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Treating Psoriatic Arthritis

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PHYSICIAN VOICES
Managing Psoriatic Arthritis: What I Want My Patients of Color to Know

Medically Reviewed By Alana Biggers, M.D., MPH

As a rheumatologist, I treat People of Color with psoriatic arthritis. Many of my patients receive late diagnoses, because People of Color are less likely to see a specialist early on who can make a proper diagnosis. This is a result of a variety of factors, including the fact that they’re less likely to be referred to a specialist by their primary care doctor. Despite the challenges, I want People of Color with psoriatic arthritis to feel empowered to overcome obstacles. 

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1. Find the right doctor

A rheumatologist is a doctor who specializes in treating psoriatic arthritis. However, there is a rheumatologist shortage in this country, and there may not be a rheumatologist near where you live. However, it is important to see a rheumatologist who is comfortable prescribing the most up-to-date treatments. If there are no rheumatologists in your area, specialists who offer virtual visits or less frequent visits may be willing to help manage your psoriatic arthritis alongside your primary care doctor.

People of Color who stay in primary care for the treatment of their rheumatic conditions may be prescribed medications that only treat the symptoms of psoriatic arthritis, without delaying the progression of the disease. They also may overly rely on steroids, which are not actually helpful for psoriatic arthritis. If you can, try to get a referral to see a rheumatologist, because they will be the doctor best suited to help you manage your condition.

In rheumatology, very few specialists are People of Color, but we do know that when patients see culturally congruent physicians, they feel more heard and receive more comprehensive care. Since diversity in the rheumatology workforce is limited, allyship is key. Look for a doctor who listens to you, who is aware of their own biases and makes an effort to stay open and empathetic to your unique experience.

When it comes to criteria for the “right” doctor, there are tangibles and intangibles. When you think about tangible criteria, ask yourself: am I getting appropriate screening? Are my X-rays being done on an annual basis? If I’ve been on steroids, is someone checking my bone density? Am I receiving a full physical exam every time I see the doctor? If I’m taking certain drugs, am I getting laboratory monitoring I need?

The intangibles are found in the doctor-patient relationship. Do you feel that your doctor has empathy for you? Do you feel like your doctor takes your concerns seriously? Do they spend enough time describing your condition and treatment choices? Do you have a good understanding of your disease and your treatment plan?

If you don’t feel like you’re being heard, you don’t fully understand your care, or you aren’t receiving the tools and education you need to take care of yourself at home, then you may not have the right doctor. 

Treatment success is important, as well. If you keep coming to your doctor’s appointments with the same concerns and no one is changing your medication despite the fact that you still have other options available, that might not be the right doctor for you. Receiving a disease-modifying medication is key; that means the drug is affecting how your disease progresses, not just easing symptoms. The more that your inflammation goes unchecked, the more your joints may be injured, and the more likely it is that you’ll experience a disability.

2. Connect with a healthcare team

I recommend finding a doctor who works in a center where there is a team of health professionals. Social workers, physician assistants, dietitians, physical therapists, and other experts can be a part of your team and provide you with holistic care that centers on your wellbeing. They’ll also help you navigate any challenges with insurance and receiving your medications. For example, a pharmacy care specialist is a care team member who can handle prior authorizations and insurance coverage appeals. That can make a big difference, because it means the burden is not only on the physician; there’s an infrastructure that will work to help get you the right medication.

3. Set yourself up for success in appointments

I always tell my patients to keep a journal of their symptoms. Often, patients may feel intimidated when they’re in the exam room and talking to the doctor, and they also may feel rushed. They don’t always bring up everything that would be helpful to know. And they may not remember everything that affected them in the months prior. 

When you come in with a journal tracking your symptoms, you have so much information at your disposal to rely on. When you’re home without the pressure of the doctor’s office, you can think of and write down questions to ask later. You can list symptoms and notice patterns over time. Then, once you’re talking to the doctor, you have something to refer to.

I also recommend that patients bring loved ones to their appointments. Often, that person will be able to speak up in times where you can’t. They may feel more comfortable in the environment and they may remember something you don’t think of at the time. They can help you feel more grounded so you can have more confidence to advocate for yourself.

4. Prioritize mental health

It’s extremely important to focus on your mental health and address any challenges you’re experiencing. Most of your disease management is done by you; you’re only in the physician’s office a few times a year. You need to be able to take care of yourself fully, and if your mental health is suffering, it’s harder to care for your psoriatic arthritis.

We also have to acknowledge the ways in which chronic illnesses like psoriatic arthritis affect mental health. Many people with the condition, especially those who live with significant disability, may not be able to do things they used to; they may not be able to work or get around or be as social as they once were. Those are tasks that give us self-esteem and a purpose in life. 

Patients often have to reframe what it means to live their lives when they’re grappling with an illness like this. Mental health counseling can be crucial in this scenario. At the very least, talking with a therapist occasionally can serve as a check-in. So often, you’re caring for your disease and life just rushes by. It’s helpful to slow down and check in with yourself to really see how you’re doing. 

Beyond counseling, there are many support organizations and groups that can help people living with psoriatic arthritis. At my hospital, we offer tons of resources, like patient groups, peer mentors, and other tools to help people feel supported from all angles. Your doctor can share resources like this with you, and you can also find community online or in your area.

Living with a condition like psoriatic arthritis is hard. Learning how to manage the disease and accepting this new version of your life can be a challenge. I want patients to know their lives don’t have to stop; they don’t have to completely avoid what they were doing before, but life may just look a little different. You can still live a very fulfilling life with psoriatic arthritis, especially if you have the right doctor and lots of support.

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Medical Reviewer: Alana Biggers, M.D., MPH
Last Review Date: 2023 Jul 31
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.