How you experience psoriatic arthritis (PsA) will be unique to you, however, studies show that Blacks with PsA have more psychological effects than whites. Fortunately, though there are a few ways to tell if your PsA is getting worse.
New joint pain or swelling
“In terms of your joints, you always want to pay attention to pain and swelling,” Rebecca Haberman, M.D., associate director at NYU Langone Orthopedic Hospital Arthritis Clinic in New York City explains. “For example, it is important to do a self-check at least seasonally and determine if more joints or new joints have become involved or if your lower back or buttocks have started to hurt.”
Ali Ajam, M.D., a rheumatologist and associate professor at Ohio State University Wexner Medical Center in Columbus, OH advises watching out for back pain as well.
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“A common culprit of increased back pain in those living with PsA is sacroiliac joint dysfunction,” he says. “If there is an increase in inflammation occurring around the sacroiliac joint, this may feel like more back pain or more hip pain.”
The sacroiliac joint is what connects the hip bones to the sacrum (a triangular bone between the lumbar spine and the tailbone).
Elbow or foot inflammation
According to Dr. Ajam an increase in disease impacts joints throughout your body, “Because an increase in inflammation can target any joint or tendon, if your disease is worsening, you may be experiencing disorders such as Achilles heel, plantar fasciitis, golfer’s elbow, and tennis elbow.”
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In fact, the Arthritis Foundation notes that approximately one in three people with psoriatic arthritis will develop enthesitis, which is inflammation at the site where a tendon or ligament inserts into a bone. Enthesitis is also the root of many common overuse disorders including Achilles heel and tennis elbow.
Increased fatigue
When your disease worsens, you may feel an increase in fatigue and there are many reasons for it. Inflammation or itchy skin may make it difficult to get rest. Additionally, high disease activity adds additional stress to your body, which can leave you feeling wiped out. Certain medications may also cause you to have sleepless nights.
“You may feel more tired in general and have difficulty completing tasks and activities that you normally do on a daily basis if your disease is worsening,” Dr. Haberman adds.
“You may find it more difficult to find the motivation to exercise or maybe recovery from activity is taking longer,” Dr. Ajam shares. “Experiencing more pain and swelling than usual after exercise can also indicate a worsening of your disease, or you may notice your joints locking up, and more pain and stiffness.”
Dr. Ajam also advises PsA patients to watch out for mental fatigue. “Mental fatigue may look like an increase in feeling more run down as an example, or you may feel overly anxious and be experiencing sleep problems.”
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Prolonged stiffness
“Whenever the weather is changing, this is a good time to keep an eye out for subtle changes in your disease,” Dr. Ajam notes. “This includes stiffness not just when you are first waking up, but that now lasts longer into the morning.”
Some PsA patients may also have a difficult time getting up after sitting for long periods of time.
More frequent flares
How is your skin? According to the National Psoriasis Foundation, even mild psoriasis (appearing on less than 3% of the body) may point to significant inflammation in the body.
Dr. Haberman suggests checking your skin and asking yourself questions such as “is more area of my body covered with psoriasis?” Or “has my skin become redder or is the scale thicker?”
Worse nail condition
Yes, psoriatic arthritis can affect the nails as well, and where it shows up depends on the location of the inflammatory process.
If you are experiencing nail pitting, the nail matrix (where the nails grow) may be involved. On the other hand, an inflamed nail bed may cause your nails to separate from the skin. If you have horizontal ridges in your nail, this usually indicates weakness in the nail bed.
Checking your nails also involves checking your fingers and toes. Toenail psoriasis is often misdiagnosed as a fungal infection.
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Eye inflammation
PsA can also affect your eyes. If you are living with psoriatic disease, you may experience eye changes such as eye redness, pain in one eye or both, blurred vision and sensitivity to light as a result of systemic inflammation.
Additionally, treatment may affect your vision. Methotrexate and acitretin may cause eye damage and certain biological therapies may also cause eye changes according to a 2021 study published in Experimental and Therapeutic Medicine.
When to see a doctor
Because you know your body better than anyone else, it is best to pay attention to any changes in symptoms and notify your doctor. If you notice things getting worse, your doctor can adjust your treatment or pursue additional methods of treatment.
Dr. Haberman says doctors, “Will likely ask you more about your symptoms and may order additional tests, such as bloodwork and x-rays to help determine your disease activity and whether you need any changes to your treatment regimen.”
Treatment will help reduce the inflammation that often leads to other health issues. It is important that you get treated because when left untreated, PsA can lead to permanent joint damage.
