### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi, I am a 52 year old woman and I was diognosed with psoriasis about 7 years ago. Over the years I got more and more back pains and pains in other joints like elbows and shoulder and knees. I kept on working but after another break upin the relationship and since my mother passed away in january, i am unable to work at all. The pains were horrible, couldn t walk the stairs or move my right arm. At the hospital i was finally diognosed with Psoriatic Arthritis . I got shots in my shoulder and hip and since then it is bearable but still very sore. Also got perscription for Methotrexate and Folic acid . My questions are the following 1) This all was triggered by stress, does that mean that when my life settles it can just as sudden disappear again? 2) Can I start exercises even though I am still in pain or do I make things worse by doing that? Thanks in advance Hendrika

### output:

Hello Hen Chat Doctor. .thanks for your query do understand your concerns regarding the pain and well as the stress due to multiple occurrences. It is important to understand that psoriasis and its outcomes are triggered by stress, however, the pathology occurring is not only due to that. The exact causes are not yet known, but a number of genetic associations have been identified for psoriasis and psoriasis arthritis. Hence, it is important to take the medications and stop them only after proper medical advice. In many cases, a smaller dose of the same medication helps in maintaining the remission and keeps you debility free. Exercise is advised to many suffering from this concern as this helps in improving the symptoms and maintaining remission. However, any kind of exercise should not be started /pursued without advise and supervision of physiotherapist. So you can consult one and learn what kind of exercises are suitable for you. Hope this helps. Take care.