• Stress can contribute to worse psoriatic arthritis (PsA) symptoms.
• Stress-management techniques may help to reduce stress-related psoriatic arthritis flare-ups and symptoms.
• Exercise, relaxation techniques, and improved sleep hygiene can help reduce stress.

Stress can create a complicated cycle for people with chronic inflammatory conditions such as psoriatic arthritis. Navigating doctor visits, treatment options, medical bills, and symptoms of a chronic condition can all cause stress. In turn, increased stress levels could worsen psoriatic arthritis symptoms, such as joint pain and fatigue. Managing stress is very important for maintaining a good quality of life, especially if you have a condition like psoriatic arthritis.

Doctors and researchers are working to better understand the connection between stress and conditions like PsA. Scientists are also studying how different stress-reduction techniques could help to decrease psoriatic arthritis features, including joint pain and inflammation. Stress-management techniques provide a practical way to potentially disrupt the cycle between stress and psoriatic arthritis.

The Relationship Between Stress and Psoriatic Arthritis

Psoriatic arthritis occurs when the immune system mistakenly attacks healthy cells and tissues, leading to inflammation, swelling, and stiffness in the affected joints. It is caused by a combination of genetic and environmental factors. Stress has the potential to worsen symptoms and cause flare-ups.

Stress can contribute to psoriatic arthritis in several different ways. During a stress response, muscles in the body tense up. If someone experiences constant stress, they may also experience constant muscle tension, and this process can increase arthritis pain.

Additionally, stress can affect the immune system and trigger an inflammatory response. Long-term exposure to stress can result in chronic inflammation, which worsens PsA and damage to the joints.

Psoriatic arthritis can also affect stress levels. Research studies have found that people living with psoriatic arthritis report having constant low levels of stress. Living with and managing symptoms of psoriatic arthritis may cause stress. Moreover, some people report that visible symptoms of psoriasis, such as skin plaques, make them feel self-conscious, which also can contribute to stress. Additionally, psoriatic arthritis symptoms fluctuate, so their unpredictability and potential for sudden onset may also contribute to feelings of stress.

Members of MyPsoriasisTeam are familiar with the troubling cycle between stress and psoriatic arthritis. Many relate to the feeling that stress worsens their psoriatic arthritis and vice versa. “It took a long time to realize that stress causes flare-ups more than flare-ups cause stress,” one member wrote. “It’s a terrible cycle, but I decided to attack the stress. More gym, meditation, and trying to not let stress get the best of me. Seems to be working.”

Another member commented, “Stress is one of my biggest causes for a flare, especially with my PsA.”

Although stress can become overwhelming at times, there are a wide variety of tools and techniques that may help to reduce stress-related PsA flare-ups and symptoms. Stress-management techniques are tangible lifestyle habits that can improve your quality of life and overall well-being.

5 Techniques for Reducing Stress

There are many different coping strategies that are helpful for managing stress. Here are just a few that you can test out.

1. Exercise

Exercising causes the body to release feel-good chemicals called endorphins that help reduce feelings of stress. Engaging in exercise may be difficult if you have symptoms such as pain and fatigue, but you don’t need to exercise very intensely or for a long period of time in order to gain its benefits.

The National Institute of Mental Health suggests that 30 minutes of walking each day can help to improve mood. If 30 minutes feels like too long, start with a shorter duration and slowly increase. Make sure to talk to your health care provider before starting any new exercise routine. They can help you determine what exercises are safe for you or refer you to a physical therapist.

In addition to improving mood and reducing stress, physical activity can also help you directly manage symptoms of psoriatic arthritis, such as pain and inflammation. Physical activity also can help reduce the risk of developing related conditions, including heart disease.

MyPsoriasisTeam members have recommended swimming as a gentle form of exercise. “I love going to the pool. It also helps my back which I have problems with,” one member wrote.

Before swimming in a pool, you should first test that your skin isn’t sensitive to chlorine, as the chemical could cause itching and affect existing psoriasis plaques.

2. Try Relaxation Techniques

Relaxation techniques such as meditation and mindfulness are useful for reducing stress and managing chronic disease. They help by calming your body and mind, allowing you to organize your thoughts, and instilling a sense of inner peace. Meditation and mindfulness are also low-cost and relatively easy to incorporate into your daily life.

“I’ve been taking the opportunity to switch off from work over the weekend by lying in the sun and listening to music and mindfulness meditations,” one MyPsoriasisTeam member posted.

Mayo Clinic suggests several techniques for relaxation and stress relief, like:

• Meditation
• Guided imagery
• Visualization
• Deep-breathing techniques

Digital apps such as Headspace and Calm are popular resources for different types of meditations to improve mental wellness. Other relaxation techniques — like yoga or tai chi — incorporate movement, and different classes and tutorials can be found online or at local fitness centers.

3. Consider Your Stressors and Set Boundaries

There are many sources of stress that are out of our control, such as a family tragedy or a natural disaster. There are, however, other stressors that we do have some level of control over. One of the most useful tools for stress management is the process of identifying your stressors, realizing what you can and cannot control, and establishing personal boundaries.

First, make a list of things that cause you stress or worry. Next, ask yourself which of these things you have control over (like preparing dinner or making weekend plans) and which ones you don’t (like a winter storm or economic changes).

As you assess the items on your list, cross out the things that you don’t have control over. For the remaining items — those you do have control over — ask yourself some questions:

• Is it necessary that I complete all of these tasks?
• Do I need to complete all of these tasks today, or even this week?
• Is it reasonable to ask family or friends for help with these tasks?

Additionally, learning how to say no to requests or tasks can also help you manage your stress. You have a limited amount of time and energy each day, and managing a chronic disease like PsA might further limit your capacity. Prioritize doing things that are important to you, and consider saying no to things for which you do not have the time, energy, or interest.

Setting boundaries can be difficult at first. One MyPsoriasisTeam member wrote, “I am, unfortunately, a bit of a people pleaser and have to be reminded it’s OK to say no and set boundaries.”

4. Improve Sleep Hygiene

Getting quality sleep is important for managing stress. Unfortunately, that can be difficult if you have psoriatic arthritis. Research studies have shown that psoriasis and psoriatic arthritis can cause sleep disturbances, due to symptoms like joint pain and itching throughout the night.

Difficulty sleeping is a common topic of discussion for MyPsoriasisTeam members: “I hurt and ache all night, making it impossible to rest.”

“I didn’t fall asleep until 3 a.m. because of my joints and skin being so sore and so itchy,” another member wrote.

Getting quality sleep will help you to manage your stress levels. Following are some tips for improving your sleep:

• Avoid electronic devices, such as phones and computers, before bed.
• Avoid caffeine, alcohol, and large meals several hours before bed.
• Establish a relaxing bedtime routine.
• Keep a consistent sleep and wake schedule.

5. Seek Professional Help

Sometimes, the stress of life with psoriatic arthritis can become overwhelming, and it’s OK to seek professional help if you feel like you need it. If stress starts to interfere with your daily life and responsibilities and your self-care and stress-management techniques aren’t enough to help you, it might be time to reach out to a counselor, therapist, or doctor.

“Seeing a psychologist has helped me,” a MyPsoriasisTeam member shared. “As a nurse, I tried to manage it myself and found it was OK to need some help with my mental well-being.”

Counselors and therapists often help people when their burden of psychological stress has become too heavy. They can provide professional advice and practical tools to help you manage stress. Your health care provider or rheumatologist may be a great resource for managing stress. They might have helpful stress-management suggestions and tools that they recommend specifically for people with psoriatic arthritis.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis and their loved ones. On MyPsoriasisTeam, more than 112,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis and psoriatic arthritis.

Are you living with stress and psoriatic arthritis? Share your experience in the comments below, or start a conversation by posting on your Activities page.