Meet Donica Baker, The PsA Rheum You’ve Been Looking For!

Psoriatic arthritis (PsA) is a unique and complex condition. With an often challenging diagnosis process and difficult search for an effective treatment, cultivating a strong and supportive relationship with a rheumatologist is important. Unfortunately, it is not always easy. Many community members with psoriatic arthritis wish that their rheumatologist could better understand the effects of PsA on so many aspects of their lives.

That is why we are excited to highlight Dr. Donica Baker, a board-certified rheumatologist and author of the book, "The Psoriatic Arthritis Roadmap," to share her knowledge and expertise in helping people with psoriatic arthritis manage their condition holistically.

What is your background and experience working with individuals with psoriatic arthritis?

"I started becoming interested in musculoskeletal conditions and patient mobility when I was a kinesiology major at the University of Michigan in Ann Arbor. I was pre-med but didn't want to do the regular microbiology biochemistry. I continued to have an interest in musculoskeletal conditions and then became interested in arthritis and autoimmune diseases as well. So I started working with patients with psoriatic arthritis when I was doing rheumatology rotations and my rheumatology fellowship."

Can you speak to the uniqueness of this condition?

When reflecting on the uniqueness of psoriatic arthritis, Dr. Baker says, "It really impressed upon me that whereas the other types of arthritis sometimes seemed invisible, psoriatic arthritis had visible symptoms too. So not only did patients feel terrible in terms of their joints and pain levels, but they also were faced with that visible aspect.

One patient shared with me, 'All my grandchildren are scared to touch me because they think it's some kind of, like, skin disease or skin infection that is contagious.' I think people see these skin and nail symptoms and assume a person doesn’t take care of themselves or they are not healthy. They don't know or understand that it's like an autoimmune condition that can't necessarily be controlled."

What inspired you to write your book specifically for those with psoriatic arthritis?

"The idea came together when my patients started asking about holistic or natural aspects of managing their condition outside of just the typical medications."

After researching, Dr. Baker thought a book summarizing what she found – holistic approaches and traditional treatments – could be a helpful resource. In the book, she also explains how a psoriatic arthritis diagnosis is made and the symptoms of the condition. At the time of writing in the pandemic, with a lot of patients immunosuppressed from their biologics and autoimmune diseases, she decided to add a section about vaccines, boosters, and protecting the immune system. "In the end, it just turned out to be a book that I wanted to share with people and put out there."

Receiving an official PsA diagnosis does not come easy. What has your particular process looked like when it comes to officially diagnosing someone?

When it comes to a PsA diagnosis, Dr. Baker stresses the importance of starting with a person’s story of when they began experiencing their symptoms. "Sometimes people have had the psoriasis plaques for years and years and years, and then they never had joint pain until maybe just several months ago. The time course is so different for everyone. Some people have skin symptoms and arthritis starting at the same time."

Next, Dr. Baker learns more about their joint pain and swelling. She also looks out for symptoms like dactylitis, which is unique to psoriatic arthritis, enthesitis, and any nail changes.

Getting a set of labs to see whether their inflammatory markers are elevated and whether they have the genetic marker is also an important step. Labs also can rule out an overlap syndrome for other kinds of arthritis to make sure someone doesn’t have 2 types of arthritis at the same time.

Additionally, Dr. Baker will request X-rays of the joints that the patient is really suffering from. These often include hand X-rays, foot X-rays, and the lower back as well. "In the end, I put that all together with the history, the physical exam, the lab results, and the X-rays, and then I see what the nature of their arthritis is and what the best course of treatment would be for that individual."

Could you talk a little bit about the emotional impact of receiving a PsA diagnosis? What would you tell someone experiencing these emotions?

"Usually, I call them about their lab. I share the goal of what we were looking for, including a reason for their pain. Sometimes I share it in terms of good news and bad news. So sometimes I say the bad news, it looks like you do have psoriatic arthritis. The good news is that we have identified something that explains your pain and symptoms. We can start treating it and get you on a journey of healing.

Sometimes they're excited because even though they have this arthritis that nobody would want, at least it has been diagnosed, and we can start treatment. I think some people are relieved when they know that they have answers. For patients with chronic pain and fatigue, not having an answer can sometimes be more devastating and frustrating."

How can we cope with the grief of a PsA diagnosis?

This is also a topic Dr. Baker discusses in her book, "I talked about certain cognitive thought process changes we could use for grief. These thoughts were focusing on what you have and not what you don't have or focusing on the present and not the past or future. For example, one of them is focused on what you can do and not what you can't do.

A lot of my patients like gardening. So, something you could kind of say to yourself is, I can't do gardening all day long like I used to do, but I can garden in short spurts and find new hobbies that I enjoy doing or focus on the present and not the past or future. You could be worried about what joint progression would look like in 20 to 30 years but still choose to live today the best way one can, even with arthritis."

It is important to both acknowledge the sense of loss, while looking for ways to stay positive. "Yes, your life has changed, and what a bummer it is to take these medications, probably at a young age, that other people may not have to take. I definitely witness the sense of loss and grief over diagnosis. So I think it's really tough."

In your book, you speak a lot about caring for the holistic self. What sort of lifestyle changes do you recommend or find most helpful for your patients?

Dr. Baker notes that many of her patients are very sensitive to stress, so managing stress levels is very important. "Stress management is a huge part of psoriasis and psoriatic arthritis because it can become a vicious cycle. As you become stressed and your skin and joints flare, then you feel even more terrible, and then that causes more stress from having a flare."

What are tips to help with stress management?

With stress being a common trigger, Dr. Baker shares some actionable stress management tips, "Taking time in the morning before going to work or school to ground yourself with 5 minutes of stretching or yoga, preparing yourself mentally for a positive day or saying to yourself, 'no matter what happens today or what other people do, I'm going to just try my best to stay on a positive note.'

In the evening too, before going to bed to get yourself ready for rest, go back to the 5 minutes of stretching or yoga again to calm yourself and tell yourself that it's time to slow down your thoughts and calm your body."

How does diet play a role in PsA management?

When it comes to diet, she shares how she has been working towards increasing vegetable consumption, and reducing processed foods or too much meat. Of course, it is not always so simple, "I think it's really tough to do a complete overhaul and sometimes I even get so frustrated with eating healthy... it's not so much overhauling your entire fridge or entire diet, but just making small changes here and there."

Some small changes Dr. Baker has made include swapping regular white flour for almond flour when baking, "which makes it gluten-free since many are sensitive to gluten. But it also had more protein and less processed simple carbs. It was also more keto friendly." And then switching sodas to sparkling waters "because I really liked the bubbly fizzy sensation of it, but then it didn't have the sugar and the chemicals in it, so those seem like they were doable for me. I could give up one for the other and it would still be okay."

Looking for more insight from Dr. Baker?

Working with a rheumatologist for psoriatic arthritis isn’t always easy. But we hope Dr. Baker’s answers can reveal some more insight and considerations to bring to your next rheumatology appointment. More information from Dr. Baker can be found in her author archive.