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“The results from the scan didn’t fit in with any sort of injury, or any sort of wear and tear damage, and with a few other nagging bits in my history, it meant that I was referred straight to the rheumatology team,” Wilson says. Despite inconclusive blood tests, Wilson was diagnosed with rheumatoid arthritis. It wasn’t until she was 28 that she had what she describes as her “largest breakthrough”—she moved to another part of the country and saw a new doctor. “A fresh pair of eyes meant my diagnosis changed to psoriatic arthritis, and with that my treatment changed too,” she says.
Unlike Parker, Wilson doesn’t have skin psoriasis, which is possible (though less common) and another factor that may contribute to a delayed diagnosis. In some cases, PsA symptoms may present before the skin symptoms show up, especially in young patients, Dr. Fors Nieves adds. The skin psoriasis may also be present in less visible parts of the body, like the scalp, under the arms, or on the groin or genitals.
Psoriatic arthritis treatment is often a case of trial and error.
The first hurdle of treatment is typically finding the right specialist, which can be a struggle for some. While Parker’s first rheumatologist wasn’t the right fit, she eventually found a provider she felt comfortable with. “I wanted someone who I could relate to and feel heard,” she says. “I wanted to see someone who understood a person of color may have different experiences with medical staff, and a professional who knew how to communicate with me in a way that was helpful and hopeful.”
The next step is finding a treatment method that works for you. In the decade since she first saw a doctor for her joint pain and swelling, Wilson has tried several different treatments with varying levels of success. A few years ago, she underwent arthroscopic surgery to try to reduce some of the inflammation of her knee joint. Wilson says it helped for a while, but it certainly wasn’t a cure. She currently manages her condition with a combination of anti-inflammatory medications, biologic injections, exercise, and sleep.
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Early and mild PsA is often treated with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. “For some patients, sporadic use of these medications is sufficient to control their symptoms,” Dr. Fors Nieves says. But in more severe cases, and in patients who are experiencing joint damage from the inflammation, stronger medications are often required.
“In the case of a patient who is having regular flares with attacks of swollen joints and severe stiffness, we may need to add immunomodulatory medication since PsA is an autoimmune condition,” says Dr. Fors Nieves. These might include conventional disease-modifying antirheumatic drugs (DMARDs), biologics, or enzyme inhibitors.
“Some patients may require multiple medicines to have their skin and joint disease under control,” Ronald Yglesias, MD, a rheumatologist in Aventura, Florida, tells SELF.
Lifestyle modifications can make a big difference.
Managing this condition isn’t just about taking medications—lifestyle changes can actually be life-changing for people with PsA. The key is listening to your body to get an idea of what it needs (or what it really needs a break from.) For instance, Wilson started to cut back on alcohol when she realized it was a major trigger for pain and stiffness the next morning.
Source: SELF
