Coping with Psoriatic Arthritis

By Joanne Barker

Treatment options have come a long way toward helping control the symptoms of psoriatic arthritis. Yet many people are living with the joint damage they suffered before newer treatment and prevention methods came along.

And even now — since psoriatic arthritis can be difficult to diagnose — it can do lasting harm before treatment begins.

The good news: Combining your medical treatment with simple but significant lifestyle changes can help with the emotional and physical challenges of living with psoriatic arthritis and improve your outlook from day to day.

Psoriatic Arthritis: Coping With Your Emotions

Karen, who asked that her full name not be used, is 60 years old and has been living with psoriatic arthritis for 20 years.  She wakes up each day hoping her psoriatic arthritis has gone away. And each day, she has to confront the fact that it’s still with her. She once had an active, outdoorsy life. Now she is limited by pain and exhaustion. She has to cope with anger and guilt. “I know it’s not realistic, but I think I should be able to control this,” she says.

When it comes to emotions, coping strategies are as diverse as the people using them. Unfortunately, some methods can do more harm than good. For instance, many people turn to food or alcohol while turning away from friends and family.

Healthier, more lasting ways to deal with the emotional effects of psoriatic arthritis include:

• Finding professional help for depression. Depression is often at the root of harmful coping behaviors. In one study, 32% of people with psoriasis were diagnosed with depression, compared to about 7% of the general population.  If you have a feeling of sadness or emptiness that you can’t shake, talk with a health care provider. Depression is a serious condition that can be treated.
• Connecting with others. “Knowing that you are not alone is crucial,” says therapist Madelyn Petrow-Cohen. “Whether with a good friend or in a group, it’s very important to have a chance to voice your emotions.”

“People tell me that stress causes this; like I could just do away with the stress in my life,” Karen says. Arthritis pain and stress have a way of building on each other. “Just dealing with this disease is stressful,” she says.

“Patients are overwhelmed with the disease, and the time it takes to manage it,” says Christopher Ritchlin, MD, a rheumatologist and professor at the University of Rochester Medical Center. You may not be able to rid your life of stress, but you can take steps to keep it under control, including:

• Plan ahead. In her daily schedule, Karen makes time for herself, for relaxation. “I go to work early so I can get home and spend time outdoors while it’s still light,” she says.
• Step back. Petrow-Cohen suggests listening to a relaxation CD, taking a walk, or working on a puzzle to shift your focus away from stressors.
• Meditate. “Meditation and mindfulness can train you to watch your thoughts without becoming attached to them,” Petrow-Cohen says.

Fighting a Lack of Confidence With Psoriatic Arthritis

Alice Gottlieb, MD, PhD, chair of dermatology at Tufts Medical Center in Boston, often sees her patients’ self-confidence torn down by psoriasis and psoriatic arthritis. Although they are not all clinically depressed, they may often have a terrible self-image, Gottlieb says: “And many people who don’t have the disease are happy to reinforce that image.”

Instead of beating yourself up or letting other’s expectations get you down, pick yourself up by:

• Building your self-esteem. Psoriatic arthritis is a part of your life. But it doesn’t have to define who you are. Don’t shy away from others. Join a support group and spend more time with friends. Doing so can help you feel more comfortable with yourself and feel less self-conscious. “I’ve seen a lot of people in support groups develop confidence to be more proactive about their needs,” Petrow-Cohen says.
• Educating yourself. Learn what psoriatic arthritis is, and what it is not. It may help to know, for instance, that psoriatic arthritis is not contagious. “You need to become informed about your disease,” Gottlieb says.

Preventing and Treating Psoriatic Arthritis Pains

Though others can’t see it, pain is impossible to ignore when you’re experiencing it. Pain can interfere with everything, from relationships to sleep, and the ability to function at work. Any effort you put into reducing your pain could pay off in many areas of your life. You may be able to shrink the effects of your psoriatic arthritis pain by:

• Getting treatment. Medications called TNF blockers can relieve pain from psoriatic arthritis while also preventing further damage to your joints. “With the right treatment, pain should be dramatically improved,” Gottlieb says.
• Avoiding triggers. You might get temporary relief from smoking or drinking, but not without risking your overall health. Plus, alcohol can have very serious side effects when combined with certain psoriasis medications. And heavy drinking can make some psoriatic arthritis medications less effective.
• Finding an exercise plan that works for you. A 5-kilometer walk on Thanksgiving Day made Karen feel surprisingly better. Yoga, on the other hand, makes her feel worse.
  Psoriatic arthritis varies from person to person. What works for one may not work for another. But generally, moderate exercise can provide a number of physical and mental benefits for people with psoriatic arthritis. Consult with a physical therapist who can help you learn which activities meet your needs and abilities.
• Eating a healthy diet. A diet that is high in fruits and vegetables, and low on fats and sugars, is not only good for your health. It’s good for your weight. Losing excess pounds can also relieve pressure on your joints.

Using Time to Your Advantage

Staying on top of psoriatic arthritis can take a lot of time. Your daily routine may involve taking several medications, using special shampoo and skin lotion, plus making time to exercise and prepare healthy meals. If fatigue is one of your symptoms, you have to fit all this in with a low reserve of energy. To make the best of every moment:

• Communicate your needs. If you have trouble keeping up with the demands of treatment, talk with your physician. “It’s important to have a treatment regimen that you’re comfortable with and can do,” Ritchlin says.
• Control what you can. You may not be able to make psoriatic arthritis disappear. But you can make decisions about how it will affect your life. Plan ahead to reduce stress and congratulate yourself every time you do something good for your well-being.