Can Psoriatic Arthritis Be Prevented?

Psoriatic arthritis (PsA) is a type of inflammatory arthritis that affects the joints and entheses (the areas where tendons and ligaments meet bone) throughout the body. PsA affects about one-third of people with the autoimmune skin condition psoriasis. PsA might also affect the spine, leading to back and hip pain.  

There is no way to prevent PsA. There is also no way to know which people with psoriasis will go on to develop PsA. Both PsA and psoriasis occur because of genetics and environmental triggers, including joint and skin injuries, infection, and chronic stress.

While there is no current preventive strategy for PsA, getting a prompt diagnosis and effective treatment can reduce the frequency and severity of disease flare-ups (periods of high symptom activity) and prevent joint damage.

This article will cover information and research on PsA risk factors, preventing flare-ups, treatment, and when to see a healthcare provider.

Can You Prevent PsA?   

PsA is an autoimmune disease in which the immune system malfunctions and attacks healthy tissues. The immune system’s attacks in PsA focus on the joints, entheses, and skin cells. Autoimmune diseases are generally not preventable, although reducing risk factors like stress, smoking, and toxin exposure might help.

Experts do not know of any ways to prevent PsA. There are no treatments available for people with psoriasis that guarantee they will not develop PsA down the road. Because some people will have PsA and never have psoriasis, or they will develop PsA first, it is difficult to identify who might be at risk for PsA.

One 2019 medical review looked at the challenges healthcare providers experience trying to prevent PsA in people with psoriasis. The review’s authors noted the difficulty in identifying triggering events in people with psoriasis that might cause them to have PsA.

In time, there will be conclusive ways to prevent PsA. In the meantime, healthcare providers place their focus on managing symptoms and disease progression in people with psoriasis. They also advise people to speak up if they experience symptoms of PsA, including joint pain, morning stiffness, swollen fingers and toes, and low back pain.

How to Prevent PSA Flare-Ups

PsA is known for periods of flare-ups and remission. Flare-ups are periods in which symptoms of PsA get worse or new symptoms develop. Remission means PsA symptoms improve, and a person with the condition experiences few or no disease symptoms.

It is difficult to predict when a flare-up might occur. Even so, there are steps you can take to reduce the number of flare-ups you experience with PsA.

Exercise

Research on the benefits of exercise for people with PsA is clear. People with PsA who exercise regularly report less pain and fatigue, and overall better quality of life, according to a 2021 review in the journal Rheumatology.

The review looked at numerous studies and found that regular exercise in people with PsA reduced disease activity and comorbidities (coexisting conditions) and improved well-being. Side effects linked to exercise in people with PsA were minimal.

Exercise has additional benefits for people with PsA. It can help to improve muscle strength, flexibility, range of motion, fatigue, cognitive function, and the ability to participate in work and life.

If you are not someone who frequently exercises, you will want your healthcare provider's approval and advice on starting slowly. They might prescribe physical therapy. A physical therapist can assess you to determine what activities are safest for you based on your overall health and the effect PsA has had on your joints.

Understand Your Triggers

Any number of things can trigger a PsA flare-up. The immune systems of people with PsA can become active if they experience significant amounts of stress, an illness or injury, or if they smoke or are around second-hand smoke.

Once that happens, a few or many of their joints will become inflamed, stiff, and tender. You might also experience severe fatigue.

It is important for people with PsA to understand how everyday stressors can lead to a flare-up. Those triggers vary from person to person. For example, your PsA might flare up as soon as you change your diet or the weather changes. Someone else might experience a flare-up when they experience stressors at work or home.

You will want to learn to recognize your personal triggers as you work toward managing and preventing them and reducing their ability to cause a PsA flare-up. You will want to avoid flares because ongoing inflammation, over time, leads to joint damage and potential disability.

Talk to your healthcare provider if you find that avoiding triggers doesn't help reduce the number of flares you experience. Your provider can prescribe or adjust medications to potentially reduce flares.

You should always follow your healthcare provider's instructions about medications and lifestyle changes to get the most out of your treatment plan.

Use Heat and Cold Therapy

Heat and cold therapies can resolve pain and other joint symptoms. Both are generally safe, but you must be cautious when using these methods.

Heat therapy can help loosen stiff joints by increasing blood flow in and around joints and muscles. Less joint stiffness reduces pain and allows you to get around better. Options for heat therapy include heating pads, warm baths, and warm showers,

Cold therapy reduces blood flow to muscles and joints. That can reduce joint swelling and inflammation. Options for cold therapy include ice, gel ice packs, a frozen towel, or an ice massage using a frozen water bottle. Take care not to expose bare skin to ice.

Meal Planning

Since PsA is an anti-inflammatory condition, it is possible to prevent flare-ups by eating an anti-inflammatory diet. An anti-inflammatory diet emphasizes fruits, vegetables, lean proteins, whole grains, fatty fish, nuts, and plant-based fats.

You should also avoid foods considered pro-inflammatory, such as red meats, sugary desserts and drinks, alcohol, processed foods (i.e., hot dogs and bacon), junk foods, and refined carbs (such as white bread, pasta, and rice). For some people, dairy might be a flare trigger to be avoided and substituted for non-dairy options.

Stress Reduction

Stress is a common trigger of PsA flares. It can encourage the release of inflammatory chemicals that lead to more inflammation in the body and eventually a PsA flare.

While you cannot always avoid stress in your life, you can find ways to better manage it. Healthy ways to manage stress include:

• Eating healthy
• Exercising regularly
• Avoiding alcohol and tobacco
• Practicing relaxation techniques, including deep breathing, mediation, and yoga
• Eliminating life stressors, such as finding a job that is less stressful or removing yourself from stressful situations
• Learning to say no to activities that demand too much of your time and energy
• Setting realistic goals and expectations for yourself

Treatment

Lifestyle therapies like exercise and eating a healthy diet can help reduce flare-ups, but they may not always be enough. There is a wide range of medicines your healthcare provider can prescribe to manage PsA pain, stiffness, fatigue, and more.

Treatments for PsA include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation
• Corticosteroids for periods of flare-up
• Conventional disease-modifying antirheumatic drugs (DMARDs) like Trexall (methotrexate) to reduce inflammation, manage symptoms, and slow down disease progression
• Biologic DMARDs such as Enbrel (etanercept) to target specific parts of an overactive immune system
• Janus kinase (JAK) inhibitors such as Xeljanz (tofacitinib) for targeting specific inflammatory enzymes to taper down the immune system and stop joint damage
• Physical therapy to help you stay active and move safely
• Surgery to repair joint damage and get you moving safely and painlessly once more

If you experience skin symptoms with PsA, your healthcare provider might prescribe topical medicines, such as corticosteroid creams. These medications can reduce skin symptoms and treat itching and skin pain.

When to See a Healthcare Provider

If you have never been diagnosed with PsA and experience joint and other symptoms that last longer than a few weeks, you should reach out to your healthcare provider. You should also contact them if you have psoriasis and experience new or worsening arthritis symptoms.

If you already have been diagnosed with PsA, call your healthcare provider if your disease isn't responding to treatment or you develop new or worsening symptoms.

If you are experiencing a mild PsA flare, symptoms should subside in a day or two. However, contact your healthcare provider if your flare-ups last longer than a few days or a mild flare becomes severe. You can also reach out if you are unsure about symptoms or flare severity.

Your healthcare provider might be able to adjust your medications to help you get better faster. They will put you back on your regular treatment plan after the flare has passed. They might also prescribe an oral corticosteroid or give you a corticosteroid injection to help reduce inflammation quicker.

Summary

Psoriatic arthritis is a multifaceted condition. It can develop from factors including genetics, joint and skin injuries, chronic stress, or psoriasis. There is no way to prevent the condition. Even in people with psoriasis, experts are unsure about triggering events that might lead to the development of PsA.

Fortunately, PsA is treatable, and there are plenty of treatment options for the condition. You can also do a lot to reduce PsA flares, including managing triggers, watching your diet, exercising, and reducing stressors.

You should see your healthcare provider if you have psoriasis and experience arthritis symptoms. If you already have PsA, contact your healthcare provider for any new or severe symptoms or to manage an intense, long-lasting flare.

A Word From Verywell

PsA is a lifelong condition without a cure. Symptoms will come and go, and you will experience periods of flare-up and remission throughout your lifetime. But the outlook for PsA can be good, thanks to the many available treatment options.

You should follow your treatment plan exactly as your healthcare provider has prescribed to prevent flares and reduce the potential for disease complications like joint damage. Working with your healthcare provider is the best way to manage PsA and improve your outlook.