The connection between psoriatic arthritis (PsA) and anxiety is a two-way street. Anxiety and stress can worsen PsA symptoms, but the reverse is also true: PsA can impact your mental health.
Research shows that joint pain and inflammation from PsA can impact your confidence and your quality of life.
There is also evidence that cytokines, a type of proteins released by your body’s cells, play a role in both PsA inflammation and symptoms of depression and anxiety. So there’s a reason you might feel both anxious and inflamed.
Still, there are ways to manage social anxiety with PsA that create a positive feedback loop. Research in 2021 found that managing anxiety and depression made it possible to minimize the effects of PsA.
Physical and psychological symptoms
PsA and the resulting inflammation can cause a wide range of physical and psychological symptoms.
Some of the physical symptoms of PsA are:
- fatigue
- painful and inflamed tendons
- swollen fingers and toes
- joint pain and stiffness
- reduced range of motion
- nail changes
- eye redness and pain
Anxiety symptoms that may affect people with PsA include:
- anxious thoughts
- restlessness
- rapid heart rate
- dizziness
- shortness of breath
- sleep disturbance
- social withdrawal
- fatigue
- muscle aches
Symptoms of depression include:
- sadness
- irritability
- hopelessness
- fatigue
- trouble with concentration
- sleep disturbance
- appetite changes
- physical signs like headache and digestive issues
- thoughts of suicide
It’s a bit of a vicious cycle, because physical and mental symptoms can intensify each other. For example, some research suggests stress may cause PsA flares, which can create anxiety, which can feed into depression. In turn, depression can worsen the impression of pain, according to a 2003 research review.
Mood disorders are more common among people with PsA. A 2014 study found that rates of depression were higher among people with psoriasis than in the general population — and that rates were even higher in people with PsA.
A 2020 review found that 51 percent of people living with PsA may experience depression.
Fatigue resulting from PsA sleep disturbance and pain is associated with anxiety and depression, according to research from 2020. Anxiety and depression can also contribute to fatigue.
It’s no surprise that these complications can all impact your social functioning.
Social anxiety
When PsA affects your ability to enjoy time with friends, social events, and travel, you can miss out on an important outlet. Social interaction is essential for your well-being. We are people who need other people! But sometimes other people can cause anxiety.
A 2017 study on PsA’s close sibling, psoriasis, offers some insight into social triggers that likely apply to both conditions. The study found that the age of disease onset affected its influence on social anxiety.
For people diagnosed with psoriasis in adulthood, the primary cause of social anxiety was concern about their appearance. For people diagnosed before age 18, stigmatizing experiences mattered the most.
Regardless of which applies to you, PsA can increase social anxiety and make you self-conscious about your appearance.
How you feel about the way you look might not seem important until you consider the impact it has on your social support system.
Finding the confidence to get out there socially can make a huge difference, as you will see from these tricks of the trade.
Self-confidence tactics
There are things you can do to feel better emotionally, regardless of the physical effects of your PsA.
Fantastic, right? So let’s look at some ideas.
Therapy
Talk therapy can help you change the thought patterns that are undermining your confidence.
There are many different types of therapy, but cognitive behavioral therapy (CBT) has been found effective at helping to improve social anxiety. This goes for in-office visits and CBT appointments held online with therapists.
The CBT techniques you may use include reappraisal of your negative thoughts and exposure therapy.
Further, a 2020 study involving CBT looked at the connection between inflammation and psychiatric disorders. CBT didn’t reduce the levels of inflammation-causing cytokines, but participants experienced improvements in their anxiety.
You can start by asking your doctor for advice or asking a friend who has already found an effective practice. There are also search tools, like the Anxiety & Depression Association of America’s therapist directory, that allow you to filter for people who specialize in chronic illness.
Medication
If you’re taking medication to treat your PsA, you might feel reluctant to add another prescription to the mix. However, there could be a safe and effective option that helps you feel better if anxiety is interfering with your daily functioning.
A 2017 review found some evidence that selective serotonin reuptake inhibitors (SSRIs) helped with diagnosed social anxiety disorder. These meds alter chemicals in your brain, affecting mood and emotion.
SSRIs are typically prescribed by a primary care doctor or a psychiatrist. Often you start with a low dose. You should not stop taking the medication without talking with your doctor.
Exercise
Exercise has been shown to reduce joint stiffness, pain, and fatigue in people with PsA. It’s also a great way to improve your mood.
Low impact options to consider include:
- walking
- strength training
- swimming
Nutrition
Eating well and adjusting your diet may ease PsA symptoms and improve your mood, but the diet that works best for you might not work for everyone with PsA.
A 2018 review of studies on diet and PsA gave only weak recommendations for any given diet in helping with symptoms. The researchers warned that studies generally used low quality data.
In cases of obesity and overweight, the researchers recommended diets designed for weight loss.
A 2019 study of Swedish people with PsA found that short-term weight loss helped reduce symptoms. However, side effects included severe constipation, hair loss, and low blood pressure. The link between weight and PsA is not straightforward.
Connection
It can help to connect with other people who can listen to your story and issue a cathartic “SAME!”
The National Psoriasis Foundation has a peer support program called One to One for people living with psoriasis and psoriatic arthritis.
Healthline also has Bezzy PsA, a private forum where people with PsA can connect.
Intention
Research suggests that self-critical behaviors can make it harder to manage PsA.
Positive beliefs and determination are important parts of a successful mental health strategy for managing chronic pain, according to people interviewed for a 2018 study. So are support people like family, friends, and your medical team.
Being realistic about what you can accomplish can also help you put your condition in perspective and pace yourself.
tl;dr
So, there you have it — how you feel matters with PsA. Symptom management is important not just for your physical health, but for your emotional well-being too.
Medication and therapy can help if social anxiety is interfering with your everyday life. Self-care techniques can help you adjust your expectations and perspective on living with the condition and connect with others. Social support and connection can, in turn, become an important piece of your PsA care plan.
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