Psoriatic arthritis, a form of arthritis that causes joint inflammation, most often leads to pain, stiffness, or swelling in the joints. Most people with PsA also have psoriasis, with symptoms such as patches of thickened, scaly skin or pitting of the nails.
In some cases, people diagnosed with PsA begin a treatment plan that involves separate treatments for joint symptoms and skin symptoms. This may work for some people, but it leaves others with ongoing symptoms. Those who follow this type of treatment plan may not realize that these therapies are not addressing the underlying sources of inflammation that are contributing to psoriatic arthritis and psoriasis.
When initial treatment stops working, people with PsA often switch to more aggressive treatment options. These target the underlying causes of disease, rather than only providing symptom relief. If your current therapies aren’t effectively managing your joint and skin symptoms, you may want to talk to your doctor about other possible treatment approaches.
A wide range of therapies can help ease symptoms and improve quality of life for people with psoriatic arthritis. People may use different types of treatments depending on the type and severity of their symptoms. For people with milder disease, some treatment options may be helpful in and of themselves. Other such treatments may be paired with more aggressive therapies to provide extra symptom relief for people with more severe disease.
People with early-stage or mild PsA often use nonsteroidal anti-inflammatory drugs (NSAIDs). These medications can help reduce small amounts of inflammation, and they can also relieve symptoms of psoriatic arthritis, including joint pain and tenderness. These medications include over-the-counter (OTC) options like ibuprofen (Advil) and naproxen (Aleve), as well as prescription drugs such as celecoxib (Celebrex).
For people whose psoriatic arthritis affects just a couple of joints, a doctor may prescribe corticosteroid injections to ease pain and swelling.
Oral steroids can help treat joint symptoms when PsA flares (gets worse), but they can also temporarily make skin symptoms worse. Oral steroids are usually used only for short periods of time in order to lessen the chances of experiencing side effects.
Physical therapy, occupational therapy, and massage therapy may all be potential solutions for reducing joint pain and making it easier to accomplish daily tasks.
Some other options can also relieve joint symptoms. You may want to try:
There are several different types of topical (applied to the skin) medications that can help with psoriasis. Your dermatologist may recommend:
Doctors often recommend light therapy to treat skin symptoms. Also called phototherapy, this treatment is often given in a doctor’s office or clinic. It uses types of UV light that are safer than what you’re exposed to from sunlight or tanning beds.
Lifestyle changes may work for skin symptoms as well as joint symptoms. They include:
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Other treatments help address the underlying causes of both psoriasis and PsA. These medications work to treat symptoms of both the skin and joints. Rheumatologists often prescribe these drugs for people experiencing skin and arthritis symptoms. If you’re interested in trying one of these therapies, ask your doctor if they would be a good fit based on your personal needs.
Treatments like NSAIDs may eventually stop working for PsA, especially if the disease becomes more aggressive and starts to cause more severe symptoms. In this case, doctors typically recommend DMARDs.
DMARDs work in different ways to lessen the activity of the immune system. The U.S. Food and Drug Administration (FDA) has approved several DMARDs that have long been used to treat PsA, including:
Newer DMARDs like apremilast (Otezla) have also been developed. Apremilast blocks phosphodiesterase 4 (PDE4), an enzyme that helps control inflammation throughout the body. Doctors may prescribe this medication for mild to moderate PsA when other therapies have failed or can’t be used.
Another option is biologic drugs. These medications are types of DMARDs that can slow or prevent further joint damage. Biologics address the underlying causes of both joint and skin symptoms by blocking different parts of the immune system. They may change which chemicals are made by the immune system or block different types of immune cells from becoming activated.
FDA-approved biologics for PsA include:
Biologics may be used along with another type of DMARD, such as methotrexate, to treat more severe PsA.
Newer types of DMARDs called Janus kinase (JAK) inhibitors also target the underlying factors that lead to both psoriasis and psoriatic arthritis. These drugs block Janus kinase, an enzyme that controls many different processes that lead to inflammation. They can prevent PsA from getting worse.
The FDA has approved three JAK inhibitors for PsA: baricitinib (Olumiant), tofacitinib (Xeljanz), and upadacitinib (Rinvoq).
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