Psoriatic arthritis (PsA) affects nearly 30 percent of people living with psoriasis, a chronic condition that causes inflammation in the body. While there’s no cure, there are safe and effective treatments to help reduce the pain, inflammation, and joint damage of PsA and improve your overall health — but only if you get proper medical care.
As with any rheumatic condition, the earlier a patient with PsA gets an accurate diagnosis and begins treatment, the better. “Psoriatic arthritis can cause damage to joints through erosions of the bone. There are a number of other issues that can arise, such as an eye condition called uveitis, sausage-like swelling of the fingers or toes, and a lot of significant deformities that impair quality of life. These won’t happen in every case, but it’s important to treat early to try to prevent that in cases where it may happen,” says Jason Liebowitz, MD, a rheumatologist in Rockaway, New Jersey.
But often patients are hesitant about asking for medical help or don’t feel comfortable telling their doctor about their symptoms, leading to delays. A Scandinavian study published in the Journal of the European Academy of Dermatology and Venereology found that more than a third of respondents with severe PsA symptoms had never discussed systemic treatments with a physician. (Systemic treatments are those that affect the entire body, such as oral medication and injections.)
If you have PsA, it’s important to find the right doctors. Here’s how to gather the team that’s best for you.
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Start With a Psoriatic Arthritis Specialist
Managing the complex symptoms of PsA requires a multidisciplinary approach to treatment, beginning with a rheumatologist, a specialist who treats arthritis and related diseases.
To diagnose PsA, a rheumatologist will do a physical exam, discuss your family history, run laboratory tests, and order any other necessary scans or X-rays. With this information, the doctor can prescribe an effective treatment plan.
When deciding on a rheumatologist, make sure to choose one that you feel comfortable with. Do you prefer a male or female physician? Young, middle-aged, or older? Does the physician conduct clinical research and have access to the latest treatments? You also want to make sure that the office hours and location are convenient for you.
Be Open and Honest About Your Symptoms
Have a consultation with a potential rheumatologist before making a commitment. You want to be sure that the doctor is easy to communicate with and has a good bedside manner.
Be open and honest about your symptoms: Describe them clearly and let your doctor know how long you’ve had them. Tell the doctor if a parent or sibling has PsA, as there may be a genetic component. If you’ve already tried psoriatic arthritis treatment, such as NSAIDs (nonsteroidal anti-inflammatory drugs) or biologics, tell your doctor what worked and what didn’t. You and your physician need to communicate clearly and be on the same page.
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Watch for This Red Flag
A rheumatologist may not be right for you if it seems like they’re talking more than you are during the visit. There should be explicit discussion and recognition of the points that a patient brings up. Maybe all the doctor can say in response is something like: “I’m hearing what you’re saying in terms of the symptoms. I don’t yet know the best way to treat it, but I want you to know I’m keeping in mind that that’s important to you.” Dr. Liebowitz says it’s important that doctors “express empathy and understanding by letting the patient know that they’re hearing them and not just dismissing their concerns.”
Other Specialists You May Need
Along with a psoriatic arthritis doctor, you may need to consult with a dermatologist to address skin and nail issues.
Other specialists on your healthcare team may include:
- A dietitian to teach you about anti-inflammatory foods and weight management
- An occupational therapist to teach you hand stretches and exercises and ways to make daily activities easier
- A pharmacist to monitor your medications and answer any questions you may have
- A physical therapist to teach you joint exercises to help ease pain and stiffness
Your primary care physician (PCP) will play a key role in managing your medical team and helping you stay well in the midst of treatment.
What if You’re Not Satisfied With Your Results?
A patient’s dissatisfaction with their doctor can have consequences for their health. According to research published in Clinical Rheumatology, about a quarter of patients with psoriatic arthritis disagreed with their rheumatologists when describing how satisfied they are with their PsA control. The repercussions for patients with PsA are quite serious: The researchers found an association between doctor-patient “misalignment” and increased disease activity and disability.
If you’re not seeing results after a few months, Liebowitz notes that you and your doctor can take some further steps. “It is important for the rheumatologist to keep reevaluating the situation if it’s not going as planned,” he says. “Unfortunately, we’re still in the era of trial and error, where we don’t know which medicines will definitely help which patient. It’s usually not incompetence, but just the matter of finding the right medicine. And that may take a little bit of time and patience. You don’t necessarily need to find a new doctor, but you just need to be on the same page with where to go next.”
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Communication Is Key to Healthy Outcomes
It’s important for patients to share their concerns and for doctors to ask patients what they hope to get out of treatment for their disease. It’s also important for doctors to communicate whether those expectations are realistic and what can actually be achieved.
“Patients need to be their own advocates and be clear about what their goals are. Doctors and patients need to keep asking questions of each other. We are learning more every day, so it’s always good to reevaluate and see if there are other things to think about from a different perspective,” says Liebowitz.
