While getting the right treatment for psoriatic arthritis is a must, your day-to-day lifestyle choices can also have a big impact on how you feel. Here’s what you need to know to avoid psoriatic arthritis triggers — and psoriasis triggers, too. According to the Arthritis Foundation, most people with psoriatic disease say a psoriasis flare often precedes a flare of arthritis symptoms. RELATED: 5 Tips to Recognize and Manage Psoriasis Triggers Why? Stress sets off the immune system’s inflammatory response, according to the Arthritis Foundation. Inflammation, in turn, can fuel joint damage in people with psoriatic arthritis and other arthritic conditions. The longer you’re exposed to stress, the worse your psoriatic arthritis symptoms may get. Another reason stress can create a cycle of pain, then more stress, is that when you’re stressed, you tend to sleep less, says Dr. Ogdie-Beatty. And when you get less sleep, your pain is likely to seem worse. Stress can also prompt you to engage in unhealthy behaviors like smoking, drinking alcohol, and overeating, which may worsen symptoms. How to avoid this trigger Stress busters such as yoga and meditation can help ease pain, according to the Arthritis Foundation. RELATED: 6 Simple Yoga Poses for Psoriatic Arthritis
Skin Injuries Can Worsen Psoriatic Arthritis Symptoms
Whether it’s a scrape, sunburn, or something more serious, skin damage can trigger flares for people with psoriatic arthritis. A review published in May 2019 in Archives of Medical Science found that surgical incisions (and stress related to the surgery) can cause psoriatic arthritis or make symptoms worse. The link between skin injury and psoriatic arthritis flares probably goes back to the immune system’s abnormal inflammatory response, says Ogdie-Beatty. How to avoid this trigger Exercise caution in the sun so you don’t get burned — and think twice before you get a tattoo. A Finnish survey, published in June 2017 in Acta Dermatovenerologica Alpina, Pannonica et Adriatica, of 90 psoriasis patients with one or more tattoos found that 27 percent experienced an increase in plaques on the tattoo, a reaction known as the Koebner phenomenon; among those, 30 percent reported having a psoriasis flare in the weeks after tattooing. Lithium, for instance, which is used to treat bipolar disorder, can aggravate psoriasis conditions that are especially resistant to treatment. Antimalaria drugs, including chloroquine and hydroxychloroquine (which may be prescribed for rheumatoid arthritis), can also trigger a bout of psoriasis. Inderal (propranolol), a beta-blocker used to treat high blood pressure and other conditions, such as tremors and anxiety, also may worsen psoriasis. Other drugs that can lead to flares include some antibiotics; benzodiazepines like the anti-anxiety drug Xanax (alprazolam); and even NSAIDs (nonsteroidal anti-inflammatory drugs) commonly used to treat pain, such as ibuprofen. Also, be very careful about using the steroid medication prednisone, warns Ogdie-Beatty. “When patients come off it, it can cause a bad flare,” she says. How to avoid this trigger Be sure to tell your doctor about any prescription or over-the-counter medications or supplements you are taking in case your psoriatic arthritis treatment plan requires an adjustment.
Alcohol May Intensify Symptoms
“Alcohol consumption does have a pro-inflammatory effect,” says Delamo Bekele, MBBS, a rheumatologist and an assistant professor of medicine at the Mayo Clinic in Rochester, Minnesota. While research on the link between alcohol and psoriatic arthritis flares has so far been inconclusive, a study published in March 2020 in the British Journal of Dermatology found that moderate drinking did increase the risk of psoriatic arthritis in people with psoriasis. Drinking may also have an impact on the effectiveness of methotrexate, a medication that doctors commonly prescribe to people with psoriatic arthritis. “Alcohol can affect the liver and so can methotrexate, which is another reason for people with PsA to limit what they’re drinking,” says Dr. Bekele. But even people on that drug may find that they can imbibe occasionally: A study published in Annals of the Rheumatic Diseases in August 2017 found that people with rheumatoid arthritis taking methotrexate experienced no ill effects as long as they drank fewer than 2 drinks a day or 14 drinks a week. How to avoid this trigger “Given that the data on alcohol and psoriatic arthritis isn’t consistent, we usually advise people to limit alcohol use or cut it out completely if they can,” says Bekele. RELATED: 8 Common Habits That Worsen Psoriatic Arthritis
What You Eat (or Don’t) Might Have an Impact
When it comes to diet and symptoms of psoriatic arthritis, Ogdie-Beatty says, “it’s really an individual thing. Some people say tomatoes, some say gluten, or sugar can cause symptoms to worsen.” Adds Bekele, “Diet is interesting, because we know that in some ways, it affects inflammation in the body globally, but though many people are doing research, we don’t yet have a clear idea of what foods are best or worst for people with PsA.” For instance, given that psoriatic arthritis is linked to gut health, there have been many claims that probiotics — supplements for gut health — might help reduce symptoms of psoriatic arthritis. Yet a study published in May 2020 in ACR Open Rheumatology found that there were no differences in health outcomes between people with PsA who took probiotics and those who didn’t. On the positive side, there is evidence that certain foods seem to fight inflammation in the body, including turmeric, flaxseed, olive oil, and kale, though again, “We really don’t know how much impact eating these foods has on inflammation and PsA,” Bekele says. But it’s not a bad thing to include these foods in your diet. “Usually, we tell patients to try a Mediterranean diet, and tailor it depending on how they feel, whether that means reducing sugar or gluten,” Bekele says. How to avoid this trigger Bekele recommends keeping a food journal and seeing if certain foods correlate with symptom flares: “Then you can try a process of elimination to see if that helps.” RELATED: Can a Special Diet Help You Manage Psoriatic Arthritis?
Extra Weight Can Increase Inflammation
The evidence that excess weight increases the risk of developing psoriasis — and that it can exacerbate symptoms of psoriatic arthritis — is fairly clear, according to Bekele. “If you’re overweight, you’re also likely to have more severe disease,” he emphasizes, “including increased joint pain and more skin involvement.” The difficult thing about having psoriatic arthritis and managing weight is that it can be a bit of a vicious cycle. “It’s complicated, because if you’re in a lot of pain, you’re less active, which can lead to further weight gain,” says Bekele. A review published in Rheumatology and Therapy in September 2020 affirms that patients with psoriatic arthritis are more likely to develop obesity and the conditions that go along with that, including high blood pressure, diabetes, and cardiovascular disease. Again, inflammation may be the issue: Fatty tissue, the authors of the study wrote, “is thought to promote a chronic low grade inflammatory state,” and inflammation is associated with psoriatic arthritis. People who are obese may also not respond as robustly to medication, says Bekele, specifically a class of medication known as biologics. A study published in 2018 in PloS One found that as a person’s body mass index increases, the effectiveness of their medication decreases. How to avoid this trigger To take off extra pounds, be sure to get the support you need, since losing weight isn’t easy. Many experts recommend that people avoid excess sugar and processed foods and stick with a Mediterranean-style diet that emphasizes produce, whole grains, seafood, and olive oil — as well as fitting in exercise that works for your body. The effort should pay off: A study published in January 2019 in Arthritis Research & Therapy found that obese women with psoriatic arthritis who lost a significant amount of body weight (18 percent) had a dramatic reduction in joint pain, swelling, and fatigue. But losing just a little weight can help, too: Just 5 percent can ease symptoms, according to a report in Annals of the Rheumatic Diseases. RELATED: 9 Psoriatic Arthritis-Friendly Weight Loss Tips
The Evidence About Smoking Is Mixed
Besides the other known health problems associated with smoking, studies indicate that a nicotine habit may cause psoriatic arthritis flares and impede the effectiveness of certain medications, specifically TNF inhibitors. But the evidence is not cut-and-dried. A study published in January 2018 in the Annals of the Rheumatic Diseases found that while smoking increased the risk of psoriatic arthritis in the general population, it did not boost the risk of PsA in individuals with psoriasis. How to avoid this potential trigger “While the evidence is mixed, it makes sense to stop smoking for all the reasons that make it a bad idea — to reduce the risk of heart problems, diabetes, and associated conditions,” says Bekele. Don’t hesitate to get the support you need to kick the habit. Additional reporting by Anna Marrian and Paula Derrow.
