It’s common for people with psoriatic arthritis to occasionally need a change in their treatment plan, whether it’s adding a medication, switching to another medication within a drug class, or starting a new treatment in a new drug class. But how do you know if it’s time to talk to your doctor about changing your psoriatic arthritis treatment? The first step is often simply knowing “what your baseline is. What was your life like prior to your diagnosis, at the time of diagnosis, and in the last several months,” says Amanda Lusa, MD, a rheumatology fellow at the University of North Carolina in Chapel Hill. “That alone helps your doctor better analyze whether or not you need to change your treatment plan.” “With all forms of inflammatory arthritis, it can be really hard for both the patient and the doctor to distinguish mild flares of a patient’s disease” from new or worsening symptoms, explains Dr. Lusa. Keeping a regular record or log of your symptoms can help, says Eric Ruderman, MD, associate chief of rheumatology at Northwestern Medicine in Evanston, Illinois. “I often encourage patients every week or so to stop, take stock, and ask, Am I feeling better? Or: What symptoms am I feeling or what symptoms have dissipated?” he notes. “Sometimes it’s more granular than that. Asking yourself, What is it that I want to be able to do? Is it going on a run? Is it that it’s really important that I can take a walk with my spouse? You want to be able to see movement in the right direction, and that involves keeping track of how you’re feeling.” Things that are critical to think about, according to Dr. Ruderman, are whether or not you’re experiencing new or worsening symptoms, if older symptoms that were once gone have reemerged, or if your daily activities are impacted negatively. Or it may be simply that you’re dissatisfied with how your current treatment plan is working, he says. On that latter point, it generally takes about three months before you will begin to see the effects of a treatment plan. If you’re still experiencing symptoms within three months of starting a new treatment, be patient; if it’s been more than three months and you’re still feeling the effects of your symptoms or seeing new ones, talk to your doctor, says Ana-Maria Orbai, MD, director of the psoriatic arthritis program at Johns Hopkins University in Baltimore.
Keep the Lines of Communication Open
From there, it’s truly about self-awareness of symptoms and keeping the lines of communication open and honest with your healthcare provider, according to Ruderman. “When you have any chronic disease it’s important to seek out a physician you can communicate with,” he says. “You need to be able to communicate and say, ‘This is working,’ or, ‘This isn’t,’ and why. It’s a marriage, if you will. You have to let them know what’s going on. You don’t want to go into an office visit and say, ‘I didn’t want to bring it up’ because you didn’t feel comfortable sharing.” Dr. Orbai recommends creating a personalized checklist that covers things such as checking your skin, checking your joints for inflammation, evaluating sleep and overall mood, and evaluating how well the medication seems to be working. “All of those things are important to look at when determining whether or not you need to change your treatment plan,” she says. During any doctor’s visit, discuss the coordination of treatment plans with other specialists who may also be working with you, such as a dermatologist overseeing a treatment plan for psoriasis, Ruderman advises. “It’s important that whoever oversees your primary care is also able to engage with your other physicians about your treatment plans; otherwise it’s easy to miss things,” he notes. This coordinated effort between specialists helps each determine what needs to be tweaked or reexamined regarding your treatment plan. “Early on in a patient’s treatment, we often find we have to try two or three treatments or medications until we find what will work,” Ruderman explains. “When you find something that does work, though, that response is fairly durable. Typically, patients will find something that’s effective and then they’re good for several years. But medications can lose their effectiveness, or something else presents itself in new symptoms in which we need to address changing a patient’s treatment plan.” “It’s always a journey once a patient is diagnosed,” Orbai adds. “It’s a journey to getting better and feeling the best they can be. And for most people, it’s a satisfying journey because they’re finally able to see improvement and feel better.”
