Psoriatic arthritis (PsA) is a type of inflammatory arthritis that causes joint pain, stiffness, and swelling. Without treatment, PsA can lead to permanent joint damage that may change how joints look and move. Most people with PsA also have psoriasis, which may show up as scaly skin or changes to the nails.

Some treatments focus only on easing joint symptoms, while others also help with psoriasis of the skin. A dermatologist can help find a treatment plan based on your symptoms and risk of related health issues.

Here’s what to know about treating skin, joint, and nail symptoms.

Treating Joint and Skin Symptoms Separately

People with PsA have several treatment options that ease symptoms and improve quality of life. Depending on how severe your condition is, you may need a mix of approaches. Your treatment plan may change over time.

Treatments for Joint Symptoms

People with early-stage or mild PsA often use nonsteroidal anti-inflammatory drugs (NSAIDs). These medications help reduce swelling and ease pain. Options include over-the-counter medications like ibuprofen and naproxen or prescription NSAIDs such as celecoxib.

When PsA affects just a couple of joints — often large, like the knees — doctors may recommend corticosteroid injections to reduce pain and swelling. Doctors avoid injecting into or near skin patches because it can make them worse.

Psoriatic Arthritis Relief

Physical therapy and occupational therapy can help manage PsA. These therapies may help ease joint pain and make daily activities easier.

Simple home treatments and lifestyle changes can also provide 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) to reduce swelling and pain
• Improving your posture to ease strain on joints
• Moving around regularly during the day to avoid stiffness
• Adjusting how you sit, stand, or lift to reduce pressure on painful joints
• Using a brace or splint, if advised by your healthcare provider, to support an inflamed joint and limit painful movement

Treatments for Skin Symptoms

Several types of topical (applied to the skin) medications can help manage skin symptoms in PsA. Your dermatologist may recommend:

• Corticosteroids — These come as lotions, creams, ointments, gels, foams, sprays, and shampoos. They can calm the skin’s immune cells, reducing pain, scales, discoloration, and itching.
• Vitamin D analogs — These medications contain laboratory-made vitamin D and can slow down skin cell growth. Examples include calcipotriene (Calcitrene, Dovonex, Sorilux)​​​​​​ and calcitriol (Vectical).
• Anthralin — Anthralin makes skin cells grow more slowly, helping to get rid of scales and rough patches.
• Calcineurin inhibitors — These decrease inflammation in the skin and treat scaly, discolored (red or purple) patches. Types include tacrolimus (Protopic) and pimecrolimus (Elidel).
• Salicylic acid — Often found in shampoos, salicylic acid can help remove scale from the scalp.
• Retinoids — These treatments can slow the growth of skin cells and reduce scaling. Oral and topical formulas are available.
• Phosphodiesterase 4 (PDE4) inhibitors — These nonsteroidal treatments reduce skin inflammation. Roflumilast (Zoryve) foam, a topical PDE4 inhibitor approved for plaque psoriasis, is especially useful in areas with hair, such as the scalp.
• Coal tar — This traditional treatment can help ease itching and scaling.

Light therapy can also help treat skin symptoms. Also called phototherapy, this treatment is often given in a doctor’s office or clinic. It uses types of ultraviolet light that are safer than what you’re exposed to from sunlight or tanning beds.

Both joint and skin symptoms may improve with certain lifestyle changes, such as:

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

Treatments That Target Both Skin and Joint Symptoms

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. A specialist, known as a rheumatologist, can help decide if one of these therapies would be good for you.

Disease-Modifying Antirheumatic Drugs

Treatments like NSAIDs may eventually stop working, especially if PsA becomes more aggressive and causes more severe symptoms. In this case, doctors typically recommend disease-modifying antirheumatic drugs (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 include:

• Cyclosporine
• Leflunomide
• Methotrexate
• Sulfasalazine

Newer DMARDs like apremilast (Otezla) have also been developed. Apremilast blocks PDE4, an enzyme that helps control inflammation throughout the body.

Biologics

Another option is biologic drugs. These injected medications 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.

Available biologics for PsA include:

• Abatacept (Orencia)
• Adalimumab (Humira and its biosimilars)
• Bimekizumab-bkzx (Bimzelx)
• Certolizumab (Cimzia)
• Etanercept (Enbrel)
• Golimumab (Simponi)
• Guselkumab (Tremfya)
• Infliximab (Remicade and its biosimilars)
• Ixekizumab (Taltz)
• Risankizumab-rzaa (Skyrizi)
• Secukinumab (Cosentyx)
• Ustekinumab (Stelara and its biosimilars)

The drugs above can also treat psoriasis. A few other biologics are approved for psoriasis but not PsA. It’s likely that with more research, the list of approved biologics for PsA will continue to grow.

Janus Kinase Inhibitors

Janus kinase (JAK) inhibitors also target the underlying factors that lead to PsA. These oral medications block Janus kinase, an enzyme that controls many processes that cause inflammation. Like biologics, JAK inhibitors can prevent PsA from getting worse.

The two JAK inhibitors approved for PsA are tofacitinib (Xeljanz) and upadacitinib (Rinvoq). So far, no JAK inhibitors are approved for both PsA and skin psoriasis, but that may soon change. Deucravacitinib (Sotyktu) is approved only for skin psoriasis but is being studied for PsA. Early results are promising.

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