me sane while I got my biology degree,” she says. “I use music in different ways — it’s just not my career. I do love my job as a veterinarian though, so I can’t complain.” RELATED: Your Everyday Guide to Living Well With Psoriatic Arthritis
You May Find It Challenging to Manage Symptoms of Psoriatic Arthritis
Unlike older adults, people in their twenties typically don’t have any experience managing a chronic condition. “In general, it’s a little bit more challenging for young adults to recognize the importance of following up with a physician routinely,” says Snyder. “This may be the first time they’ve had to seek out medical attention on their own and be responsible for making and keeping appointments. They’re busy and doing a lot of other things, and this is one more task to complete.” Staying on top of everyday self-care can also be a challenge, especially when your peers are living a more worry-free life, notes Meleney, who found that psoriatic arthritis and college life didn’t always mesh well. “College was going out to bars, parties, or staying up all night watching movies or studying for an exam,” she explains. “That was an issue for me because sleep is so important for me in managing the pain and discomfort of psoriatic arthritis.” Senior Week, a string of parties that took place between the end of classes and graduation, had Meleney concerned from the get-go. “I looked at my boyfriend (now my husband) and said, ‘We’re going to have to plan this week because I’m going to have to figure out what’s important to me and what’s not,’” she remembers. A highlight of the week was Casino Night, and everyone attending was expected to dress up, she says. “All the girls were wearing heels and I thought I’d be frumpy if I didn’t, even though I knew they’d screw up my arthritis in about 10 seconds flat,” she says. At midnight everyone decided to head out to a bar, but Meleney had hit the wall. “It was hard for me to be like, ‘Sorry guys, my joints are bad, and I can’t go out tonight, but that’s what I had to do,’” she explains. She and her boyfriend quickly formed a plan B, which involved renting a Zipcar, grabbing some ice cream, and driving to the Washington Monument to relax and enjoy the view. “We had our own special date night which I’ll always remember,” she says. RELATED: 6 Tips for Couples When One Partner Has Psoriatic Arthritis
You May Have Concerns About Starting a Family When You Have Psoriatic Arthritis
Because there are a significant number of younger people with psoriatic arthritis, it’s not unusual to see patients who are at least starting to think about family planning, notes Snyder. “That’s a big conversation my husband and I are having right now,” says Meleney. “We discuss how my pregnancy may impact my arthritis and managing it while also being a parent.” While it may not be a fun conversation to have, she believes that talking through how psoriatic arthritis will impact different aspects of life — including having a family — can help make those things easier to manage. It’s also important to include your doctor in discussions around family planning, says Snyder. “There are some medications that can present a problem with pregnancy, and so those would need to be changed. It just takes a little bit of thought and preparation, but it’s certainly possible,” she says. RELATED: Special Concerns for Women Who Have Psoriatic Arthritis
You May Have Questions About Disease Severity
Being diagnosed with psoriatic arthritis in your twenties doesn’t mean that the course of your disease will be more severe, according to Snyder. “In general, when we look at patients who have psoriatic arthritis, earlier onset does tend to suggest that their disease may be more aggressive, and their joints may take on more damage over time. That’s just based on the fact that they’ve had the disease for longer than someone who develops it later,” Snyder explains. The good news is that there is a growing array of effective psoriatic arthritis therapies to help people manage the disease and prevent or limit the extensive joint damage that can occur without medical intervention. “A big thing we focus on with our patients at any stage, but certainly our young patients, is preventing the progression of their disease,” explains Snyder. “We are much better at that now than we were even 15 or 20 years ago. There are really good therapies available now.” In fact, many patients who develop disease early in their life respond very well to therapy. “These people are able to do most of the things they want to do without much joint pain or destruction of the joint,” she explains. But Snyder cautions that successful treatment is not a guarantee. “We still don’t understand some of the factors that determine how a patient will respond to different medications,” she says. Some patients may continue to have more significant symptoms over time and still have some degree of pain and damage. “We’re not 100 percent perfect at preventing this,” she adds.
You May Wonder About Your Psoriatic Arthritis Treatment Choices
If a person in their twenties gets a diagnosis of psoriatic arthritis, treatment will depend on a number of factors, including the degree of arthritis at time of diagnosis, as well as the preference of the patient. Over-the-counter or prescription strength nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin, can help reduce pain and swelling. These medications can be a good option for a patient with mild disease without any preexisting conditions to limit use, such as elevated blood pressure, kidney disease or acid reflux, Snyder notes. For people with more severe arthritis that’s limiting function or is destructive, it’s more likely that they would be prescribed a disease modifying anti-rheumatic drug (DMARD), which can help slow joint damage and the progression of the disease. “An argument could also be made to start a DMARD in patients with mild disease as an attempt to prevent progression of their arthritis,” says Snyder. Doctors often consider several factors when making the recommendation for DMARD therapy, which include:
Severity of symptomsLevel of pain or discomfortFunctional impairmentThe presence or absence of joint swelling or deformityEvidence or degree of damage on radiographs
“The medications come with risks and side effects, and we have to factor that in the decision as well,” explains Snyder.
Here’s How You Can Stay Healthy With Psoriatic Arthritis in Your Twenties — and Beyond
A diagnosis of psoriatic arthritis in your twenties doesn’t mean you can’t enjoy a fun-filled and active life. Here are some strategies that can help you manage your disease, and not feel like you are missing out.
Stick to your treatment plan. “When I think about my patients who seem to be managing their psoriatic arthritis most successfully, it tends to be the people who are keeping their appointments and taking their medications as directed,” says Snyder. “It’s not always easy to remember what you need to take and when you need to take it, but committing to that makes a big difference.”Communicate with your doctor. In psoriatic arthritis, you can have periods where you’re doing great, but there can also be flares, Snyder notes. “Be sure to let your physician know when your skin or joints start acting up. We’re here and we can help, but we don’t know that’s happening if you don’t communicate with us,” she explains.Keep a flexible mindset. Psoriatic arthritis can be unpredictable. Whenever possible, try not to have rigid expectations of how each day has to be. “Then if it’s a good day, you can accomplish more of what you were hoping to do,” says Anderson. “Try to be sensitive to yourself and mindful of how things are going, and take each day or hour as it comes.”
Meleney seconds that advice, adding, “When you lie to yourself about how you are feeling and push through it, three days later you’re not going to be able to get out of bed.”
Accept that you will make mistakes. Living life and managing psoriatic arthritis can be like a choreographed dance — and there can be missteps, notes Meleney, who admits, “I’ve had this disease for a long time, but sometimes I still make poor choices.”Consider working with a psychologist. In addition to the support of family and friends, a trained psychotherapist can help you work through any feelings of frustration or disappointment. “A therapist can help you process your emotions around this and also strike a balance between taking care of yourself and your psoriatic arthritis, yet still pursuing the things you want to do,” Anderson explains.
And, unlike family and friends, you don’t have to worry about offending a therapist. “With a therapist, you don’t have to mince your words,” she adds. “A therapist is there to hear your experience and your experience alone. They can help you reframe it, and comfort you if you’re distressed by it.”
