Psoriatic arthritis (PsA) is a chronic, inflammatory autoimmune disease where the immune system mistakenly attacks healthy tissues, primarily affecting the joints and skin. This condition leads to painful joint inflammation, stiffness, and frequently involves psoriasis, which manifests as patches of thick, scaly skin. Communicating with someone managing this lifelong condition requires sensitivity, as many well-intentioned comments can inadvertently cause distress or minimize their struggle. Learning what not to say is the first step toward offering genuine support to an individual living with PsA.
Invalidating the Experience of Pain and Fatigue
Statements that dismiss the internal symptoms of PsA often fall into the trap of “you look fine” or “it’s just arthritis.” Psoriatic arthritis involves systemic inflammation, which triggers the release of proteins called cytokines that contribute to profound, unpredictable fatigue, sometimes called “PsA fog.” This exhaustion is unlike ordinary tiredness and does not resolve with rest, significantly affecting a person’s ability to function daily.
Minimizing this experience by saying things like, “Everyone gets tired,” or “Are you sure you aren’t just stressed?” suggests that the patient’s symptoms are exaggerated or psychological. The joint pain in PsA is a result of inflammation in the entheses—where tendons and ligaments connect to bone—and in the joints themselves. Uncontrolled inflammation can lead to irreversible joint damage, making the pain a measurable medical reality. Hearing their pain is not real contributes to feelings of isolation and misunderstanding, adding emotional burden to the physical disease.
Offering Unsolicited Medical Advice and Cures
A common communication misstep is suggesting unproven “cures” or diet changes, such as, “Have you tried cutting out gluten?” or “You just need to exercise more.” While these suggestions are usually offered with good intent, they imply that the patient’s complex, chronic disease is manageable with adjustments they must have overlooked. Psoriatic arthritis is an autoimmune condition requiring specialized treatment, often involving immunosuppressive medications like biologics, to slow disease progression and prevent joint erosion.
Unsolicited advice dismisses the established medical relationship the patient has with their rheumatologist and the trial-and-error process of finding an effective treatment plan. Suggesting supplements or alternative therapies can be risky, as some products intended to “boost” the immune system may worsen an autoimmune condition characterized by an overactive immune response. Furthermore, these comments shift the responsibility for a complex medical condition onto the patient, suggesting they are failing at self-care by not finding a fix.
Commenting on Appearance or Visible Symptoms
PsA often has visible manifestations, including the scaly plaques of psoriasis on the skin, nail changes, or swollen, “sausage-like” fingers and toes, known as dactylitis. Comments focused on these visible signs, such as “What is that rash?” or “You should cover that up,” are intrusive. These remarks highlight cosmetic concerns rather than focusing on the patient’s overall well-being.
For many people with PsA, the visible skin and joint involvement causes embarrassment, social stigma, and body image issues. Anxiety and depression are common comorbidities in PsA, partly due to the physical toll and the visible nature of the disease. Drawing attention to symptoms the person is self-conscious about can intensify emotional distress and lead to social withdrawal.
Constructive Alternatives for Supportive Communication
Instead of minimizing symptoms or offering advice, focus on validating the person’s experience and offering practical support. A simple, “That sounds painful and frustrating,” can acknowledge their reality without attempting to fix it. Empathy shows that you recognize their physical and emotional burden.
Offer specific, tangible help instead of the vague, “Let me know if you need anything,” which places the burden of asking on the person with PsA. Try phrases like, “Can I pick up groceries for you today?” or “Would you like me to drive you to your appointment next week?”. Respecting boundaries means accepting their limitations without judgment. A supportive phrase like, “I believe you,” affirms their struggle with an often-invisible disease and lets them know they are seen and heard.