An illustration of a person with psoriatic arthritis, as evident by pain spots/skin plaques on the arms and hands, sitting on a chair scratching at skin plaques.
Credit: Tatiana Ayazo

Tenderness in your joints, sausage-like swelling of your fingers and toes, and red, itchy, scaly patches on your skin. Those are just some psoriatic arthritis (PsA) symptoms, and if you have the condition, you know exactly how they feel. But what you may not realize is that some of the big and little things you do every day could be making your psoriatic arthritis symptoms worse.

These aren’t things you’re doing intentionally, of course; no one sets out to make their PsA symptoms worse. And still, there are some simple, daily actions that can have frustrating repercussions. Things as simple as what you eat breakfast or what time you go to bed could impact how your joints feel. Even the most seemingly inconsequential choices — like which knife you use to prep your vegetables — could put more stress on your joints and lead to more pain.

Some psoriatic arthritis triggers are more obvious than others; some are simply out of your control. But learning what might exacerbate your PsA symptoms is a key step in managing them. Because once you identify a trigger, you can make adjustments to your routine or take extra steps to help ease symptoms and protect your joints.

Letting your doctor know about worsening symptoms is also critical, says Nilanjana Bose, MD, MBA, a rheumatologist at the Rheumatology Center of Houston in Texas. They can help determine if the uptick is related to a trigger, a concurrent condition, or if you need a tweak in your lifestyle or treatment plan.

If you’ve been experiencing extra joint tenderness or itchier skin plaques, here are 11 things that could be making your psoriatic arthritis symptoms worse.

Trigger: You’re not exercising

Normally when you sustain an injury, you’re supposed to rest or you risk making things worse. But when your joint pain is due to psoriatic arthritis, it’s important to avoid inactivity. Lack of use leads to stiffness and muscle weakness, whereas regular exercise keeps your joints flexible and muscles strong. A 2021 research review published in the journal Clinical Rheumatology found exercise helped improved disease activity, muscle strength, and well-being, as well as helped reduce some cardiovascular risk factors in people with psoriatic arthritis.

And you don’t have to be dripping in sweat to reap the benefits. According to the American College of Rheumatology, walking is an easy, low-impact way to move your body without putting too much pressure on the joints. For extra protection, consider using a walking aid or shoe inserts to help avoid undue stress on feet, ankles, or knees affected by arthritis. Other good options include exercise bikes, swimming, and yoga.

Before starting any new exercise routines, you should talk to your doctor. They may recommend seeing a physical or occupational therapist who can help you find which types of activities are best for you, and at what level or pace you should do them.

Trigger: You eat too many sweets

Indulging your sweet tooth every so often is okay, but doing so on a daily basis could be worsening your PsA symptoms. Eating too many sugary treats can cause the body to release pro-inflammatory cytokines, Jen Bruning, MS, RD, registered dietitian nutritionist and spokesperson for the Academy of Nutrition & Dietetics previously told CreakyJoints. Since cytokine levels are already high when you have inflammatory arthritis, the extra cytokines only exacerbate the inflammation, which causes pain, swelling, and stiffness in your joints.

But sweet treats aren’t the only dietary culprits to be aware of. Processed meats and refined carbs, like white bread, pasta, and rice, are also known to increase inflammation.

Following an anti-inflammatory diet, which focuses on whole, plant-based foods, could help manage symptoms. Additionally, Dr. Bose says limiting inflammatory foods — like red meat and sugary treats — helps both with managing inflammation and reducing the risk of cardiovascular disease and other comorbidities that accompany PsA.

Trigger: You don’t eat enough fish

Fish like salmon, mackerel, and tuna are high in omega-3 fatty acids, and consuming those healthy fats was found to decrease disease activity, joint tenderness, and the use of over-the-counter pain relievers in people with psoriatic arthritis, according to a 2017 study published in the journal Scandinavian Journal of Rheumatology. But if you don’t have access to these fish (or just don’t like them), there are other foods that contain omega-3s, like walnuts, chia seeds, and flaxseed. Some brands of eggs, yogurt, or soy drinks are also fortified with omega-3s. Your doctor may also suggest an omega-3 supplements if it’s appropriate for you.

Trigger: You have high stress levels

Stress can trigger psoriatic arthritis flares, says Dr. Bose; those skin and joint exacerbations can, in turn, trigger more stress. Keeping calm is easier said than done, but there are some stress management methods that PsA patients and psychologists find helpful, including resting, exercising, and asking for help.

Of course, for some people, hearing that stress is a psoriatic arthritis trigger may lead to feelings of more stress, creating a vicious cycle. But for others, knowing about this link may provide the permission you need to prioritize self-care — however you practice it — as part of your disease management toolkit.

Trigger: Your BMI is higher than 25

Having a body mass index (BMI) that’s 25 or more puts you in the overweight/obese category. A study published in the Annals of Rheumatic Diseases found that psoriatic arthritis patients who were overweight (25 to 29.9 BMI) and obese (30 BMI or greater) were less likely to achieve “sustained minimal disease activity (MDA)” compared to those with a healthy BMI (18.5 to 24.9). Sustained MDA means having low disease activity — like less pain and swollen joints — for at least one year. Additionally, a 2020 review of research on obesity and psoriatic arthritis found the chronic, low-grade inflammation produced by fatty tissue in obese people may be, in part, responsible for an increase in symptoms, as well as a reduced response to therapy. For example, the review also found that having a BMI of 25 or more affects PsA patients’ response to treatments like disease-modifying antirheumatic drugs (DMARDs) and tumor necrosis factor inhibitors (TNFi) biologics compared to people with BMIs in the healthy range.

Fortunately, losing even a little weight can help relieve the obesity-related symptoms. In one study of PsA patients being treated with tumor necrosis factor inhibitor (TNF) biologics, those who lost at least 5 percent of their total body weight showed more of a response to treatment than those who did not lose weight. One of the best ways to drop extra pounds is to follow a low-calorie diet and exercise regularly, according to a research review conducted by the medical board of the National Psoriasis Foundation.

Trigger: You don’t use assistive devices for daily activities

Changing the way you do your daily tasks can make a huge difference in how you feel. That’s where assistive devices come into play, making it easier for people with PsA to get dressed, clean, and cook. Investing in items like jar openers, adaptive cutlery, long-handled tools, and even shoe inserts can all help protect your joints, reduce pain, and make your life a little easier. But you don’t necessarily have to buy new gadgets to reap some of these benefits. There are many everyday items you likely have lying around your house that can help lessen stress on joints and ease arthritis symptoms. Think tennis balls, socks, ribbons, and more. Check out more of these surprising assistive devices.

Trigger: You skip your meds

“If your disease is well-controlled, and you miss only a dose of a long-acting medication, like methotrexate (a common disease-modifying antirheumatic drug), you may be okay,” Dr. Bose says. But if you have ongoing symptoms or an aggressive disease course, missing doses may lead to an increased risk of worsening symptoms or disease activity. A 2018 study published in the Journal of Rheumatology found that 73 percent of psoriatic arthritis patients who stopped their biologic medication after disease activity decreased experienced a recurrence in symptoms. If your treatment isn’t working for you or you have a hard time sticking to your regimen, talk to your rheumatologist about other options and ideas to help you stay on track. And to help avoid forgetting a dose, set a reminder on your smartphone or link taking your meds to part of your daily or weekly routine, like brushing your teeth or doing the laundry.

Trigger: You scratch your skin plaques

Psoriasis — a chronic skin disease that causes red, itchy, scaly skin patches called plaques — is associated with psoriatic arthritis. As tempting as it may be, scratching or picking at those scales can traumatize or injure the skin, which can result is a psoriatic flare. Try applying a cool compress to relieve the itch or gently moisturize your skin. Not only will that help quell the urge to scratch, but any kind of moisturizer will change the reflective properties of the scale so it’s harder to see, according to experts at the American Academy of Dermatology. Talk to your dermatologist about topical therapies and the best ways to manage psoriasis plaques, as good control of skin symptoms is key to managing psoriatic arthritis, says Dr. Bose.

Trigger: You have another chronic condition

When you have another disease on top of your psoriatic arthritis, it can impact symptoms, flares, and disease course, says Dr. Bose. According to a 2020 review of research, the list of reported comorbidities with psoriatic arthritis is long. It includes cardiovascular disease, metabolic syndrome, obesity, type 2 diabetes, high cholesterol, inflammatory bowel disease, fatty liver disease, uveitis, kidney disease, infections, osteoporosis, depression, central sensitization syndrome, and gout. Keep your rheumatologist up to date on all your medical issues, so they can determine a treatment plan that is individualized for you.

Trigger: You smoke

You’ve no doubt heard all the reasons you should kick this habit, but in case you need a refresher: Smoking is bad for your heart and lungs, increases your risk of cancer, and decreases immune function. It also affects your bones, eyes, and teeth. Smokers are also more likely to develop psoriasis and experience more severe symptoms, according to the Mayo Clinic. And a 2019 study in the journal Expert Review of Clinical Immunology found smoking may be linked to poor response and treatment adherence in people with psoriasis and psoriatic arthritis. Talk to your doctor about strategies for quitting and staying smoke-free.

In addition to quitting smoking, it’s a good idea to limit your alcohol intake. Alcohol can increase your risk of psoriasis, decrease the effectiveness of your treatment, and increase side effects from some medications, such as methotrexate, according to the Mayo Clinic.

Trigger: You aren’t getting enough sleep

Research has shown many people with psoriatic arthritis have trouble sleeping. A 2019 study published in the journal Dermatology and Therapy found that psoriatic arthritis is linked to difficulty sleeping and getting fewer hours of sleep. Other research has shown people with psoriatic arthritis have a higher-than-average risk of experiencing sleep apnea and restless leg syndrome — two conditions that impact the quality and quantity of sleep.

Lack of sleep not only leaves you feeling more fatigued and stressed, but over time, it can increase inflammation and pain, impact your mood, and decrease your overall quality of life. Talk to your doctor about your sleep issues; they can help evaluate your habits, assess potential sleep disorders, and provide tips to help you get a better night’s sleep with psoriatic arthritis.

What to Do if Your Psoriatic Arthritis Symptoms Are Getting Worse

Tell your doctor immediately about any worsening symptoms. They can assess the situation and determine if your treatment plan needs to be adjusted. You may need additional medication, a change in medication dose, or consider switching medications if your regimen is no longer controlling your symptoms well enough.

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Interview with Nilanjana Bose, MD, MBA, rheumatologist at the Rheumatology Center of Houston in Texas

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