Many psoriatic arthritis (PsA) treatments are available to help control the disease. If any treatment stops working, it is important to speak with a doctor.
When treating PsA, a doctor will try to alleviate the person’s symptoms and prevent the progression of the disease.
Not all treatments work well for everyone, and an individual may need to try several combinations of therapies to find the one that works best.
This article explores how to recognize when PsA treatments are not working as expected.
A 2020 review of treatment guidelines and recommendations notes that treatment aims to improve a person’s quality of life, prevent structural damage, prevent complications, and achieve remission.
The Arthritis Foundation lists other goals, which include:
- stopping the disease from progressing
- relieving symptoms
- reducing inflammation
- relieving pain
- improving and maintaining joint function and mobility
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, treatment may provide little or no relief. In other cases, interventions that once worked well lose effectiveness over time.
The following are some 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 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.
PsA can progress and worsen 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.
A person can speak with a 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, which refers to an acute worsening of symptoms in the joints, on the skin, or both.
The Global Healthy Living Foundation states that several factors may trigger a PsA flare, including:
- missing or skipping medication dosages
- skin infection or injury
- a non-nutritious diet
A person needs to 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 reevaluation.
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 someone have a good quality of life, they can let their doctor know. A healthcare professional can adjust the treatment plan to control the disease more effectively.
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:
- gastrointestinal issues
- bruising and bleeding
- allergic reactions
- a heart attack or stroke
- kidney or liver issues
- interactions with other medications
The Arthritis Foundation reports 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.
A person can 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 effectively without causing adverse effects.
Return of once well-controlled symptoms
As PsA progresses, previously well-controlled symptoms may reappear, even though the person is following their treatment plan.
If this occurs, a person can speak with a doctor. A change in the approach to treatment can help restore control over the symptoms.
PsA is a progressive, inflammatory type of arthritis, affecting
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 relating 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 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 atypical cholesterol levels
Doctors develop treatment plans for people with PsA to help reduce the severity of symptoms, prevent the disease from worsening, decrease the risk of related health conditions, and improve quality of life.
If people find their treatment not working or becoming less effective, they can speak with a healthcare professional. A doctor can adjust or change a person’s treatment plan.
PsA treatment should help relieve symptoms, prevent the disease from progressing, and improve quality of life. The best approach varies from person to person and depends, in part, on the severity of the condition.
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 necessary over time.