Psoriatic arthritis (PsA) is a chronic inflammatory condition that causes joint pain, stiffness, and swelling, often alongside skin symptoms from psoriasis. While PsA affects about 1 in 5 people with psoriasis, it can also occur in those without visible skin disease.

As an autoimmune disorder, PsA develops when the immune system mistakenly attacks healthy tissues, leading to joint and tendon inflammation. The exact cause remains unclear, but it likely involves genetic, immune, and environmental factors.

Chronic pain is one of the most challenging symptoms for people with PsA. Pain can come from joint inflammation, tendon strain, muscle tension, or fatigue, and sometimes continues even when inflammation is under control. According to Dr. Alexis Ogdie, a rheumatologist at the University of Pennsylvania, up to one-third of people with PsA experience chronic, widespread pain lasting for three or more months.

Over years of treating PsA, Dr. Ogdie has refined her approach to managing pain—looking beyond inflammation to address sleep, mental health, exercise, and lifestyle. Here’s what she wishes every patient and clinician knew about chronic pain in PsA.

The Importance of Asking the Right Questions

During an initial appointment, Dr. Ogdie emphasizes the need to look beyond joint pain and ask about coexisting conditions, known as comorbidities.

She explains, “I always cover the role of obesity, diabetes, depression, and anxiety in psoriatic arthritis. These conditions can worsen inflammation and make pain management harder.”

She also asks patients:

  • How often do you exercise?

  • How well are you sleeping?

  • What symptoms limit your daily life the most?

  • What are your personal health goals for the next 6–12 months?

This conversation helps build a roadmap—not just for reducing pain, but for improving quality of life.

Understanding Chronic Pain in Psoriatic Arthritis

People with PsA may experience two kinds of pain: inflammatory pain caused by joint swelling, and chronic pain syndrome, which persists even when inflammation is controlled.

“Sometimes, the pain becomes body-wide and doesn’t match the inflammation levels we see,” Dr. Ogdie explains. “It’s not always about switching medications—sometimes it’s about understanding what kind of pain we’re treating.”

This distinction is crucial. Treating inflammation alone won’t always relieve pain if nerve sensitivity or central pain processing plays a role. Chronic pain in PsA often overlaps with conditions like fibromyalgia, which cause fatigue, tenderness, and cognitive fog.

Monitoring and Measuring Pain

To better understand a patient’s pain profile, Dr. Ogdie’s team uses a survey modeled on fibromyalgia criteria. It asks about pain in multiple body regions and rates its intensity, producing a total pain score.

But pain is more than a number. They also track symptoms such as:

  • Fatigue and brain fog

  • Sleep disturbances

  • Abdominal or jaw pain

  • Headaches or facial tension

  • Emotional distress like anxiety or depression

“Having that constellation of symptoms helps us recognize chronic pain patterns,” she says. “It also guides us toward more personalized treatment plans.”

The Role of Exercise and Sleep

Dr. Ogdie calls exercise one of the best medicines for chronic pain. Regular movement—especially aerobic activities like walking, swimming, or cycling—helps:

  • Maintain joint flexibility

  • Strengthen muscles that support the joints

  • Reduce inflammation

  • Boost energy and mood

“Exercise helps stabilize joints and prevent further pain,” she says. “It’s essential, even if it feels hard at first.”

Sleep also plays a critical role in pain management. “Less sleep leads to more pain—and more pain leads to less sleep,” she explains. “It’s a vicious cycle.”

That’s why she often incorporates sleep hygiene strategies—such as setting consistent bedtimes, reducing screen time before bed, and managing nighttime discomfort—as part of PsA treatment plans.

Teaching Patients About Pain

When she began practicing rheumatology, Dr. Ogdie admits that chronic pain was frustrating to manage. “There aren’t always visible causes or quick fixes, and patients are understandably frustrated too,” she says.

Over time, she’s learned that patient education and empowerment make the biggest difference. “Teaching people how pain works—and giving them self-management tools—helps both sides. It allows patients to understand what they can control and where medical treatment helps most.”

She also makes sure to set clear expectations about what the care team can and cannot do. “I explain that managing chronic pain requires teamwork. We handle inflammation and guidance, but patients play a key role in lifestyle, exercise, and stress management.”

Living With PsA and Chronic Pain

Chronic pain from PsA can affect more than joints—it can impact sleep, mood, energy, and relationships. But with a balanced approach that addresses both the physical and emotional sides of pain, improvement is possible.

Effective PsA management includes:

  • Anti-inflammatory treatments (such as biologics or DMARDs)

  • Pain management techniques (like nerve-focused medications or therapy)

  • Mental health support for stress and depression

  • Lifestyle habits including regular exercise, healthy diet, and quality sleep

As Dr. Ogdie reminds her patients, “The goal isn’t just less pain—it’s living better despite the pain.”

A Quick Review

Chronic pain in psoriatic arthritis isn’t only about inflammation. It involves multiple factors—from nerve sensitivity to emotional health—and requires a whole-person approach. Asking the right questions, encouraging movement, supporting sleep, and empowering patients are key steps toward lasting relief.

With time, understanding, and teamwork, people with PsA can regain control and improve both function and quality of life.