Signs psoriatic arthritis treatment isn’t working: What to know

PsA is a progressive, inflammatory type of arthritis. The Arthritis Foundation say that up to about 30% of people with psoriasis develop PsA. A 2019 review of studies, however, reports this prevalence to be about 20%.

Common symptoms of PsA include:

• pain, tenderness, warmth, and swelling in the fingers, wrists, ankles, knees, and toes
• inflammation and swelling where tendons and ligaments meet bones, particularly in the feet, especially in the heels
• an overwhelming sense of fatigue
• itchy, scaly patches of skin, often on major joints such as the elbows
• pitting and cracking of the nails, which may lift away from the nail beds

If a person with PsA does not receive treatment, the symptoms can worsen and the underlying inflammation may damage the body over time. Some health issues related to untreated or not well-controlled PsA include:

• damage to joints, bones, and cartilage
• weakened bones that may break more easily
• eye issues, ranging from redness and irritation to vision loss
• gastrointestinal (GI) issues, such as diarrhea and bloating
• lung problems, such as shortness of breath and coughing
• damage to blood vessels and the heart
• metabolic syndrome, which includes hypertension, elevated blood glucose levels, excess body fat at the waist, and abnormal cholesterol levels

Doctors develop treatment plans for people with PsA to help reduce the severity of symptoms, prevent the disease from getting worse, decrease the risk of related health conditions, and improve the quality of life.

A 2020 review of treatment guidelines and recommendations notes that there are many goals of PsA treatment, including:

• relieving symptoms
• improving joint function and mobility
• preventing joint damage
• reducing the risk of related health issues
• improving the quality of life
• achieving remission

A variety of medications and therapies can help achieve these goals, such as:

• nonsteroidal anti-inflammatory drugs (NSAIDs)
• corticosteroid injections
• disease-modifying antirheumatic drugs (DMARDs)
• biologic drugs

The most effective treatment plan varies from person to person, and not all PsA therapies and medications work well for everyone. It may take some trial and error before a doctor finds the right treatment or combination of treatments.

In some cases, a treatment may provide little or no relief. In other cases, treatments that once worked well lose their effectiveness over time.

The following are some common signs that a PsA treatment is not working and that the treatment plan may need adjusting.

New or worsening symptoms

The American College of Rheumatology note that people with more mild forms of PsA may only need to take NSAIDs, such as ibuprofen (Advil) or naproxen (Aleve), to treat occasional pain and swelling.

Others with more advanced forms of the disease usually need disease-modifying therapies to help prevent PsA progression.

For many people, PsA progresses, getting worse over time. If a person does not receive treatment, the disease can lead to permanent joint damage, and possibly disability. In these cases, the initial PsA treatment may become less effective, or new symptoms may emerge.

Speak with the doctor about any new or worsening symptoms. These may indicate that it is time to change treatments.

An increase in the length or frequency of flares

A person with PsA may experience a flare — an acute worsening of symptoms in the joints, on the skin, or both.

The advocacy group Global Healthy Living Foundation note that several factors may trigger a PsA flare, including:

• missing or skipping medication dosages
• stress
• skin infection or injury
• illness
• poor diet
• smoking

Let the doctor know about any flares that are longer, more frequent, or worse than usual. These can be signs that the PsA treatment plan needs to be reevaluated.

Symptoms that affect the quality of life

A major goal of PsA treatment is to improve the person’s quality of life. Medications and other therapies can help achieve this by preventing joint damage, reducing pain and swelling, and increasing joint mobility.

In this way, the right treatment plan can also help support the person’s emotional well-being.

If PsA treatments are no longer helping a person have a good quality of life, they should let their doctor know. The doctor can adjust the treatment plan so that it more effectively controls the disease.

Side effects of treatments

Every medication for PsA can cause side effects, especially at high doses or over long periods. For example, NSAIDs can cause:

• GI issues
• bruising and bleeding
• allergic reactions
• a heart attack or stroke
• kidney or liver issues
• interactions with other medications

The Arthritis Foundation report that oral corticosteroids can cause side effects such as weakened bones, weight gain, bruising, and swelling in the face.

DMARDs and biologic drugs may make a person more susceptible to infection.

Let the doctor know about any side effects of PsA medications or therapies. Adjusting the dosage or switching to another medication may control the disease as effectively without causing adverse effects.

The return of once well-controlled symptoms

As PsA progresses, once well-controlled symptoms may reappear, even though the person is following their treatment plan.

If this occurs, speak with the doctor. A change in the approach to treatment can help restore control over the symptoms.

PsA treatment should help relieve symptoms, prevent the disease from progressing, and improve the quality of life. The best approach varies from person to person and depends, in part, on the severity of the condition.

In order to have the best possible control over their PsA symptoms, a person needs to work with their doctor, who will update the treatment plan as needed over time.

Read this article in Spanish.