Managing Joint and Skin Pain with Psoriatic Arthritis

Living with skin itch and joint pain can be challenging. Certain strategies, from diet and exercise to treatment, can help you find relief from both psoriasis and psoriatic arthritis symptoms.

Psoriatic arthritis is an inflammatory condition that affects about one-third of people with psoriasis. Psoriatic arthritis and psoriasis are sometimes known together as psoriatic disease. The symptoms of both conditions are caused by inflammation.

Both psoriasis and psoriatic arthritis are autoimmune conditions. This means that the immune system accidentally attacks otherwise healthy parts of the body. Psoriasis attacks skin cells. Psoriatic arthritis attacks the joints.

Taking steps to manage one condition often also helps improve the other. Several medications are available to treat both psoriasis and psoriatic arthritis. Certain lifestyle strategies may also provide relief from the pain and discomfort of skin and joint symptoms.

Here are some ways to manage both skin and joint symptoms of psoriasis and psoriatic arthritis.

When you have psoriasis and psoriatic arthritis, exercising regularly comes with a host of health benefits. A systematic review of people with psoriatic arthritis showed improved pain and fatigue as well as higher quality of life scores in those who were more active compared to those who were more sedentary.

Several studies have also shown higher rates of depression and anxiety in people with psoriasis. Exercise is a useful tool to help improve mental health.

Low impact exercises are gentle on your joints. You can try incorporating aquatic exercise, yoga, walking, or biking into your workout routine.

Many people choose to work with a physical therapist to establish an individualized exercise plan.

If you’ve noticed that stress worsens skin and joint symptoms, you’re not alone. Up to 88% of people with psoriasis feel that stress can trigger a flare. It’s thought that stress increases inflammatory proteins in the body, which can worsen symptoms.

Of course, living with psoriasis and psoriatic arthritis can also add to your stress.

It’s not possible to eliminate all sources of stress, but there are ways to better cope. Start with these stress management techniques:

• practicing mindfulness strategies
• staying connected with friends
• joining a support group
• working with a therapist
• exercising regularly
• spending more time outdoors
• journaling your thoughts and feelings

Research suggests that a Mediterranean diet is associated with an improvement in psoriasis symptoms.

A Mediterranean diet consists of:

• fruits and vegetables
• whole grains
• fish and seafood
• beans and lentils
• nuts and seeds
• olive oil
• some poultry, eggs, and dairy products

A Mediterranean eating pattern is higher in omega-3s compared to a typical Western diet. Omega-3 fatty acids are a type of oil found in fatty fish, seafood, nuts, seeds, and some plant oils. They’re shown to have anti-inflammatory properties.

One 2017 study showed that omega-3 supplements helped to reduce the levels of inflammatory chemicals in people with psoriatic arthritis. In the same study, people who took omega-3 supplements used fewer pain medications compared to the control group.

A warm, relaxing bath can ease joint pain. Just follow these guidelines to prevent irritating your skin in the process:

• Avoid hot water, which can worsen psoriasis.
• Choose fragrance-free, moisturizing soaps designed for sensitive skin.
• Gently cleanse your skin without scrubbing.
• Limit tub time to 15 minutes or less.
• Pat your skin dry instead of rubbing it.
• Moisturize while your skin is still damp.

When you have psoriatic disease, following your prescribed treatment plan is one of the best, most effective ways to manage both skin and joint symptoms. Certain medications may even be used to treat both conditions at once.

For milder psoriatic disease, your doctor may recommend simply treating the symptoms. For example, topical therapies can be used to treat mild psoriasis. Nonsteroid anti-inflammatory drugs (NSAIDs) may be recommended to help with psoriatic arthritis joint pain.

If these medications aren’t enough to help you manage, your doctor may recommend a treatment that addresses the underlying inflammation in the body contributing to skin and joint symptoms.

Traditional disease-modifying antirheumatic drugs (DMARDs)

Disease-modifying antirheumatic drugs (DMARDs) are a class of medications used for psoriatic disease. These medications help slow or stop underlying inflammation on a broad level. This helps alleviate skin and joint symptoms.

DMARDs used for both psoriasis and psoriatic arthritis include:

• methotrexate
• leflunomide (Arava)
• sulfasalazine (Azulfidine)

Biologics

Biologics are another class of medication used to treat various inflammatory conditions. Like DMARDs, biologics reduce inflammation in the body to slow or stop damage to your skin and joints. They just work in a more targeted way to suppress specific immune proteins that are causing symptoms.

Biologics approved by the Food and Drug Administration (FDA) for the treatment of both psoriasis and psoriatic arthritis include:

• adalimumab (Humira)
• certolizumab pegol (Cimzia)
• etanercept (Enbrel)
• guselkumab (Tremfya)
• infliximab (Remicade)
• ixekizumab (Taltz)
• secukinumab (Cosentyx)
• ustekinumab (Stelara)

You can talk with your healthcare professional about whether a biologic is a good option for you.

Janus kinase (JAK) inhibitors

Janus kinase (JAK) inhibitors are another treatment option for suppressing underlying immune system activity in psoriatic disease. They work in an even more targeted way than biologics. These are small-molecule drugs that interfere with a specific pathway involved in psoriatic disease-related inflammation.

Two JAK inhibitors have been approved for treating psoriatic arthritis:

• tofacitinib (Xeljanz)
• upadacitinib (Rinvoq)

Only one JAK inhibitor, known as deucravacitinib (Sotyktu) is approved for treating psoriasis.

It’s thought that taking a JAK inhibitor approved for either type of psoriatic disease may help improve both skin and joint symptoms. However, a JAK inhibitor can currently only be prescribed if you’ve already tried a traditional DMARD and either haven’t experienced improvements or cannot tolerate the drug.

Regular follow-up with your healthcare team is important. You may work with several different healthcare professionals, including:

• a rheumatologist, who specializes in arthritis and inflammatory conditions
• a dermatologist, who specializes in skin care
• your primary care doctor, who deals with your overall health

Your healthcare team may already communicate well with each other. If not, you may need to keep everyone updated on changes in your health status and treatment regimen.

If you’re not happy with how well your current treatment is working, let your healthcare team know. They may recommend switching to a new treatment.

Before you start a new medication, it’s helpful to ask some questions, such as:

• How long does the treatment take to start working?
• What side effects should I watch for?
• How do I know if the treatment is working?
• How do I know if it’s time to switch to something new?

Many people with psoriasis also have psoriatic arthritis. It can be hard to deal with both skin and joint symptoms. However, many strategies can help, from staying active to making dietary changes and managing stress.

Several medications are also available to treat both conditions. Keep in touch with your healthcare professional if you notice any changes in your symptoms. Switching to a new treatment may help you find relief.

Last medically reviewed on March 10, 2023