Care Path: Keep Thriving

It is important to talk to your health care provider if you are experiencing a flare, especially if you are having new or increasing symptoms. Although flares are often part of living with psoriatic disease, flares should not happen often when you are treating your disease effectively.

If you have flares often, talk with your health care provider about making changes to your treatment plan to better manage your psoriatic disease. Keeping a record of your symptoms and triggers can help you anticipate and treat your flares.

If you have psoriasis, it is important to watch for signs of psoriatic arthritis (PsA). About 1 in 3 people living with psoriasis also develop PsA, which causes swelling, pain, and stiffness in your joints and in areas where your tendons and ligaments connect to bone (also called entheses).

Early diagnosis and treatment are very important because if left untreated, PsA can cause permanent joint damage in as little as 6 months.

There is not one clinical test yet to diagnose PsA, but NPF is supporting researchers who are working to develop a PsA diagnostic tool. Currently, to make a diagnosis, your rheumatologist may consider many factors: an examination of your skin, joints and nails, X-rays, MRI scans, ultrasounds, and blood tests.

Take a 5-question PsA screener.

If you do not meet the target after 6 months – or if you do not see an acceptable improvement after 3 months – your provider may suggest a different treatment option. Changing the dose, adding a new treatment to the treatment plan you are already on, or switching to a different treatment are all possibilities. It may take time to find the treatment options that work for you, so keep working with your provider until you meet your treatment goal.

Just as your psoriasis or psoriatic arthritis may change throughout your lifetime, so can your treatment plans. There are a number of reasons you may wish to change or add a treatment, for example, your treatment stops working, your symptoms change, or you experience a life event such as becoming or trying to become pregnant, being diagnosed with a comorbidity, or a change in health insurance coverage.

Changing Treatments

• It is possible to build resistance over time to a treatment for your psoriasis. This means that the treatment you are taking used to manage your disease well but then is not working as well as it used to. This can happen with all biologics approved to treat psoriasis, also known as secondary failure.
• Because different biologics target different substances in the immune system you may be able to switch to a different biologic if the biologic you are taking stops working. Your provider may recommend switching to a different biologic or other treatment depending on several factors, including your health history, disease severity, and treatments you have already tried.

Adding a Treatment

• Another option if your treatment is not managing your symptoms well is to add another treatment to your treatment plan. This is known as combination therapy. Combining certain treatments may better manage your psoriasis or psoriatic arthritis. It may also mean you can use less of each treatment which may reduce possible harmful effects.5 It is always important to talk to your health care provider about combining treatments as some combinations of treatments can be harmful.

There can be several reasons why you may want to stop your treatment.

• If your treatment is not managing your psoriatic disease effectively or has too many side effects your provider may be able to recommend a different treatment.
• If your treatment is working so well that you no longer have symptoms, then it is important to talk with your health care provider about whether it is safe to stop taking your treatment. Stopping your treatment because you are symptom-free could lead to your psoriatic disease flaring. It is also important to remember that if you stop your treatment and then experience a flare the treatment you were on previously may not work as well or it may take a while for it to start working again.
• If you experience a life event such as becoming or trying to become pregnant, being diagnosed with a comorbidity, or a change in health insurance coverage, be sure to talk with your health care provider about your treatment options.

There is no cure for psoriatic disease, although the mission of NPF is to drive efforts to cure psoriatic disease. Through treatment, there is the hope of remission for some individuals living with psoriatic disease. Remission is often used to describe the reduction or complete disappearance of symptoms from a chronic or non-curable disease.

The NPF is working with health care providers and researchers to establish an agreed-upon definition for remission in psoriasis. Having a formal definition of remission in psoriasis will help improve research and clinical outcomes. Below are some questions being considered.

• What level of clear skin is needed to be in remission from psoriasis?
• Can you be in remission if you are still taking your treatment?
• How long do you need to have a set level of skin clearance before you can be considered in remission?

Remission could last for months or years but there is no way to know how long your skin or joints may stay clear. This is why it is important to regularly check in with your health care provider and have a plan ready to manage a flare if your psoriasis or psoriatic arthritis returns or worsens.

Complementary and integrative medicine (CIM), which includes natural products, lifestyle changes, and mind and body practices is a popular addition to some people’s treatment plans. It is important to know that alternative medicine may help manage symptoms of psoriasis (such as itch), but it may not address the root cause of the issue (such as the overactive immune system and systemic inflammation). That is why it is important to talk with your health care provider to make sure that you are treating your disease appropriately.

Here are a few CIM approaches that have been researched among people living with psoriasis, psoriatic arthritis, and other health conditions.

• Diet and supplements
• Physical therapy
• Occupational therapy
• Acupuncture

Find additional Integrative Approaches to Care or request your Guide to Complementary and Integrative Medicine.

Whether you're newly diagnosed or have been managing your disease for decades, you don’t have to go it alone. Find the right type of NPF support for you with our short quiz or explore one of the options below.

• One to One Mentor Program
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