From healthcentral.com
Warning signs like joint pain, stiffness, and fatigue may mean you need a change of medication or other therapies
Treatments for psoriatic arthritis (PsA) are better than ever today, thanks to targeted drug therapies and a new understanding of this chronic inflammatory condition. But if you’re noticing more joint pain, stiffness, swelling, or other symptoms like severe fatigue or swollen fingers or toes, this could be a sign that your current treatment plan isn’t working as well as it should.
PsA is an immune-mediated disease, where your immune system overacts and mistakenly attacks healthy tissue—in this case, the joints and entheses (areas where tendons and ligaments connect to the bone). Most people who develop PsA also have a history of psoriasis, which causes skin rashes with itchy, scaly patches, although arthritis symptoms can appear before the skin symptoms.
While there’s still no cure for PsA, doctors rely on an array of medications, as well as exercise and physical therapy, to slow progression of the disease and help prevent permanent joint damage. These treatments aim to relieve pain, increase mobility, and reduce inflammation.
But PsA is complicated and there may be times when your treatment plan needs to be tweaked. “PsA is a chronic and evolving condition, which means that over time, inflammation can spread to new joints or areas of the body, requiring adjustments to treatment,” says Paras Karmacharya, M.D., an assistant professor of medicine and the director of the Vanderbilt Psoriatic Arthritis and Spondyloarthritis Centre at Vanderbilt University Medical Centre, in Nashville, TN.
Learning how to tell if your treatment isn’t working properly so you and your doctor can make the necessary adjustments is crucial to preventing the disease from progressing. Consider the following warning signs, as well as what you can do when symptoms appear to be getting worse.
You're Taking More Pain Medication
If you find yourself needing more pain medication such as nonsteroidal anti-inflammatory drugs (NSAIDs) more often, it may be a sign that your PsA is not as well-controlled as it should be, says Katherine Terracina, M.D., an assistant professor in the division of rheumatology at UT Health Houston, TX.
In some cases, an increase in medication use can happen so gradually that you may not even realize it. “I’ve asked patients [during a checkup] questions like, ‘How often are you needing additional pain medicine?’ and ‘Is that normal for you? How many NSAIDs do you normally take in a month?’ and that's actually what triggered them to realize that they have been in more pain,” says Dr. Terracina.
Your Symptoms Are Persistent or Getting Worse
In addition to increasing pain, other signs that your PsA treatment may not be working can include the following, says Dr. Karmacharya:
Difficulty performing daily activities, such as holding a coffee cup
Increased frequency or severity of flares
Joint pain and stiffness that last longer and happen more frequently than normal
New symptoms, such as psoriasis or joint pain, that crop up in previously unaffected areas of your body
Persistent skin psoriasis
Recurrence of symptoms that were previously controlled
Severe fatigue
Sometimes, it’s hard to tell whether your symptoms are due to a worsening of the underlying disease or a temporary flare, adds Dr. Karmacharya. “If it’s a flare triggered by physical or mental stress, a missed dose of medication, or another temporary factor, we can often manage it with short-term therapy like NSAIDs, low-dose corticosteroids, corticosteroid joint injections, or topicals for psoriasis,” he says. But if these flares become frequent, it may be a sign your current treatment plan is not working. “That’s when we consider increasing the dose, adding additional therapy, or switching medications.”
Your Quality of Life Is Reduced
If you are making decisions about your day-to-day routine based on your symptoms, this could be an indication that your PsA treatments aren’t working as well as they once did. That might mean avoiding going to the beach because you have psoriasis flares and don’t want to show your skin, or skipping the gym because you’re having joint pain. “Avoiding life and things that you normally would do is sometimes a clear sign that worsening symptoms may be more than just the normal, minor flare up,” says Dr. Terracina.
Why Psoriatic Arthritis Treatment May Stop Working
There are several reasons why your psoriatic arthritis treatments may no longer be working as well as they once did.
Medication Tolerance or Resistance
“Some people may develop a reduced response to their treatment over time, especially with biologics,” says Dr. Karmacharya. “The immune system can sometimes produce antibodies against these medications, making them less effective.” Adding an additional therapy such as a disease-modifying antirheumatic drugs (DMARD), targeted synthetic drugs, or another biologic, or switching to a different medication may help, he says.
Inadequate Dosage
Symptoms may persist because the current dose isn’t strong enough to control inflammation, and an increase or combination therapy may be needed, says Dr. Karmacharya.
If your doctor suspects this may be the problem, they may first suggest increasing the dosage of your current medication, he says.
Missing Doses or Not Taking Medication
“In some cases, you may not take your medication because you don't like how it makes you feel,” says Dr. Terracina. But skipping your meds or not taking them as directed can allow inflammation to return or worsen. Your doctor can help you find a solution, she adds, by reducing the dose and adding another medication, or switching to a different drug altogether.
Disease Progression
“Sometimes, despite compliance, despite no other changes, there comes a point where medications stop working,” says Dr. Terracina. That may require you to try a different medication or increase the dosage of your current treatment.
Other Health Conditions
“Stress, infections, hormonal changes, or lifestyle factors like poor sleep or diet can contribute to worsening symptoms, even if the medication itself is still effective,” says Dr. Karmacharya. And related conditions such as obesity, metabolic syndrome, or inflammatory bowel disease can also affect how your PsA treatment responds, and may require additional treatment. “Addressing these factors may improve symptom control,” he adds.
When to Call Your Doctor
Call your doctor as early as possible about any significant changes, says Dr. Karmacharya. “If symptoms are more severe—such as persistent swelling, increasing pain, significant fatigue, or difficulty with daily activities—I would recommend letting your rheumatologist know as soon as possible,” he says. “The earlier we address uncontrolled inflammation, the better the long-term outcomes in preventing joint damage and maintaining quality of life.” Together, you can figure out what may be causing the problem and find a new treatment plan, whether that involves an adjustment in dose, switching to a different medication, or other measures, he adds.
And be honest and detailed about what you’re experiencing. “In many cases, patients don't want to feel like they’re letting their doctor down,” says Dr. Terracina. You may not tell your doctor that you aren’t taking your medication due to its side effects, for instance, but that’s crucial information. “There are so many medicines out there, we can easily just find a different regimen for you,” she says.
Ultimately, says Dr. Karmacharya, the goal is to regain control over inflammation while maximizing the effectiveness of treatment before making unnecessary switches. “Regular follow-ups and open communication with your rheumatologist are key to long-term disease management.”
Bottom Line
Medications and lifestyle modifications can help slow the progression of psoriatic arthritis, preserve mobility, and help prevent permanent joint damage. They can also reduce inflammation, which reduces your risk of developing related health conditions such as cardiovascular disease, obesity, and depression.
Yet while psoriatic arthritis treatments are often effective, they can sometimes not work as well as they should, or they can stop working due to a variety of factors, including a build-up of medication resistance or worsening of disease. By working closely with your doctor, you can find ways to modify your treatment plan to add or switch medications and make other changes to help you feel better.
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