Practice Perspectives on Optimal Patient Care in the Management of Psoriatic Arthritis - Episode 5

Psoriatic Arthritis Triggers

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John Tesser, MD; Nehad Soloman, MD; and Jennifer Simpson, DNP, discuss the common triggers patients with psoriatic arthritis and the importance of stress management.

John Tesser, MD: What things trigger flare-ups in these people? Jen, have you been able to identify certain environmental stresses or other factors?

Jennifer Simpson, DNP: I was just going to say stress. Stress in general. Really anything that stresses your immune system could trigger autoimmune disease in the first place, let alone trigger a flare. I mean, life is stressful, right? It’s easier said than done when you ask a patient to do stress reduction. I think there are certain ways that we take interest as humans, we can overreact to stress vs taking stress from a calmer perspective. And that’s more or less just something that as we get older, as adults, we kind of just have to learn how to choose our battles with things and not let every stress get under our skin because, otherwise, you’re just not going to be a happy person. If you have psoriatic arthritis or another autoimmune disease, then you can trigger a flare-[up] and cause worse issues. I think for our patients, it’s giving them the knowledge, and if you have the knowledge, you have power, right? Making them feel like they have control over that. They have the power to decide how they want to perceive this stress and knowing that if they perceive it worse, they are going to feel worse. So, hopefully, they take that in when they deal with any stress that comes at them which can be any number of things we deal with every day.

John Tesser, MD: Certain things can be modified to an extent or controlled and other things can’t. I mean, you can’t control if you’re going to be in a car accident or if you’re hit with an infection and all of those types of things. But mental stress, or social stress, there’s some ability there. I can’t tell you how many prescriptions for stress reduction I’ve written and that sort of goes over as a weak joke when I talk to my patients. But I do mention the notion of mind-body disciplines. I do talk to them about deep breathing exercises, and meditation, and steer them towards meditation apps [applications] they can get on their phone. And basically just getting outside and walking, especially walking around things that are green; parks and gardens and having green plants around. There’s an interesting science behind green light frequency that has a distressing effect on the central nervous system, so I do mention this. But, clearly, getting out walking and just being outside and getting the exercise is 1 way to approach this.

This transcript has been edited for clarity.