PsA – Lesson 5 – Self-care and psoriatic arthritis

• It is important for patients with PsA not to blame themselves if a medication or non-medication treatment doesn’t work. There are a number of things about your disease that you can and cannot control, such as which joints the disease will affect, how severe your disease may be at the time of diagnosis, whether you will have PsA complications, among others.

• However, you do control whether you follow the treatments as prescribed
  and other aspects of your treatment plan that you develop with your rheumatologist. Recognizing what things in your treatment plan and life that you have control over will give you focus and motivate you to follow through on the things you list in your plan. Patients with PsA who follow or “adhere” do better short- and long- term.

• Key aspects of your self-care plan are:

  • Ongoing disease education

  • Developing and following healthy lifestyle practices – Prescription exercise, physical activity and sport for pleasure

  • Self-directed, at-home treatments

  • Health journaling

  • Healthy communication

  • Taking appropriate precautions to protect your joints and skin

• Research has proved that exercise is a vitally important part of your self-care plan. When done safely, even high-intensity exercise is good for patients with PsA.

• The self-care aspects of your overall treatment plan might include things
  to improve your strength, mobility, and/or flexibility. Exercise is proved to help improve your PsA pain and overall well-being, even if you are currently experiencing pain and fatigue.

• There are three general types of PsA exercise you can consider including in your treatment plan:

  • Range-of-motion exercises: Joints are moved through as full range of motion as possible to help patients with PsA and keep them from losing mobility in affected joints. Range of motion exercises keep your joints moving and reduce pain. It is recommended that these exercises be done daily.

  • Strengthening exercises: These help patients with PsA to gain muscle mass and increase muscle strength. Strong muscles can help to protect joints.

  • Aerobic exercises: Aerobic exercises include activities like walking, swimming and cycling. These help patients with PsA improve heart and lung function, improve strength, reduce inflammation and pain, and help with self-esteem and self-confidence.

• Ongoing disease education helps a patient with PsA feel “on top of” their disease and helps to grow their “expertise” leading to greater empowerment and overall feeling of life control. Seeking out evidence-based web sites and resource materials is important to your life-long learning journey.

• Developing healthy lifestyle habits, such as getting appropriate amounts of sleep and rest, taking vitamins and minerals as discussed with your rheumatologist, following a balanced daily diet, quitting smoking if you do smoke, and minimal to moderate alcohol intake, among other self-managed behaviours.

• Your daily diet should include appropriate levels of calcium, vitamin D and folic acid – folic acid, in particular, can be effective at managing methotrexate side effects, typically nausea and mouth sores. Speaking to a dietician with knowledge about the dietary needs of people with PsA is also very helpful. Some dietician services are provided for free. Ask your rheumatologist’s office staff if they can recommend one.

• A balanced diet and exercise are particularly important when it comes to weight management and PsA. If you are overweight, losing weight may help reduce the severity of arthritis as well as psoriasis. Being overweight puts an extra burden on weight-bearing joints such as the ankles, knees, feet and hips.

• Managing your stress levels, getting enough rest, and relaxation lead to a higher quality of life with PsA, as high levels of stress can make disease activity worse.

• There are a number of “at home” treatments available to you to manage the day-to-day symptoms you may have to deal with before your treatment plan begins to work at full steam.

• Ice and heat are your friends, especially in your early days of the disease:

  • Ice applied to hot and swollen joints feels good and helps to temporarily reduce inflammation, helping you better recover from exercise sessions. It is important to have a protective barrier between the ice and the skin (i.e., paper towel, or thin cloth).

  • Apply moist hot towels, or heat packs to non-inflamed, stiff joints to get ready for activities or exercise.

  • Hot and cold baths also help relieve symptoms of joint stiffness and pain.

• In some cases, managing skin symptoms of psoriasis can help manage the arthritis symptoms of PsA:

  • To treat and protect your skin, you can use a humidifier in your home to prevent dryness.

  • Unscented lotions and creams can protect and soothe your skin. Avoid any strong perfumes or dyes in skin lotion, as these can aggravate psoriasis.

  • In some cases, moderate exposure to sunlight can reduce symptoms of psoriasis by slowing cell growth, but it is always important to take steps to avoid sunburn as too much sunlight can damage the skin. It is also important to note that some types of psoriasis can be worsened by sun exposure. Speak to your doctor to determine what is best for your disease.

• Physiotherapy and occupational therapy are helpful and can typically be arranged through your rheumatologist’s office. If your government or private health care plan does not provide coverage for these services, ask your rheumatologist what types of things they might do for you, such as joint protection techniques, stretching or strengthening, that you might be able to safely do on your own.

• A recent global study of PsA patients found that 3 in 5 patients with PsA have experienced emotional distress as a result of PsA.

• Other research has found that in individuals with arthritis, mental health issues interact with other health conditions and symptoms of arthritis (i.e. pain, fatigue, disability) such that a decline in one area can directly or indirectly affect the others. For example, pain may feel more severe when an individual is experiencing emotional distress, or vice versa, making it even more important to properly treat mental health symptoms.

• There are many self-care strategies shown to improve mental health that you may find useful:

  • Express your emotions in a way that feels safe such as talking to others, artwork or journaling.

  • When possible, exercise and eat healthy.

  • Try to have a regular sleep schedule with about 8 hours of sleep a night

  • Consider exploring new hobbies or passions to replace activities you may have lost.

  • Take time for yourself, to do things you enjoy, this could even be reading or taking a long bath.

  • Try daily breathing exercises, meditation or mindfulness. Mindfulness can be practiced by paying close attention to events as they occur in a dispassionate, or non-emotional way.

  • Consider joining a support group where you can speak with others who can relate to your experience with inflammatory arthritis or mental health issues.

• If feelings of emotional distress, depression or anxiety persist it is important to speak to your doctor and seek a referral to a social worker or psychologist.

As mentioned earlier in the course, keeping a PsA journal is proved to help patients better manage the “details” of PsA. You should be monitoring and prepared to share aspects of your progress with your rheumatologist (and family and friends if you choose), including:

• An accurate record of prescription medication taking

• Symptoms activity, such as joint pain and stiffness and general feeling of wellness (or fatigue)

• Improvement or limitations in your daily activities, at home and at work

• Questions about changes are additions you would like to make to your treatment goals or treatment plan

• New concerns or fears you may have since your last appointment