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Treating Psoriatic Arthritis and Skin Symptoms

Medically reviewed by Ariel D. Teitel, M.D., M.B.A.
Written by Maureen McNulty
Updated on January 3, 2023

  • Psoriatic arthritis (PsA) primarily causes joint pain and swelling, which can be reduced with treatments such as medication, physical therapy, or lifestyle changes.
  • Most people with PsA also experience skin symptoms of psoriasis that can be relieved with other medications or light therapy.
  • In order to treat the underlying factors that cause PsA, other medications called disease-modifying antirheumatic drugs (DMARDs) or biologics are necessary

Plaque psoriasis can cause red, scaly patches on lighter skin tones. Scaly patches can appear silvery or dark purple on darker skin tones. (CC BY-NC-ND 3.0 NZ/DermNet)


PsA is a form of inflammatory arthritis that 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 nail changes (pitting of the nail bed).

Because PsA is both a joint and skin condition, treatments may be aimed at addressing some or all associated symptoms. Sometimes, 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 plan may not realize that these therapies are not addressing the underlying sources of inflammation that contribute to PsA and psoriasis. In this case, their joint disease may progress, potentially leading to disfiguring arthritis.

When their 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.

Treating Joint and Skin Symptoms Separately

A wide range of therapies can help ease symptoms and improve the quality of life for those with PsA. People may use different types of treatments or combinations of treatments depending on the type and severity of their symptoms.

Treatments for Joint Symptoms

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 PsA symptoms, 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 PsA 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 flare when coming off the steroids. Oral steroids are usually used only for short periods of time to lessen the chances of side effects.

Psoriatic Arthritis Relief

Physical therapy, occupational therapy, and massage therapy may all be potential solutions for reducing joint pain and making it easier to accomplish daily tasks.

At-home remedies and lifestyle tweaks can also give PsA relief. The Arthritis Foundation recommends:

  • Using either heat therapy (a hot pack or warm bath) or cold therapy (an ice pack or bag of ice), which can help reduce swelling and pain
  • Improving your posture
  • Moving around regularly
  • Holding your body in ways that put less pressure on the affected joints
  • Using a brace or splint to hold an inflamed joint in place or prevent painful movements, under the direction of your health care provider

Treatments for Skin Symptoms

There are several different types of topical (applied to the skin) medications that can help treat PsA skin rashes. Your dermatologist may recommend:

  • Corticosteroids — These may come in the form of a lotion, cream, ointment, gel, foam, spray, or shampoo. They can calm the immune cells in the skin and decrease pain, scales, redness, and itching.
  • Vitamin D analogs — These contain laboratory-made vitamin D and can slow down the growth of the skin. Types of vitamin D analogs include calcipotriene (Dovonex)​​​​​​ or calcitriol (Vectical).
  • Anthralin — Sold as brands including Drithocreme and Zithranol, this makes skin cells grow more slowly, helping get rid of scales and rough patches.
  • Calcineurin inhibitors — These decrease inflammation in the skin and treat discolored (red or purple), scaly patches. Types include tacrolimus (Protopic) and pimecrolimus (Elidel).
  • Salicylic acid — Available in shampoos, salicylic acid can help treat psoriasis on the scalp by exfoliating the top layer of skin.
  • Retinoids — These treatments can slow down the growth of skin cells and treat scaling. One type is acitretin (Soriatane) by mouth and tazarotene (Tazorac), which is applied topically.
  • Coal tar (Psoriasin) — This topical treatment can help relieve skin symptoms like itching and scaling.
  • OTC emollients such as Eucerin or Aquaphor — These can help keep the skin hydrated and reduce dryness and scaling.

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 ultraviolet (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:

  • Getting more physical activity
  • Maintaining a healthy weight
  • Reducing stress
  • Avoiding alcohol and cigarettes
  • Avoiding flare-up triggers

Treatments That Target Both Skin and Joint Symptoms

People with psoriatic arthritis often experience inflamed, painful joints, as well as skin psoriasis symptoms like nail changes or skin lesions. Dactylitis is one of the symptoms of
PsA and is called “sausage digits” because it causes swelling in the fingers and toes.
(Evan Oto/Alamy)


Some treatments help address the underlying causes of both psoriasis and PsA. These medications work to treat symptoms of both the skin and joints by targeting the overactive immune system. 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 needs.

DMARDs

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. Examples of DMARDs include:

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. The American College of Rheumatology also recommends azathioprine (Imuran) for those with severe arthritis.

Biologics

Another option is biologic drugs. These medications are made from living sources and 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 that are overactive in psoriasis and PsA. They may change which chemicals are made by the immune system or block different types of immune cells from becoming activated.

Available biologics for PsA include:

Biologics may be used along with another type of DMARD, such as methotrexate at a low dose, to treat more severe PsA and prevent antibody formation to the biologics.

JAK Inhibitors

Newer types of DMARDs called Janus kinase (JAK) inhibitors also target the underlying factors that lead to PsA. These drugs block Janus kinase, an enzyme that controls many different processes that lead to inflammation. They can prevent PsA from getting worse.

Two JAK inhibitors approved to treat PsA (but not skin psoriasis) are tofacitinib (Xeljanz) and upadacitinib (Rinvoq).

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 113,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Do you have both skin and joint symptoms? Share your experiences in the comments below, or start a conversation by posting on your Activities page.

    Updated on January 3, 2023

    A MyPsoriasisTeam Member

    😥

    posted October 17, 2023
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    Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
    Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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