I was just diagnosed with PsA on 11/19/25. Help please!

Well, sorry to have to welcome you to the club. It’s not one you really want to be a part of, but now that you are, you’ve come to the right place for answers to most of your questions. The first thing you need to keep in mind is that your experience with this disease will not necessarily be the same as others’. What has worked for some may not work for you, and what has failed for others may work great for you. Your rheumatologist will very likely start you off on a traditional DMARD (Disease Modifying Anti-Rheumatic Drug) like Methotrexate. It is not inferior to to biologic drugs like Skyrizi, it just works differently. But it’s been used for a long time, and it works, is relatively safe, and cost effective. Some doctors prefer to prescribe biologics like Skyrizi right away to get the disease under control as soon as possible, while others prefer to hold off as long as possible, if other DMARDs are working, because some people’s immune systems can develop antibodies to biologics like Skyrizi (a process called immunogenicity), and this may might make it more likely that other biologics will fail in the future. There’s no real wrong way or right way about it, so long as the medication of choice reins in disease activity as soon as possible.
I was diagnosed about fifteen years ago after some years of intermittent joint pain, polyarthralgia they called it at the time. According to the rheumatologist I finally saw, I was in a major flare, and this was causing multiple joints to swell and be very painful. Same story as yours, basically. But, my rheumatologist didn’t waste time having me start take NSAIDs (i.e. ibuprofen, meloxicam, celebrex). He immediately put me on a short course of prednisone to arrest the flare, and followed that up with Methotrexate (MTX), which I took for a couple years. I finally had to discontinue MTX because I was constantly catching every little opportunistic infection that came along, due to my exposure to lots of school age children throughout the year.
After discontinuing MTX, my rheumatologist felt I could try getting by with just NSAIDs for awhile, and see how that went. For the next seven or eight years, the only medication I was on was Ibuprofen, as needed, and prednisone for the relatively rare flare. And I did pretty well, so long as I avoided things that could trigger a flare. It was only at the end of 2020 that I finally decided to try a biologic, Humira, and from then on I blew through five or six biologics between December, 2020 and August, 2024. They always worked great for awhile, and then just stopped working. From August, 2024 to this past August I was on a JAK inhibitor, Xeljanz, and it worked great. But, as with the MTX, Xeljanz weakened my immune system to the point that I caught multiple opportunistic infections, and I actually had to pause the medication for weeks at a time, meaning I was off of it almost as much time as I was on it. So, now I’m on Apremilast, brand name Otezla, and it seems to be working just fine, without weakening my immune system in the way that Xeljanz did.
If you’ve managed to read this far without getting bored to death, then you’re probably wondering what my definition of “doing pretty well” is. Well, in 2015 I ceased two things that I felt were significant obstacles to my continue well being; smoking, and alcohol use. And I began running again, something I used to do in my youth. In 2016, at the age of 50, I began running half marathons. And I was pretty fast for a guy in his 50s who was a former smoker, and had struggled with a disease like PsA. In 2019, my average half marathon pace was around 7:30 per mile. That’s pretty a pretty quick pace to maintain for 13.1 miles. I continued running like this until late last year, at which point the constant year round training for long distance events finally began to catch up with my joints that weren’t affected by PsA. But I still run several times a week just to stay fit, have been capable of running a 23:30 5k time, and I continue to bike in good weather, and as I close in on 60 I’m still pretty fit, and active.
So, what’s my “secret”? How did I go from struggling to walk without pain, even having to use an assistive device at times, to running? Well, to this day, I still have some amount of pain every day. It’s just something I’ve gotten used to, and managed to live with. But it’s nothing compared to what it was in those dark early days. Well, sometimes it is, but not often. Not gonna lie to you; you cannot expect to live 100% pain free, though you may well do so. But, you can mitigate the damage to your joints caused by PsA, and you can limit the amount and severity of pain to the point that it becomes unnoticeable.
This is what has worked, and continues to work, for me. I stopped eating red meat, highly processed foods, foods high in added sugar, and essentially anything that wasn’t nutrient dense. Living as a runner made this somewhat easy, as it became part of a disciplined training regimen. But avoiding those kinds of foods, as well as alcohol and tobacco, and other illicit drugs (I will include cannabis here, sorry), has limited inflammation, and provided an environment to allow the medications to work more effectively. I eat a lot of fresh fruits and vegetables, whole grains, legumes, lean proteins like fish and poultry (but animal flesh is something I limit to no more than one meal a day), eggs, low fat and non fat dairy, and lots of nuts. Nutrition and remaining active are just as important, maybe more so, as medication in managing this disease.
And if I’m being honest, I’ve met quite a few people with PsA, on this forum and elsewhere, who simply do not get that, or they don’t want to hear it. They want to just be given a medication that will take away all their symptoms, while they maintain a sedentary lifestyle and an inflammatory diet, as well as refusing to give up things like alcohol and tobacco. And then they’re seemingly surprised when “nothing works” for them. Psoriatic Arthritis, like diabetes, requires a great deal of self care and discipline in management. Medication alone will only get you half way, if that far. So, be prepared to make some changes in your life if you haven’t already. Also, educate yourself and your loved ones on this disease, and prepare them for times when you will have flares that limit your ability to participate in some activities. This may take time to sink in with them, but don’t let anyone not understanding what you are going through stop you from taking time to rest and recharge when you need to. And it helps to find like minded people you can hang out with once in a while; people with whom you can share your worries, your gripes, and even you anger and frustration over little, inconsequential things. And for that, we are always here for you.

Hello welcome to the community. While I’m sorry to hear about your recent diagnosis, I am glad that you have found our community here. Treatment for PsA can vary person to person, but I do hope some of our community members can share some of their experiences with you.

Have you had your appointment with your doctor to discuss treatment options yet? I will share a link here with some information on treatments, https://psoriatic-arthritis.com/treatment. It’s important to remember that finding the right treatment can take some time. Unfortunately, not every treatment will have the same impact or work the same for every person. And I hope people here can reassure you that even if the first treatment you try doesn’t seem to help, there are so many options available.

I do also want to share this article written by one of our health leaders about being newly diagnosed, https://psoriatic-arthritis.com/living/letter-newly-diagnosed.

Please know this community is here for you, and reach out anytime. If you’re comfortable, please let us know how your appointment goes and what you decided about treatment.

Wishing you a gentle day.

—Warmly, Christine (Team Member)

Many rheumatologists like to start patients on a traditional DMARD (Disease Modifying Anti Rheumatic-Drug) such as Methotrexate, due to its low cost and proven efficacy. Don’t worry about side effects, your rheumatologist will order regular labs regardless of medication you are on. Whether it’s Methotrexate, or a biologic medication like Skyrizi, there are possible side effects, but don’t get yourself in too big of a worry over them. I’ve been on Methotrexate, and numerous biolgogics, JAK inhibitors, and now I’m on Apremilast, a PDE4 inhibitor. With Methotrexate, you can expect nausea that will subside as your body gets used to the medication. But not everyone who takes it experiences nausea. And Methotrexate works because it reduces the immune system’s level of activity, thereby leaving a patient more susceptible to opportunistic infections. So users of Methotrexate are advised to remain current on vaccinations (not live vaccines, though), mask in public, as well as limiting contact with sick people, during cold and flu season. Skyrizi belongs to a class of biologics called IL-23 inhibitors. There is another class of biologics, IL-17 inhibitors, that work similarly to the IL-23i’s, and share the same side effect profile. With these, you could have a lowered immune resistance to skin infections, things like folliculitis, fungal infections, and the like. These aren’t all that common, but they do occur, and they are highly treatable. I had a mild scalp fungus and mild folliculitis when starting Cosentyx, but they both cleared up within a week or two with appropriate treatments, and never recurred. While taking MTX (Methotrexate), I got hammered by opportunistic infections because I was around school age children a lot (little harbingers of doom, I call them), so I was discontinued MTX. JAK inhibitors lowered my immune resistance even more than MTX, so I had to discontinue that drug class, as well, and was put on Apremilast, which is working well with no apparent side effects for me. So, there are a lot of options, each with its pros and cons. Your rheumatologist will help guide you in deciding which medication is appropriate to your personal disease experience, but ultimately, it is your decision. Most insurers, however, will require patients be started on less expensive, though still effective, medications, and then only approve more expensive drugs like Skyrizi if the previous medication is deemed ineffective or otherwise inappropriate.