The Emotional Effects of Psoriatic Arthritis

Psoriatic arthritis decreases a person’s quality of life and can cause significant emotional distress in patients. The chronic pain and impact of the disease on mobility, daily functioning and ability to work takes a significant toll on people with PsA, and many people with psoriatic arthritis report feeling frustration, depression, embarrassment, and fear, which are exacerbated by fatigue and loss of normal function.^1,2

Characteristics of mood changes in psoriatic arthritis

In addition to the frustration and fear of dealing with a chronic condition, people with psoriatic arthritis are twice as likely to be depressed as those with psoriasis alone, and they are also more likely to have clinical depression and anxiety. Depression and anxiety in psoriatic arthritis patients are highly associated with unemployment, severe disease, disability, pain, and fatigue.³

Depression has several symptoms, not all of which are experienced by every patient. Symptoms of depression can range in severity and may vary over time. Common symptoms of depression include:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies or activities, especially those which were previously enjoyable
• Decreased energy or fatigue
• Difficulty concentrating, remembering, and making decisions
• Difficulty sleeping, early-morning awakening or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide
• Restlessness, irritability
• Persistent physical symptoms⁴

If you are experiencing thoughts of suicide, please contact a suicide hotline or seek emergency medical assistance immediately.

Generalized anxiety disorder is characterized by excessive anxiety or worry over several months. Patients with generalized anxiety disorder may experience symptoms such as:

• Restlessness, feeling wound-up or on edge
• Fatigue
• Difficulty concentrating or having their minds go blank
• Irritability
• Muscle tension
• Difficulty controlling the worry
• Sleep problems, such as difficulty falling or staying asleep, or restless or unsatisfying sleep⁴

How are mood disorders diagnosed?

Many patients with psoriatic arthritis are under the care of a rheumatologist, as well as a dermatologist for psoriasis. Mood disorders like depression and anxiety are often undetected by these specialists, who are focused on the disease on the joints and the skin. Patients who are experiencing symptoms of depression or anxiety are encouraged to seek mental health care through a psychiatrist. Many patients with psoriatic arthritis may benefit from seeing a mental health counselor or therapist. Counselors and therapists can provide coping skills to help psoriatic arthritis patients deal with the psychosocial and emotional aspects of living with a chronic, painful disease.^2,3

How are mood disorders treated?

Mood disorders like anxiety and depression are treated with psychotherapy (or “talk therapy”), medications, or a combination of therapy and medication. Research studies have demonstrated a better outcome when patients receive both therapy and medication compared to those receiving treatment with just one or the other.⁴

A psychiatrist or primary care physician can prescribe antidepressants or anti-anxiety medications. These medications often take several weeks to start working. As with all medications, antidepressants and anti-anxiety drugs have side effects. Patients should discuss any possible side effects and the risks and benefits of each drug with their physician.⁴