Psoriatic arthritis (PsA) is a type of inflammatory arthritis that causes joint swelling, stiffness, and pain. It’s closely linked to psoriasis, a skin condition that leads to red, scaly, and inflamed patches. While PsA affects about one in five people with psoriasis, it can also develop in individuals who have no visible skin symptoms.

As an autoimmune condition, PsA occurs when the immune system mistakenly attacks healthy tissues in the body. The exact cause remains unclear but likely involves both genetic predisposition and environmental triggers.

Chronic pain is one of the most challenging aspects of PsA. People may experience discomfort not only in their joints but also in tendons, muscles, and skin, often accompanied by fatigue that amplifies pain perception.

According to Dr. Alexis Ogdie, a rheumatologist and associate professor at the Hospital of the University of Pennsylvania, “Up to a third of patients with psoriatic arthritis have chronic pain.” Chronic pain, she explains, refers to pain lasting for three or more months across multiple body regions.

Dr. Ogdie shared her evolving perspective on diagnosing, treating, and managing chronic pain in PsA patients — and the lessons she wishes she had known earlier in her medical career.

What To Ask During a First Appointment

understanding the full picture
“I’ve learned how crucial it is to address comorbidities — the other health issues that often occur alongside PsA,” says Dr. Ogdie. “In my first visit, I always discuss obesity, diabetes, and mental health conditions like depression or anxiety.”

She also screens for chronic pain syndrome, which may occur with or without visible inflammation. Beyond the medical history, Dr. Ogdie explores lifestyle factors:

  • How much the person exercises

  • How well they sleep

  • Which activities are most difficult for them

  • Their health goals over the next six to twelve months

These questions, she explains, help tailor treatment and set realistic expectations.

Treating Chronic Pain Syndrome

separating inflammation from pain
For patients with ongoing joint swelling, pain often comes and goes depending on the level of inflammation. While treating PsA typically reduces pain, Dr. Ogdie notes that distinguishing inflammatory pain from other pain syndromes can be complex.

“Sometimes, switching medications isn’t the answer,” she explains. “If inflammation isn’t increasing, the pain may stem from chronic pain syndrome rather than active arthritis.”

This distinction is vital for creating effective treatment plans — especially for patients who have tried multiple therapies without success.

Monitoring Pain Levels

measuring more than numbers
To evaluate pain accurately, Dr. Ogdie and her team use a survey based on fibromyalgia criteria that assesses pain across different body regions, producing an overall pain score.

But she emphasizes that pain assessment goes beyond the numbers. “We also look at fatigue, cognitive issues, sleep disturbances, abdominal discomfort, headaches, depression, and jaw or facial pain,” she explains. “Even though not all of these count toward the score, they help us understand the broader experience of chronic pain.”

This holistic view allows healthcare providers to address both the physical and emotional dimensions of PsA.

The Role of Exercise and Sleep

how lifestyle habits shape recovery
Dr. Ogdie highlights aerobic exercise as one of the best tools for managing chronic pain and fatigue. “Exercise strengthens the muscles around joints, stabilizes them, and prevents further inflammation,” she says.

Equally important is sleep. Poor sleep can worsen pain, while severe pain makes it harder to rest — creating a vicious cycle. “Helping patients improve sleep is as essential as prescribing medication,” she notes.

Strategies such as consistent sleep routines, gentle movement, and mind-body techniques can make a noticeable difference in how patients feel day to day.

Working With Patients To Manage Pain

collaboration and education matter
“As a young rheumatologist, I found chronic pain frustrating,” admits Dr. Ogdie. “There weren’t many visible solutions, and both doctors and patients often felt helpless.”

Over time, she realized that patient education and self-management are key. “When patients understand their pain and have practical tools to manage it, they feel more in control — and that makes the treatment partnership much more successful.”

She also emphasizes open communication. “I make sure patients know what my team can help with — and where their own effort matters most. Managing PsA pain is truly a shared journey.”