6 Signs Your Psoriatic Arthritis Treatment Isn't Working

How to tell when psoriatic arthritis is out of control.

Medically reviewed in November 2021

Living with an illness that has no cure can take a toll on both your body and spirit. But just because psoriatic arthritis (PsA) doesn't have a cure, it doesn't mean you can't enjoy your life while slowing the damage on your joints. Experts agree that the best way to get relief from PsA is with the right treatment. So if PsA is still weighing you down, maybe your treatment isn't working as well as it could.

"Ideally, the goal is to get every patient symptom free," says Arthur Kavanaugh, MD, professor of medicine and director of the Center for Innovative Therapy (CIT) at UC San Diego Rheumatology, Allergy & Immunology. "Medications act at different speeds. But usually by 6 months, treatments have done what they're going to do, and if the result isn't good enough, it could be time to move on."

So after 6 months of medication, the following health issues may be warning signs that your treatment isn't as effective as it could be:

  • Exhaustion: Fatigue is a lesser known but important symptom of PsA that makes living with the disease even more difficult. Some medication may cause fatigue, like methotrexate. But usually, your meds should give you more energy to live your life to the fullest.
  • Depression: It's easy to feel a sense of hopelessness if your treatment isn't working. Physical pain often translates into emotional pain for people with PsA.
  • Psoriasis flare-ups: Even if your joints are feeling better, clearing up your skin should still be a treatment goal.
  • Nagging joint pain: Your current treatment may focus on only one set of joints, such as an injected steroid treatment for hip or shoulder joints. But the rest of your body deserves relief, too.
  • Inflammation: Certain blood tests can show inflammation in your body, such as erythrocyte sedimentation rate or C-reactive protein tests. Dr. Kavanaugh says these tests can be helpful in some—but not all—people with PsA, depending on their signs and symptoms.
  • Feeling about the same—or worse: This one is simple—if you don't feel better, something has to change.

Remember, doctors can't read your mind. They only know about the symptoms and side effects you're having if you tell them. "Many side effects, thankfully, are not common, but they can still be scary," Dr. Kavanaugh says. He advises his patients to weigh the risk of side effects against the dangers of letting PsA run wild, including permanent joint damage and a poor quality of life. And don't worry about sounding whiny or weak, either. Rheumatologists are eager to hear about your symptoms, Kavanaugh says.

Tell your doctor the improvements you want to see when planning a new treatment regimen. You can then work together to find the right medication and lifestyle changes that get you to those goals.

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