Psoriatic Arthritis Pain and Mobility Management

About

➀ Read and Learn

The following course content

Introduction   

When hearing the phrase psoriatic arthritis, what comes to mind? If you’re a nurse, you’ve definitely heard about psoriatic arthritis, skin conditions, and chronic health conditions at some point in your nursing studies and career. Maybe even before nursing school, conversations about skin health, psoriatic arthritis, and other health conditions existed every so often. Presently, patients seek guidance and information on various health topics from nurses, including psoriatic arthritis. The information in this course will serve as a valuable resource for nurses of all specialties, education levels, and backgrounds to learn more about psoriatic arthritis pain and mobility management.  

Defining Psoriatic Arthritis 

Psoriatic arthritis is a chronic inflammatory condition that affects an estimated 20% of people with psoriasis. Psoriasis is a chronic dermatological and immunological condition that affects millions of people in the United States and globally. The exact cause for psoriasis is unknown, and the cause for psoriatic arthritis is still being researched. Psoriatic arthritis can affect several parts of the body, interfere with a patient’s quality of life, and affect someone’s pain and mobility levels. Psoriatic arthritis is a type of arthritis that can cause mild to severe pain and mobility concerns, interfering with someone’s quality of life, ability to work and go to school, and ability to care for themselves. While psoriatic arthritis does not have a cure, there are many management options for patients experiencing pain and mobility issues (1).  

What is the Prevalence of Psoriatic Arthritis? 

The prevalence of psoriatic arthritis can vary significantly because of possible underdiagnosis and mistreatment. Present prevalence rates of psoriatic arthritis in the United States are estimated to be about 20% of people who have psoriasis. Psoriasis is estimated to millions of people annually, with several people being underdiagnosed as a result of lack of health care services and knowledge of psoriasis and psoriatic arthritis (1). Given this rough estimate, it is estimated that at least one million people in the United States have suspected or confirmed psoriatic arthritis, making this condition a serious challenge for pain management and mobility management concerns for patients and health care. While several studies, medications, and interventions for psoriatic arthritis have traditionally focused on adults, pediatric and adolescent populations must also be educated and assessed for psoriatic arthritis as well (1).  

What if Psoriatic Arthritis Is Left Untreated?  

If left untreated, psoriatic arthritis can lead to further health complications, unmanaged pain concerns, physical disability, and further decreased quality of life. For many people with psoriatic arthritis, psoriatic arthritis can interfere with their abilities to maintain their autonomy through activities of daily living (ADLs) depending on the severity of their conditions. By leaving psoriatic arthritis untreated or not adequately managed, this can cause further chronic issues to someone’s health, mobility, pain management, and livelihood (1,2).  

Psoriatic Arthritis Pathophysiology 

There are several studies, theories, and speculations regarding psoriatic arthritis’s pathophysiology. One common factor is that psoriatic arthritis’ pathophysiology is not a one size fits all, as many things can influence the prevalence and severity of psoriatic arthritis in people. From genetics, environmental exposures, and skin trauma, all of these are suspected to influence the pathophysiology of psoriatic arthritis. For instance, for some patients, an environmental exposure, such as an infection or mechanical stress, can trigger joints and skin inflammation and increase the number of cytokines, especially IL-23. In particular, distal interphalangeal joints are most often involved in psoriatic arthritis since the interphalangeal joints have many entheses and not as much synovial tissue compared to other joints. In addition, CD8+ T cells are a necessary biomarker for psoriatic arthritis since CD8+ T cells are substantiated by their connection with HLA Class I alleles and their association with late-stage human immunodeficiency virus (HIV) infection (1,2). 

Psoriatic Arthritis Etiology 

Similar to psoriatic arthritis’s pathophysiology, the true exact etiology and cause of psoriatic arthritis is not known. It is important to note that not all patients with psoriasis will develop psoriatic arthritis. Several studies show the role of genetics, trauma, infections, stress, and more influencing the etiology of psoriatic arthritis. Psoriatic arthritis can affect people of any age, gender, culture, or location. That said, because there are several etiologies of psoriatic arthritis with more research needed, it is important to consider several options for psoriatic arthritis pain and mobility management in direct patient care (1,2).  

Psoriatic Arthritis and its Implications on Pain and Mobility  

Because psoriatic arthritis can affect multiple joints in the body, the most common symptoms of psoriatic arthritis can be joint pain, joint stiffness, inflammation in fingers and toes, and fatigue. Because of the wide range in severity of symptoms, possible co-morbid health conditions of a patient, and severity of psoriatic arthritis itself, many patients report several complications with pain and mobility. Some patients might not report any pain, but for other patients, pain from psoriatic arthritis can be extreme enough to warrant an emergency room visit. For some patients with psoriatic arthritis, they must rely on caregivers, family members, home health aides, and other people to perform ADLs, such as cooking, cleaning, or administering medication. While the exact prevalence and information on psoriatic arthritis and its implications on pain and mobility ae not known, considerations for pain and mobility management must be addressed when assessing and caring for patients with psoriatic arthritis (1,2). 

Psoriatic Arthritis Pain and Mobility Management Paths 

There are many options for pain and mobility management for patients with psoriatic arthritis. First, it is important to understand the patient’s baseline pain and mobility levels and their severity of psoriatic arthritis. Key considerations for health assessment skills for psoriatic arthritis include (1,2): 

• Obtaining blood work, such as a complete metabolic panel (CMP), complete blood count (CBC), vitamin levels (specifically D and B12), iron and folate levels, and a complete thyroid panel  

• Obtaining a detailed, honest patient history of substance use (including marijuana, tobacco, stimulants, and alcohol use), recent and historical trauma (abuse, skin trauma, car accidents), and medical history (all current and prior medication use, existing health conditions) 

• Obtaining an infectious disease screening panel to include HIV and COVID-19  

• Asking questions about skin health in general to screen for other skin health conditions, such as asking if a patient has any other skin concerns, or a family history of psoriasis or psoriatic arthritis 

• Performing a general physical skin examination, taking skin cultures if possible, and performing a mobility assessment 

Upon examination and lab work result completion, it is also important to ask about pain and mobility concerns, especially in the hands and feet. Some people cannot write or use a keyboard because of the severity of psoriatic arthritis in their joints (1,2). Health care provider professional discretion and patient condition should guide therapy. Consider your patient’s health history and needs prior to prescribing any medication. 

What Are Options for Psoriatic Arthritis Pain and Mobility Management? 

Options for psoriatic arthritis pain and mobility management include prescription medications, over the counter (OTC) medications, physical therapy, occupational therapy, and psychotherapy (1,2). These options will be discussed later in this course.  

How and Where Are Psoriatic Arthritis Pain and Mobility Management Used? 

Medications for psoriatic arthritis pain and mobility management are used in America and around the world in pediatric, adult, and geriatric populations. Medications can be taken by mouth as a pill, capsule, patch, or IV solution. Non-pharmacological therapies, such as physical or occupational therapy, can be done in person or online depending on the provider’s ability and patient preference. The role of telehealth has also increased access to health services in rural and underserved areas, making psoriatic arthritis pain and mobility management more accessible in these communities as well (1,2).  

What Is the Average Cost for Psoriatic Arthritis Pain and Mobility Management? 

Cost for psoriatic arthritis pain and mobility management can significantly vary depending on the type of medications used, therapies recommended, insurance, dosage, frequency, and other factors (1,2,3). Cost is among a leading reason why many patients cannot maintain their medication or therapy regime (3). If cost is a concern for your patient, consider reaching out to your local pharmacies or patient care teams to find cost effective solutions for your patients. Consider also looking into telehealth therapy options for your patients or in collaboration with your place of work as well.  

Common Psoriatic Arthritis Pain Management Medications 

Health care provider professional discretion and patient condition should guide therapy. Consider your patient’s health history and needs prior to prescribing any medication. There are many options to manage psoriatic arthritis pain and mobility, so it is important to keep the patient involved in decision making and be aware of the latest research affecting this condition (1,2).  

Disease-Modifying Antirheumatic Drugs (DMARDs) 

• Examples and Method of Action: Disease-Modifying Antirheumatic Drugs (DMARDs) are prescription medications that can manage inflammatory conditions, such as psoriatic arthritis, other arthritic pain, and other connective tissue conditions. These medications are immunosuppressive and are often divided into conventional or biological DMARDs. Common examples of DMARDs include hydroxychloroquine, sulfasalazine, leflunomide, and methotrexate. It is important to consider other possible conditions a patient has that can be affected by these medications, in addition to cost, ease of access, and medication administration route.   

While these medications are among the most common for psoriatic arthritis pain management, they also come in various dosages. It is often recommended to start a patient on the lowest dosage possible and monitor the patient for symptom alleviation or changes. Some patients will respond well to the lowest dosage of a DMARD, while others will respond better to a higher DMARD dose (1,4,5).  

DMARDs have a method of action unique to the specific DMARD because of their immunosuppressive nature. For instance, hydroxychloroquine works by inhibiting the intracellular toll-like receptor TLR9. Sulfasalazine has an unspecified method of action of preventing oxidative, nitrative, and nitrosative damage. Leflunomide has a method of action that inhibits dihydroorotate dehydrogenase, which causes an inhibition of pyrimidine synthesis, triggering decreased lymphocyte production. Furthermore, methotrexate inhibits the enzyme AICAR transformylase, leading to hindrance in adenosine and guanine metabolism. As a result, adenosine, which has anti-inflammatory properties, accumulates, triggering a cascade of events in immune function and regulation (1,4,5). 

• Side Effects: All medications have a risk of side effects, and DMARDs medications are no exception. Common medication side effects for DMARDs include weakened immune system, gastrointestinal (GI) upset, possible reactivation of prior viral infections (such as reactivation of human papilloma virus or herpes zoster), and possible hepatoxicity. However, DMARDs also have their unique side effect profiles as well.  

Hydroxychloroquine is thought of to have one of the safest DMARD safety profiles, but can still have the possible side effects of rash, retina complications, anemia, cardiac complications, and leukopenia. Sulfasalazine has a specific severe adverse event of GI distress that can lead to severe GI complications. Leflunomide has specific adverse effects of possible changes in blood pressure, weight changes, and nerve pain. Sulfasalazine, leflunomide, and methotrexate have possible side effects of liver damage and bone marrow suppression (1,4,5). 

It is important to note that many DMARDs can pose complications to patients with various health conditions, such as pregnancy, existing liver complications, existing bone complications, and more. Because of the extensive patient profiles with psoriatic arthritis and side effect possibilities, education and discussion with patients on medication options is essential (1,2,4,5). 

• Implications for Pain Management: While DMARDs are often among the first-line option for pain management for psoriatic arthritis given their immunomodulating and anti-inflammatory properties, DMARDs can vary in their therapeutic response for patients. Some patients can respond well to leflunomide for pain management for a few years at a specified dose, whereas others can still have high levels of pain while on leflunomide for years. Because DMARDs can vary in their therapeutic response, some patients will have no pain concerns on a specific dosage. However, because everyone’s body is different, it is important to consider the realities of pain management options in conjunction to and without DMARDs as well (1,4,5).  

Tumor Necrosis Factor (TNF) Inhibitors 

• Examples and Method of Action: Tumor Necrosis Factor (TNF) inhibitor medications typically have a method of action of modifying a person’s immune response, allowing for a patient to have less inflammation in their body. Some examples of TNF inhibitors used for psoriatic arthritis pain include adalimumab, infliximab, etanercept, certolizumab pegol, and golimumab. Adalimumab, golimumab, certolizumab pegol, and infliximab have a method of action of inhibiting TNF-a activity, thus leading to decreased TNF-a activity in the body. Etanercept has a method of action of inhibiting TNF-a and TNF-b activity, thus leading to decreased TNF-a and TNF-b activity in the body (1,6).  

• Side Effects: All medications have a risk of side effects, and TNF inhibitor medications are no exception. Common side effects of TNF inhibitor medications include upper respiratory infections, weakened immune system, headache, GI upset, lymphomas, skin reactions, drug-induced lupus, and cardiac complications. While TNF inhibitors are typically well-tolerated pain medication options for people with psoriatic arthritis, education and awareness of these side effects are essential (1,6). 

• Implications for Pain Management: While TNF inhibitors are often among the first-line option for pain management for psoriatic arthritis given their immunomodulating and anti-inflammatory properties, like DMARDs, TNF inhibitors can vary in their therapeutic response for patients. Some patients can respond well to golimumab for pain management for a few years at a specified dose, whereas others can still have high levels of pain while on certolizumab pegol for years. Because TNF inhibitors can vary in their therapeutic response, some patients will have no pain concerns on a specific dosage. However, because everyone’s body is different, it is important to consider the realities of pain management options in conjunction to and without TNF inhibitors as well (1,6).  

IL-17 Inhibitors (IL-17i) 

• Examples and Method of Action: Interleukin-17 inhibitor medications (IL-17i) typically have a method of action of modifying a person’s immune response, allowing for a patient to have less inflammation in their body. Some examples of IL-17i used for psoriatic arthritis pain include ixekizumab, secukinumab, and brodalumab. Broadalumab, seckinumab, and ixekizumab all have a method of action of inhibiting the interleukin-17 receptors, altering the patient’s immune response and inflammation (1,7,8).  

• Side Effects: All medications have a risk of side effects, and IL-17i medications are no exception. Common IL-17i side effects are headache, a weakened immune system, GI upset, rash, and leukemia. While IL-17i medications are typically well-tolerated pain medication options for people with psoriatic arthritis, education and awareness of these side effects are essential (1,7,8). 

• Implications for Pain Management: While IL-17i are often among the first-line option for pain management for psoriatic arthritis given their immunomodulating and anti-inflammatory properties, like DMARDs and TNF inhibitors, IL-17i medications can vary in their therapeutic response for patients. Because IL-17i medications can vary in their therapeutic response, some patients will have no pain concerns on a specific dosage. However, because everyone’s body is different, it is important to consider the realities of pain management options in conjunction to and without IL-17i medications as well (1,7,8).  

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) 

• Examples and Method of Action: Pain medication options, such as non-steroidal anti-inflammatory drugs (NSAIDs), are possible options for patients with psoriatic arthritis. NSAIDs have a method of action of inhibiting the cyclooxygenase (COX) pathways, thus reducing inflammation. Common NSAIDs are ibuprofen, ketorolac, and naproxen. Since NSAIDs are often OTC medications, these are often a first line pain management option for patients with psoriatic arthritis (1,9,10).  

• Side Effects: All medications have a risk of side effects, and NSAIDs are no exception. Common side effects of NSAIDs include GI upset, headache, renal impairment, cardiac impairment, hepatic impairment, and ulcers. While these side effects are more pronounced with prolonged use of NSAIDs, it’s important to understand that many patients with psoriatic arthritis use NSAIDs for initial pain management (1,9,10).  

• Implications for Pain Management: NSAIDs are often the first-line option for millions of people with psoriatic arthritis given their low-side effect profile, ease of access OTC, and cost. That said, NSAIDs, especially when taken with other pain medications, can have severe side effects and might not be adequate enough to control pain. It is important to monitor patients who take NSAIDs, even if it is occasional OTC use, as part of their medication regime and pain management to ensure that pain is being properly managed and adverse effects are monitored (1,9,10). 

Opioids 

• Examples and Method of Action: Pain medication options, such as opioids, are possible for psoriatic arthritis patients. Opioids are typically considered some of the strongest pain medications and are available by prescription only. Most opioid medications method of action is activating the mu and kappa receptors located throughout the body. Commonly prescribed opioids include morphine, hydromorphone, oxycodone, and codeine (1,11).    

• Side Effects: All medications have the risk of side effects, and opioids are no exception. In fact, while opioid medications can provide great pain relief, they have some of the most severe side effects, such as constipation, respiratory depression, bradycardia, and miosis (pinpoint pupils). Certain opioids, such as those with serotonergic activity like fentanyl or codeine, also have the possibility to trigger serotonin syndrome (1,11). 

• Implications for Pain Management: While opioids are great for pain management, they are not anti-inflammatory, meaning that the pain from psoriatic arthritis can still linger, even with opioid use. Because of this, close monitoring, especially for patients with other co-existing health conditions, is essential, especially for outpatient opioid medication use (1,11). 

Common Psoriatic Arthritis Mobility Management Options 

Physical Therapy and Psoriatic Arthritis 

One of the most complementary non-pharmacological mobility management options for psoriatic arthritis is physical therapy (PT). Because psoriatic arthritis can trigger severe inflammation in the fingers and joints, PT can be a serious game changer for many patients. Given the COVID-19 pandemic, telehealth PT has become increasingly popular, leading to a surge of online therapy options for several age groups and populations typically hard to reach with traditional office visit times.  

While in-person PT is an option for many patients, the virtual aspect might be more feasible for patients with transportation issues, those living in rural areas, or those who are in chronic pain. Patients can opt in for PT with a licensed physical therapist and see this therapist a few times a week or a few times a month depending on their mobility needs. Often, health care providers and physical therapists can work together to determine a plan of care and monitor patient’s responses to PT, medication, and home exercises. Physical therapy’s cost can vary by insurance, location, and provider, so if cost is a concern, that is something to address with a patient as well (1,2,9,12).   

Occupational Therapy and Psoriatic Arthritis 

One of the most complementary non-pharmacological management options for psoriatic arthritis is occupational therapy (OT). Occupational therapy is especially important for patients who had mobility prior to psoriatic arthritis and want to maintain mobility, autonomy, and their ADLs. Occupational therapy can help patients with skills, such as cooking, going to the bathroom, and cleaning on their own.  

Many home health programs have occupational therapists who can see patients in their home, and some clinics have occupational therapists on-site as well. While occupational therapy can vary in cost, location, and insurance coverage, many patients can benefit from this option as they adjust to a life with psoriatic arthritis. Often, health care providers and occupational therapists can work together to determine a plan of care and monitor patient’s responses to OT and ADLs (1,2,9,12).  

Nursing Considerations 

What Is the Nurse’s Role in Psoriatic Arthritis Patient Education, Medication, and Management? 

Nurses remain the most trusted profession for a reason, and nurses are often pillars of patient care in several health care settings. Patients turn to nurses for guidance, education, and support. While there is no specific guideline for the nurses’ role in psoriatic arthritis patient education and management, here are some suggestions to provide quality care for patients with a current or suspected psoriatic arthritis (1,2,12).  

1. Take a detailed health history. Often times, pain and mobility concerns can be often dismissed in health care settings, even in dermatology and rheumatology health settings. If a patient is complaining of symptoms that could be related to psoriatic arthritis, inquire more about that complaint. Ask about how long the symptoms have lasted, the locations of symptoms, what treatments have been tried, if these symptoms interfere with their quality of life, and if anything alleviates any of these symptoms. Ask specific questions about a patient’s quality of life and pain. If you feel like a patient’s complaint is not being taken seriously by other health care professionals, advocate for that patient to the best of your abilities.  
2. Review medication history at every encounter. Many times, in busy clinical settings, reviewing health records can be overwhelming. While millions of people take medications, there are many people who take medications and are no longer benefiting from the medication. Ask patients how they are feeling on the medication, if their symptoms are improving, and if there are any changes to medication history. Make sure to specify if the patient is taking any over-the-counter supplements or herbs as well.  
3. Ask about family history. If someone is complaining of symptoms that could be related to psoriatic arthritis, ask if anyone in their immediate family, such as their parent or sibling, experienced similar conditions or if there is a family history of psoriasis or psoriatic arthritis.  
4. Answer questions. Be willing to answer questions about rheumatological health, pain, mobility, and medication use. Society stigmatizes open discussions of prescription medication and quality of life. There are many people who do not know about the benefits and risks of pain analgesic-related medications, the long-term effects of unmanaged psoriatic arthritis, or possible treatment options. Be willing to be honest with yourself about your comfort level discussing topics and providing education on medication and health conditions. If you are not comfortable discussing something, please refer to another health care professional.   
5. Communicate the plan of care. The care plan should be communicated to other staff involved for continuity of care. For several patients with psoriatic arthritis, pain and mobility management often involves a team of mental health professionals, nurses, physical therapists, occupational therapists, primary care specialists, pharmacies, and more. Ensure that patients’ records are up to date for ease in record sharing and continuity of care. 
6. Engage in self-learning. Stay up to date on continuing education related to medications and mental health conditions, as evidence-based information is always evolving and changing. You can then present your new learnings and findings to other health care professionals and educate your patients with the latest information. You can learn more about the latest research on medications and mental health by following updates from evidence-based organizations.  

How Can Nurses Follow Up and Monitor Someone Who Has Psoriatic Arthritis?  

Unfortunately, it is not possible to look at someone with the naked eye and determine if they have psoriatic arthritis. While some symptoms of psoriasis and psoriatic arthritis can be visible, such as changes in skin and mobility, nurses can identify and assess if someone has psoriatic arthritis by taking a complete health history, listening to patient’s concerns, and communicating any concerns to other health care professionals. Unfortunately, there is no single standardized test to determine if someone has psoriatic arthritis, as this condition can vary significantly in clinical presentation (1,2).  

Nurses can recommend self-monitoring for patients with known or suspected psoriatic arthritis, especially regarding medication side effects and quality of life. Patients should know that anyone has the possibility of experiencing side effects on pain management and psoriatic arthritis modulating medications, just like any other medication. Patients should be aware that if they notice any changes in their mood, experience any sharp headaches, or feel like something is a concern, they should seek medical care (1,2,12).  

Nurses should also teach patients to advocate for their own health in order to avoid progression of psoriatic arthritis affecting their mobility and pain and possible unwanted medication side effects. Here are important tips for patient education in the inpatient or outpatient setting.  

• Tell the health care provider of any existing medical conditions or concerns (need to identify risk factors and co-morbid health conditions) 

• Tell the health care provider of any existing lifestyle concerns, such as alcohol use, other drug use, sleeping habits, diet changes, menstrual cycle changes (need to identify lifestyle factors that can influence medication use and pain and mobility management) 

• Tell the health care provider if you notice any changes in your mood, behavior, sleep, or weight (possible changes that could hint at more chronic side effects of medication use) 

• Tell the health care provider if you have any changes in urinary or bowel habits, such as increased or decreased urination or defecation (potential risk for medication malabsorption or possible unwanted side effects) 

• Tell the nurse of health care provider if you experience any pain that increasingly becomes more severe or interferes with your quality of life (possible unmet pain management needs) 

• Keep track of your quality of life, activities of daily living, skin changes, medication use, and health concerns via an app, diary, or journal (self-monitoring for any changes) 

• Tell the health care provider right away if you are having thoughts of hurting yourself or others (possible increased risk of suicidality is a possible side effect for medication use or unmanaged pain) 

• Take all prescribed medications as indicated and ask questions about medications and possible other treatment options, such as non-pharmacological options or surgeries 

• Tell the health care provider if you notice any changes while taking medications or on other treatments to manage your psoriatic arthritis (potential worsening or improving health situation) 

What Should Patients Know About Psoriatic Arthritis?  

Patients should know that psoriatic arthritis is a chronic health condition that can require extensive medical intervention and support. Some people will need more support than others, and everyone will respond to medications differently. Some people will have more pain and mobility concerns because of psoriatic arthritis, whereas some people will not experience the same levels of pain and mobility concerns. Because of the non-linear trajectory of psoriatic arthritis, it is important to be realistic of your expectations, be honest with your pain and mobility concerns, and seek care, when possible, to address your concerns (1,2,12).  

Upcoming Research 

There is extensive publicly available literature on psoriatic arthritis via the National Institutes of Health and other evidence-based journals. If a patient is interested in participating in clinical trial research, they can seek more information on clinical trials from local universities and health care organizations. 

Case Study 

Stephanie is a 25-year-old woman working as a banker. She arrives to her annual exam at her rheumatologist. She says she’s been feeling more tired over the past few months, but she is also wanting to get pregnant. Stephanie reports having some trouble sleeping and trouble eating but doesn’t feel too stressed overall. She has juvenile psoriatic arthritis since age 15 and has tried several DMARDs. Currently, she is on a low-dose methotrexate and reports taking ibuprofen OTC. Her vital signs are within normal limits, and she wants to see her options for pain medication during pregnancy and postpartum.  

• What are some specific questions you’d want to ask about her preconception health? 

• What are some health history questions you’d want to highlight? 

• What lab work would you suggest to perform?  

• How would you discuss changing her medications if Stephanie desires pregnancy?  

Stephanie agrees to the updated medication regime and will switch from methotrexate to etanercept within the next few weeks. Four months after her annual, Stephanie arrives to the office stating that she is 8 weeks pregnant and establishing prenatal care at the local OB/GYN. The OB/GYN practice wants to consult regarding her medication use during pregnancy. The OB/GYN office also wants you to discuss pain management options because Stephanie says the etanercept is not working as well as the methotrexate and the ibuprofen is not helping as much either. She states she is having some more mobility issues with her hands and is concerned about this in pregnancy.  

Stephanie wants to consider using stronger pain medications, such as opioids, or a higher dose of NSAIDs. After speaking with Stephanie, she agrees to stay on etanercept for a few more months to see how she is progressing. You write an email discussing Stephanie’s use of etanercept during pregnancy and explaining the risks versus benefits of using this medication in pregnancy. You begin to discuss other pain management options as well.  

• How would you discuss Stephanie’s pain management concerns regarding psoriatic arthritis during pregnancy?  

• How would you explain to Stephanie the influence of lifestyle, such as sleep, diet, pregnancy, and environment, on psoriatic arthritis and inflammation?  

• What side effects would you educate Stephanie on?  

• How would you educate Stephanie on self-monitoring while on a new medication? 

Stephanie returns to the office at 36 weeks pregnant, and she reports doing fine with the etanercept and not using NSAIDs as often. She reports no issues with her pregnancy and that her joints in the hands are still inflamed, but not so much lately. She has been doing yoga weekly, swimming a few times a week, and meeting with a physical therapist who specializes in maternal and pregnancy care. She’s at the office before delivery for options on medication management postpartum and breastfeeding since she would like to breastfeed her infant. She also would like to know if she can resume NSAIDs or go back to methotrexate while breastfeeding.  

• Knowing her concerns, what are some possible other pharmacological and non-pharmacological management options for Stephanie’s psoriatic arthritis during her last weeks of pregnancy and early postpartum? 

• Stephanie might benefit from a referral to which other specialists? 

• How would you counsel Stephanie on breastfeeding with joint inflammation in her fingers in case of a flareup?  

Conclusion

Psoriatic arthritis pain and mobility management is a complex process for people. While there are several medical interventions and guidelines, psoriatic arthritis pain and mobility can vary in clinical presentation and response to therapies person to person, making this condition extremely personalized in management, assessment, and care. Psoriatic arthritis management is often a lifetime process that involves several medical interventions, assessments, follow-ups, therapies, appointments, medications, and people professionally and within one’s social circle. Education and awareness of different pain and mobility management options and different clinical presentations of psoriatic arthritis can influence the lives of many people in a healthy way. 

➁ Complete Survey

Give us your thoughts and feedback

➂ Click Complete

To receive your certificate