At 45, Tracy Pereira, of Missouri City, Texas, is a typically busy mom. Her oldest is away at college, but Graeme, 15, and Robyn, 11 (both below, helping Mom) need to be driven to marching band, Scouts, and soccer. Tracy volunteers with the band, a clothing center for disadvantaged students, the garden club, a local preschool, and the parent-teacher organization. She is Robyn’s Girl Scout leader, and she handles paperwork for her husband, a research scientist.

With all that, Tracy is less active than she used to be. She realizes that even with the best medical management, her psoriatic arthritis—a combination of the skin and joint conditions—will worsen if she doesn’t get enough rest.

“When you experience pain, you learn to plan better,” she says. For example, before clambering up the bleachers to watch her son’s band perform at football games, Tracy first makes sure to gather everything she’ll need. At home, she uses a grabbing device to retrieve items from upper shelves and grippers to open jars. She tries to schedule all her errands for one day each week. That day, the family eats out because Tracy knows she’ll be too tired to cook.

“The kids help a lot,” she says. “They understand that sometimes I just have to rest.” Fatigue remains the number-one issue for Tracy, particularly toward the end of the cycle of infusions of medication she receives every six weeks. But thanks to determination, family support, and good medical care, Tracy feels she’s able to handle motherhood well enough that few people realize she suffers from a painful chronic condition. And that gives her great satisfaction.