Is Depression Making Your Psoriatic Arthritis Worse?

When it comes to psoriatic arthritis (PsA), depression and anxiety can make managing the disease much more difficult.

“We all want our patients to get to remission or have minimal disease activity, but depression and anxiety are important factors that prevent that from happening,” says Vinod Chandran, MD, PhD, a rheumatologist and clinician-scientist at the University of Toronto, the co-director of the psoriatic arthritis program at the University Health Network, and a co-author of that study.

The Toll on Emotional Well-Being in People With PsA

“These issues should be addressed by clinicians when managing patients with psoriatic arthritis,” says Chandran.

How Depression and Anxiety May Fuel Psoriatic Arthritis Pain

Although no research has proved a cause-and-effect relationship between depression and psoriatic arthritis, PsA pain can heighten depression. Conversely, when a person is depressed, he or she may not take care of their health by exercising, for instance, which can make psoriatic arthritis symptoms worse.

“I tell people that depression and anxiety are not the only reason for their pain, but it’s like squirting [lighter] fluid on a campfire — it just makes the flame grow bigger,” Smith says.

Stanford Shoor, MD, a clinical professor of medicine and rheumatology at Stanford University in Palo Alto, California, explains that depression and anxiety can also lower a patient’s pain threshold.

“Pain is in the mind of the beholder,” he says, “and depression and anxiety can make the same amount of inflammation present in a joint feel worse. It’s very important to determine whether the discomfort a person feels is actually from the inflammation or if it’s more related to processing the pain — and depression and mood play a role in that.”

Recognizing Serious Mental Distress and Getting Help

Smith notes that he sometimes works with a psychologist who can provide specialized support for patients who are grappling with mental health or psychological issues.

“We have to address the patient as a whole person rather than just a handful of joints and some skin changes,” he says.

While Dr. Shoor emphasizes that psoriatic arthritis is “not just a body disease — the mind plays a role,” he points out that rheumatologists are not experts in the treatment of depression. If he believes a person needs mental help, Shoor may suggest they see a therapist or possibly a psychiatrist.

Patients who are proactive may also find emotional support among social groups of other psoriatic arthritis patients. The Centers for Disease Control and Prevention provides links to self-management education workshops that can help teach you how to cope with arthritis symptoms and maintain healthy behaviors.

• Persistent sad, anxious, or empty mood
• Feelings of hopelessness, pessimism
• Loss of interest or pleasure in hobbies and activities
• Lower energy, fatigue, feeling slowed down
• Difficulty concentrating, remembering, or making decisions
• Insomnia, early-morning awakening, or oversleeping
• Decreased appetite and weight loss or overeating and weight gain
• Restlessness or irritability

Including Mental Health as Part of Comprehensive Care

Chandran believes that clinicians need to not only focus on therapies that can suppress joint inflammation but also expand care to a more multidisciplinary approach.

“Comprehensive management of PsA should include measures for addressing anxiety and depression so that more patients achieve a state of MDA,” his study concludes.

Identifying and treating depression takes a multi-team approach working with your rheumatologist, primary care providers, as well as behavioral and mental health professionals.