Life with psoriatic arthritis can present challenges, but you can take them on by working closely with your care team, planning ahead, and following a healthy lifestyle.
Gender Differences in Psoriatic Arthritis
“Differences between men and women are apparent in the way psoriatic arthritis affects different parts of the body,” says Anca Dinu Askanase, MD, MPH, director of rheumatology clinical trials at Columbia University Irving Medical Center in New York City. Men tend to experience more spine disease and joint damage. Women generally experience more arthritis in their arms and legs, fatigue, disability, and a reduced quality of life, Dr. Askanase adds. Successfully treating psoriatic arthritis can help improve your quality of life. Talk to your doctor if your treatment isn’t working or if you’re experiencing side effects. Be prepared for your doctor’s appointments — try to provide specific examples of what’s bothering you, as opposed to just saying you don’t feel well, advises Elaine Husni, MD, MPH, a rheumatologist at Cleveland Clinic in Ohio.
Special Considerations for Women
Anyone with psoriatic disease is at higher risk of diabetes, obesity, high blood pressure, inflammatory bowel disease, uveitis (eye inflammation), heart disease, and stroke, according to the National Psoriasis Foundation (NPF). But there are certain things that women, specifically, with psoriatic arthritis should consider, including: Pregnancy and motherhood If starting a family is in your plans, sit down with your doctor before you start trying. Bring your partner with you for support if possible, Dr. Husni suggests. “Those who are able to come to the visit together can help manage [pregnancy] together and have another support system regarding doctor visits," she says. Your psoriatic arthritis should be well controlled before you try to conceive, because the stress of a flare can make it harder to get pregnant. Plus, getting psoriatic arthritis under control first can help ensure that it stays stable during your pregnancy. Many women actually get a reprieve from psoriatic arthritis symptoms during pregnancy. “We think that’s a protective mechanism from the immune system when you’re pregnant,” Husni says. But after you have the baby and go back to your “regular immune state,” psoriatic arthritis can flare up again, she adds. But it’s possible that the stress of having a newborn may also bring on a flare and teasing this out can be challenging, Husni notes. You may also need to change your treatment plan before you get pregnant. Some medications used to treat psoriatic arthritis or psoriasis can cause side effects and have been linked to potential birth defects, according to the NPF, including methotrexate, tazarotene, and acitretin. Talk to your rheumatologist and obstetrician about the risks and benefits of all your medications, says Askanase. Work with your doctors to develop specific treatment plans for after the baby comes, especially if you plan to breastfeed. You also may need special accommodations for childbirth if you have lower back or severe hip arthritis, Askanase says. Talk to your obstetrician-gynecologist to find out if a vaginal delivery is possible, she suggests. Anxiety and depression Mood disorders are also related to psoriatic disease — particularly if your joints hurt. In fact, people with psoriatic arthritis are more likely to experience depression or anxiety than people with psoriasis only, according to a study published in The Journal of Rheumatology in May 2014. The researchers also found that women were more at risk for developing a mood disorder than were men. If you’re experiencing symptoms of anxiety or depression, seek professional help. Treatment options such as talk therapy and medication are available. Psoriasis and its emotional toll Psoriatic arthritis often occurs in people with skin psoriasis. Women in particular may feel pressure to look attractive, and therefore may be more vulnerable to feeling ashamed of psoriasis plaques and limitations brought on by psoriatic arthritis pain, says Julie Shafer, PhD, a psychologist in Portland, Oregon who has expertise in the emotional impact of chronic disease. Appearance is especially important when women are dating and thinking about being intimate with a partner, Shafer adds. It can be awkward to have to explain plaques — which can make you feel different or unattractive, she notes. The same is true when explaining swollen and painful joints. Pain and lack of self-confidence due to psoriasis plaques and psoriatic arthritis pain can affect your work life, too. According to Shafer:
Pain can affect sleep, and exhaustion decreases self-confidence.Pain can get in the way of doing your job, which reduces self-confidence even more.You may feel limited by your appearance or pain and decide not to apply for certain jobs or go after promotions.
Tips for Women Who Have Psoriatic Arthritis
There are steps you can take to overcome the obstacles that women with psoriatic arthritis face. Start by:
Making healthy lifestyle changes. “As much as possible, exercise, eat right, and get plenty of sleep,” Shafer says. This reduces your vulnerability to stress and raises your emotional resilience, she notes. Be sure to drop bad habits, too — like smoking and drinking too much, Husni adds.Getting to your goal weight. Being overweight stresses your joints, and excess fat can cause medication to not work as well, Husni says. Obesity also puts you at greater risk for diabetes, heart disease, and other health problems related to psoriatic arthritis.Being kind to yourself. It’s essential for improved self-confidence, Shafer says. “You won’t be able to feel better about yourself if you’re regularly putting yourself down.”Leaning on others. Ask family and friends for help if you’re struggling, Shafer says. “Connect with other people who have psoriatic disease to talk about your experiences living with the condition," she says. “The validation that comes with knowing you are not alone is a great confidence booster.”Working with your care team. Checking in regularly with your doctor can help you stay on top of your psoriatic arthritis management plan and make adjustments along the way as needed.
