Swollen Fingers And Toes
PsA may also affect the smaller joints of the fingers and toes. These joints can get so swollen they cause the digits to appear sausage-like, a hallmark symptom called dactylitis.
According to the National Psoriasis Foundation, 40% of people living with PsA experience dactylitis. This symptom doesnt just inflame the joints of the fingers and toes it causes the entire finger or toe to swell up.
Psoriatic Arthritis: Flares And Fatigue
Psoriatic arthritis might cause fatigue in several ways. In part, the disease process itself may be to blame.
When you have psoriatic arthritis, your immune system releases proteins called cytokines. Those proteins trigger inflammation throughout your body a hallmark of the disease. Researchers believe the cytokines also cause fatigue, perhaps through several different pathways in your body.
Psoriatic arthritis symptoms come and go. Sometimes, they are relatively mild. Other times, the pain and swelling become significant. Those bad periods are known as flares. And when a flare occurs, fatigue often comes along for the ride.
Have Your Vitamin D Tested
There has been plenty of research that shows a connection between vitamin D deficiency and psoriatic arthritis. For example, one 2015 study reported in Arthritis Research & Therapy finds up to 40.9% of the PsA study participants also had vitamin D deficiency, this compared to only 26.9% of the control participants.
Chronic fatigue is one of the most common symptoms of vitamin D deficiency. If you think you have a deficiency, talk to your healthcare provider about getting your blood levels tested. Vitamin D deficiency is easily treated by eating more vitamin D rich foods, and with vitamin D supplements.
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Open Up To Those Closest To You
You may not want to open up to close friends and family about how PsA affects you, but loved ones cant help you if they dont know what you need. Help them to understand your condition and how it makes you feel. You may also want to call on them when you need help whether for a listening ear or help at home. Choose to nurture your relationships where possible.
Can Psoriasis Make You Feel Tired
Scientists arent entirely sure why this happens. What is clear is that many people who have psoriasis say they feel exhausted. Some people say the constant fatigue, which can interfere with everyday life, is one of the most troublesome symptoms of psoriasis.
While theres no quick fix for ending the fatigue, dermatologists say you may be able to boost your energy by making some changes.
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Banking And Budgeting Your Energy
Often, those with psoriatic arthritis feel like they have to be mindful of their energy levels because their condition causes chronic fatigue. In fact, one 2019 cross-sectional study in the journal PLoS One found that severe fatigue affects more than half of people with PsA. Know that you are not alone in your energy struggle, and there is nothing wrong with you.
With PsA, your energy levels are like an energy bank. For every task you complete, you withdraw from your daily energy balance. Something as simple as showering can deplete your balance, and depending on how you are feeling on a particular day, you may have more or less in your bank than you did the previous day.
If you find that your energy levels are low and you are struggling to get through the day, a simple analysis might reveal areas you can focus on to feel better.
From People Like You
When I eat more red meat than usual I find that my symptoms get worse. I still enjoy meat from time to time, but balance it because its such an easy thing I can do to improve flares.
Half The Battle Is Getting The Right Diagnosis
Teresa Dishner, 64, a former chemistry teacher from Virginia, saw her primary care doctor after experiencing sudden painful symptoms. I was having extreme pain while getting dressed, and my fingertips bled while teaching class, says Dishner, who was diagnosed with psoriatic arthritis in 2002. The doctor initially told her to simply lay off salt. But Dishner had a feeling that something more was amiss, so she decided to see a rheumatologist. Thats how she got the right diagnosis.
If you suspect theres something behind your pain, dont ignore it and think it will go away, says Renae Rabe, a finance manager living with psoriatic arthritis in West Allis, Wisconsin. She believes she had psoriatic arthritis for at least five years before receiving her diagnosis. Go to your doctor until you get answers, Rabe says.
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You Wish More People Understood What Youre Going Through
Because psoriatic arthritis is not a particularly common condition , it can be hard to find someone else who’s going through the same thing you are. It took 12 years after my diagnosis to meet someone else with psoriatic arthritis, Dishner says. That means its important to create your own support system. Keeping your friends and family involved in your experiences with psoriatic arthritis and your treatment plan, says Markenson, may help them to better understand what you’re going through and how to help you.
Living With Psoriatic Arthritis Fatigue: Amandas Story
These results are not news for blogger Amanda Steyer, who has psoriatic arthritis. Fatigue is a huge part of living with psoriatic arthritis, she says. There are days when I dont want to get out of bed and spend the entire day wishing I could get back into bed. Steyer has a lot of motivation to get going though: She homeschools three of her five children, ages 17, 14, and 12.
Steyer was formally diagnosed with psoriatic arthritis at 41 but has had symptoms on and off throughout her life. In my early twenties, I was in the process of working with doctors to get to the root of my extreme fatigue and back and leg pain and then got pregnant with my oldest child, and my symptoms disappeared, she recalls. Each pregnancy temporarily put her symptoms into remission. But after her fifth and last pregnancy, her symptoms returned with a vengeance. She takes medication to manage her symptoms, but some of her fatigue also appears to be due to her psoriatic arthritis treatment regimen.
My energy levels are better not fantastic, but much more manageable than when my psoriatic arthritis is untreated, she says. She can move more freely and even hike with her family, a pastime shes always enjoyed.
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What Are Options For Pain Management
Minor pain and stiffness of mild PsA can be alleviated with non-steroidal anti-inflammatory drugs . In addition, injections of corticosteroids may be used.5
For moderate to severe disease, treatments that target joint disease in PsA frequently can reduce symptoms and prevent disease progression. Recommended treatments include disease-modifying anti-rheumatic drugs .
The first step for treatments is usually DMARDs such as methotrexate, leflunomide, or sulfasalazine. Other treatments include medicines that target tumor necrosis factor , a chemical that produces a wide range of inflammation in PsA.
Examples of TNF blockers include etanercept , adalimumab , infliximab , golimumab , and certolizumab pegol . Other DMARDs that have proven effective in clinical trials include ustekinumab , and secukinumab .1
The FDA has also recently approved Inflectra , a biosimilar to infliximab, for the treatment of psoriatic arthritis.7Physical and occupational therapy can be critical treatment approaches to both protect the involved joints and maintain function.5
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Assess Your Treatment Plan
Taking your medications as prescribed can ease inflammation and pain and minimize the amount of fatigue you experience. If you find that your fatigue isnt improving despite making changes, talk to your healthcare provider. They might recommend a dose adjustment or consider a more advanced treatment, like a biologic, that might better help. Your doctor can also evaluate and see if another condition like depression or anxiety might be causing or adding to your symptoms.
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Try Setting Small Goals
Victories are energizing, so try setting yourself up for one or more every day. This strategy works for Judy Lenn, 68, who has had psoriasis and psoriatic arthritis for 10 years. What gets me through a difficult flare is setting a goal every day. It can even be something as simple as writing a letter to one of the boys I sponsor through Compassion International or World Vision.
Each little accomplishment propels you toward the next one, which can help you reverse that vicious cycle into something much more positive. Lenn adds: Goals keep me moving, especially when I dont feel like doing anythingwhich is when I need to move the most!
Your Energy Level Is Like A Bank Account
Psoriatic arthritis can cause extreme fatigue. For every task you complete, or plan to complete, you drain your daily energy bank. Putting on mascara or talking to a neighbor on the street costs you energy. And sometimes, even if its the first thing you do after waking up, a shower may be all it takes to put you right back in bed.
Its important to rest when you need to and not push yourself too hard, especially on days when your symptoms are particularly severe, says Joseph Markenson, MD, a rheumatologist at Hospital for Special Surgery in New York City. Its also important for the loved ones of those who have psoriatic arthritis to understand how draining the condition can be for example, people with psoriatic arthritis may have to cancel plans frequently or head home early.
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Treating Fatigue From Psoriatic Arthritis
The key to treating or managing fatigue is identifying the contributing conditions and addressing each of those. Fatigue can be linked to both physical and emotional triggers, and the conditions that may be contributing to fatigue must each be treated.5
As with all symptoms of psoriatic arthritis, treating fatigue begins with treating the underlying disease. Recommended treatments include disease-modifying anti-rheumatic drugs . The first step for treatments is usually DMARDs such as methotrexate, leflunomide, or sulfasalazine. Other treatments include medicines that target tumor necrosis factor , a chemical that produces a wide range of inflammation in PsA. Examples of TNF blockers include etanercept , adalimumab , infliximab , golimumab , and certolizumab pegol . Other DMARDs that have proven effective in clinical trials include ustekinumab , brodalumab , and secukinumab . 6 The FDA has also recently approved Inflectra , a biosimilar to infliximab, for the treatment of psoriatic arthritis.7
Lifestyle changes can also improve the symptom of fatigue. Exercise can reduce pain and improve well-being, both of which have an impact on fatigue. Some patients also find anti-inflammatory diets improve their energy levels and reduce fatigue.5
Changing Your Diet Wont Cure Psoriatic Arthritis
There is no known cure for psoriatic arthritis, and making dietary changes like going paleo or gluten free isn’t a remedy. The good news, however, is that a healthy diet with plenty of anti-inflammatory fruits and vegetables that’s low in fats and sugars can help keep psoriatic arthritis symptoms under control. Also try to steer clear of dairy and caffeine, which may aggravate psoriatic arthritis symptoms, says Dr. Markenson.
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What Psoriatic Arthritis Fatigue Feels Like: What Researchers And Rheumatologists Say
There are many different ways patients with PsA talk about their fatigue, says rheumatologist Alexis Ogdie, MD, Director of the Penn Psoriatic Arthritis Clinic in Philadelphia and Associate Professor of Medicine at the Hospital of the University of Pennsylvania.
Some people describe fatigue like their battery running out some people talk about exhaustion before the end of day like by 3 p.m. you cant go on without a nap or drinking excessive amounts coffee, which doesnt work and some people talk about not being able to mount energy , she says.
To come up with a framework of how people with psoriatic arthritis think about fatigue, Dr. Ogdie along with several researchers recruited 19 patients with PsA and asked them to describe the experience of fatigue in their own words. The findings were published in 2020 in the journal RMD Open: Rheumatic & Musculoskeletal Diseases. Patients responses included:
- Wiped out
- Worn out
Fatigue can be very subjective, says rheumatologist Eric Ruderman, MD, Professor of Medicine at Northwestern University in Evanston, Illinois. I might not totally understand what fatigue feels like for you, but I can understand how it impacts you, or what you need to do differently to manage it on a daily basis.
Schedule Your Rest Time
When living with a chronic disease, youll inevitably feel tired from time to time. You might find that the best way to manage your fatigue is to schedule it into your daily activities.
A quick nap or just lying down in the middle of the day could be just what you need.
You can also plan to do your most intensive tasks when you usually have the most energy. Consider dividing up your exercise or other activities into shorter segments.
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When To See A Doctor
A person should see a doctor if they experience new or worsening symptoms of fatigue or fatigue that affects their ability to function in daily life.
The doctor will investigate whether there is an underlying cause or condition that needs additional treatment.
A doctor will recommend treatments and strategies to help a person manage the fatigue that occurs with PsA.
Some lifestyle choices can help a person manage PsA.
The Pain In My Hand Didnt Go Away It Got Worse
Id just moved from London to the countryside and one of the benefits was going out for walks. I was keen to get some movement and exercise again after the operation.
I started to develop discomfort in my left foot, like a small pebble in my shoe. The more I tried to push through it and keep walking the worse it became. One of my toes on that foot had also become swollen.
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Why Do I Feel Tired All The Time
People with psoriasis or psoriatic arthritis often feel tired all the time. Some people who develop this symptom think there must be something psychologically wrong with them. There isnt fatigue is a common and recognised symptom of the conditions. It is also acknowledged that doctors underestimate fatigue as a component of psoriasis and in particular of psoriatic arthritis. People often feel frustrated about the lack of support and understanding they get when presenting with a debilitating and invisible symptom.
It appears that fatigue is more severe in people with psoriatic arthritis than those who have psoriasis alone, with studies suggesting that three out of every ten people with psoriatic arthritis have symptoms of fatigue. Fatigue may be an early symptom or sign of inflammatory activity in people who may have psoriasis and or psoriatic arthritis both are classed as long-term inflammatory conditions. Inflammation is linked with the release of powerful chemicals. These include:
- inflammatory proteins which increase the stickiness of blood platelets
- proteins which bind to antibodies and circulate as immune complexes
- immune system chemicals that help immune cells communicate with each other, such as interleukins, especially interleukin 1.
Psoriatic Arthritis And Brain Fog
Some people find that psoriatic arthritis leads to another kind of fatigue: brain fog. People have reported problems with concentration, memory and other thinking skills.
In part, this fuzzy-headed feeling may be the result of not getting enough sleep at night because of chronic pain. Its also possible that the inflammation caused by psoriatic arthritis may affect brain function in some way.
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You’re A Psoriatic Arthritis Expert
Most people who have psoriatic arthritis usually do research on symptoms and new therapies after they’ve lived with the condition for a time. They also take it on themselves to talk about their findings with people close to them. Its important to educate the people around you, says Rabe. I consider myself an expert because I’m always researching and learning about my disease, which makes me comfortable answering questions to help my loved ones better understand what Im going through.
The Advice I Would Give To Others Includes
- Dont ignore any odd pains that go on for any length of time!
- Check family history as many autoimmune conditions are hereditary. My mother has been ill for many years and it turned out rheumatoid arthritis and psoriatic arthritis runs in my mums family.
- Looking back there has been a pattern to my pain, if you have a list of similar things, please get it looked into. When speaking to busy medical professionals, bring up similar things that have happened in the past.
- No matter how bad the pain and condition can become, if you can get the right treatment, it can become better and easily manageable.
- Support from family and friends can be crucial. At the beginning they wont understand unless theyve been through it. Information from organisations like Versus Arthritis can help explain and educate.
- Overall health is so important diet, weight, and physical activity play a vital role. You need to find out what works.
- Youre not alone. It can be difficult to adjust but by speaking to others whove been through the same can be reassuring and supportive.
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Just Because You Dont Appear Sick Doesnt Mean That You Are Not Sick
My psoriasis is not visible to others, and the days Im really struggling with my arthritis, I dont leave my house. So when people see me, they think Im fine. Its been a roller coaster of good days and bad, but nobody sees the bad days when you cant get out of bed. I really find that lack of understanding to be the hardest part of an invisible illnessjust because you dont appear sick doesnt mean that you are not sick.
I used to be quite active, and its difficult to not be able to do what I used to do. Psoriatic arthritis strips you of your identity, but you eventually build yourself back up, learn to live with it, and accept that things will be different. For example, I love to travel, but I now travel very differently. Im more conscious of burnout and fatigue, and I make sure I have lots of time to rest and dont push myself to the limit. But I refuse to let psoriatic arthritis control my life or hold me back. Brenda S., 35
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