People with Psoriatic Arthritis (PsA) often wake up so stiff that they are barely able to move. Some people require assistance just to get out of bed in the morning. It is not “arthritis” in the way most people think of arthritis, such as the wear-and-tear arthritis many older adults develop with age. A more accurate medical description would be an autoimmune inflammatory spondyloarthropathy rather than simply “arthritis.” That wording helps people understand that it is a systemic inflammatory disease, not just age-related joint wear and tear.
Since the word “arthritis” can be misleading, many doctors and organizations now use the broader term “Psoriatic Disease.” And just in case you are wondering, it is possible to have Psoriatic Disease without having obvious or active psoriasis at the time. For some people, visible psoriasis appears later in the course of the disease, while for others it may only become active or noticeable during certain periods of their lives.
Most doctors and researchers believe Psoriatic Arthritis and Psoriatic Disease are caused by a combination of genetics, immune system dysfunction, and environmental triggers. In simple terms, the immune system becomes overactive and mistakenly attacks the body’s own tissues, especially the joints, tendons, spine, skin, and the areas where tendons attach to bone.
There is also a strong genetic component. Many people with PsA have family members with psoriasis, rheumatoid arthritis, autoimmune diseases, or other inflammatory conditions. Certain genes, especially HLA-B27 in some patients, are associated with more spinal involvement and inflammatory disease.
There are also triggers that may “switch on” the disease in someone who is genetically predisposed. These can include:
• Severe stress or trauma
• Infections, especially strep infections
• Illnesses
• Physical injury
• Hormonal changes such as puberty, pregnancy, perimenopause, or menopause
• Sometimes surgery or major illness
Psoriatic Disease is not caused by aging, “wear and tear,” laziness, lack of exercise, poor diet, or simply “getting older,” even though many people still misunderstand it that way. While there are medications that help many people, some can come with serious long-term side effects for certain patients, including increased infection risk, kidney issues, gastrointestinal problems, fatigue, or cognitive side effects often described as “brain fog.”
Many people with Psoriatic Arthritis put off trying medical treatments because of concerns about side effects and because they fear the medications will completely destroy their immune system and leave them vulnerable to every illness around them. That is not exactly how these medications work.
With PsA, the immune system is overactive and mistakenly attacks the body’s own tissues. Many of the medications used to treat PsA are designed to calm parts of that overactive immune response and bring it closer to normal levels.
Yes, some of these medications can increase the risk of certain infections, and doctors do monitor patients carefully for things like tuberculosis and other opportunistic infections. However, taking these medications does not mean someone will automatically catch every illness they are exposed to or need to live in complete isolation out of fear of getting sick.
In addition to NSAIDS, DMARDs, and biologics, the thing that helps the most is gentle movement, even though movement can be extremely painful at first. It does not have to mean walking a mile or doing intense exercise. Simple walking, stretching gently, and moving around the house can help as much as anything else.
Doctors often use morning stiffness as one way to gauge how active PsA is. If stiffness improves within about 20 minutes, it is often considered milder disease activity. Stiffness lasting around 45 minutes may suggest moderate disease activity. Stiffness lasting longer than 45 minutes can point to uncontrolled disease or a significant flare. The key is to keep moving, even when we are stiff, exhausted, and in pain.
We often wake up exhausted before the day even begins. Simple tasks like showering, getting dressed, brushing our teeth, holding a phone, brushing our hair, typing on a computer, opening jars, or even walking can become painful during flares. Even so, there is no choice except to keep moving when we first wake up and then rest when needed throughout the day.
The stiffness and pain also become worse if we stay in one position for too long. Things like long car trips, air travel, standing in line, sitting at a desk all day, or even staying in bed while sick with something like the flu or COVID can significantly increase stiffness and pain. Getting too cold or sitting directly in the path of a fan or air conditioner can also make the stiffness and pain worse.
We learn to keep smiling and showing up for others, even when we are quietly struggling with pain and fatigue, because living in complete isolation can sometimes feel even worse than the pain and fatigue. After a while, friends and family sometimes begin to expect this from us, even during severe flares.
But there are also times when we simply cannot do it. We cannot shower. We cannot cook. We cannot open jars or cans. Sometimes we cannot even walk safely because the stiffness, weakness, pain, or fatigue make us too likely to stumble and seriously injure ourselves.
Why do we push through the stiffness and exhaustion? Why do we say we are fine when we are anything but fine? Because what kind of life would it be if all we ever did was talk about pain? We still want friendships, relationships, laughter, normal conversations, hobbies, and experiences. We still want to participate in life.
But there is a downside to constantly pushing through and pretending we are coping better than we really are. The people around us often begin to believe that things are not all that bad, or that we are handling everything well. Many times, that is the furthest thing from the truth.
We also learn very quickly that talking too openly about pain, exhaustion, limitations, or fear often makes other people uncomfortable. Sometimes people respond with denial because it is difficult to accept that someone they love is truly struggling. Other times, people quietly pull away because it hurts to realize there is very little they can do to fix it.
One of the hardest parts of living with Psoriatic Arthritis is that many people simply cannot imagine being this sick, being in this much pain, or living with this many limitations for years or even decades. They struggle to understand how we can manage certain things on one day, but during a flare, find those very same tasks nearly impossible the next day.
Because of that, people sometimes assume we are exaggerating, being inconsistent, not trying hard enough, or somehow causing our own problems. Instead of responding with empathy and support, some people become frustrated, angry, dismissive, or even hostile. In some cases, they begin blaming the person with PsA for the illness itself or for the limitations the disease causes.
What many people do not understand is that Psoriatic Disease is unpredictable. Symptoms fluctuate and flares happen. A person may seem relatively functional one day and be almost unable to move the next. That does not mean the illness is not real. It means the disease itself is unpredictable and relentlessly exhausting.
Over time, many of us learn to stay quiet. We learn to smile, to change the subject, and to say, “I’m fine,” even when we are in pain, exhausted beyond words, barely functioning, or desperately wishing someone understood that we are not doing nearly as well as we appear to be.
by Jan Mariet, 5/19/2026
My original article about PsA from 2021 can be found at this link. When Your Loved One Has Psoriatic Arthritis (PsA) – Jan Mariet’s A Day in the Life
