• 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 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) are necessary.

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.

Treating Joint and Skin Symptoms Separately

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.

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 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:

• Using either heat therapy (such as a hot pack or warm bath) or cold therapy (like 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 with psoriasis. 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 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.
• Retinoids — These treatments can slow down the growth of skin cells and treat scaling.
• Coal tar — 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 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

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.

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, including:

• Leflunomide (Arava)
• Sulfasalazine
• Cyclosporine
• Methotrexate (Otrexup)

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.

Biologics

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:

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

Biologics may be used along with another type of DMARD, such as methotrexate, to treat more severe PsA.

JAK Inhibitors

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).

Talk With Others Who Understand

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