Treatment for psoriatic arthritis (PsA) can help you reduce painful symptoms and control disease progression.
No single treatment works for everyone with PsA, but your health care team will work together to identify the most effective treatment plan for you.
Among the most common PsA treatments are disease-modifying antirheumatic drugs (DMARDs), corticosteroids, and nonsteroidal anti-inflammatory drugs (NSAIDs).
Psoriatic arthritis is a complex disease characterized by joint pain, tenderness, and swelling, often along with the skin symptoms of psoriasis. Nearly 30 percent of people with psoriasis are affected by PsA, according to the National Psoriasis Foundation.
Although there is no cure for psoriatic arthritis, treatment can control disease progression and reduce painful symptoms. Newly approved therapies provide even more options for personalized care and better outcomes.
Complete disappearance of symptoms — called remission — is rare, but about 40 percent of people with PsA can achieve minimal disease activity, according to the Arthritis Foundation.
Early diagnosis and treatment of PsA can help prevent or limit joint damage from occurring as the disease progresses.
A team of dermatologists, rheumatologists, physical therapists, and other practitioners will work together to identify the most effective treatment options for your psoriatic arthritis type and stage. Your treatment may be different depending on the joints affected such as the shoulder, hands, or feet. Your team can also help you adopt self-care practices that protect joints and skin, minimize flares, alleviate stress, and improve overall health and quality of life.
Psoriatic arthritis treatment aims to:
Your doctors will consider several factors when developing a treatment plan. These factors may include:
Many clinicians follow a treat to target approach, where you and your doctor will jointly decide on goals for disease improvement and how to modify treatment if those targets are not met.
Regular monitoring — either monthly or every few months, depending on disease activity — will determine if the target has been reached. At each visit, medications may be changed or adjusted until a low level of disease activity is achieved.
No single treatment works for everyone with PsA. Some medications can control disease and joint damage, while others only manage symptoms, such as pain and skin lesions. A comprehensive treatment plan will often include a combination of drugs for psoriatic arthritis and psoriasis.
DMARDs are systemic drugs prescribed for moderate to severe PsA that has not responded to treatment with nonsteroidal anti-inflammatory drugs. DMARDs relieve symptoms and slow the progression of PsA by reducing joint and tissue damage.
Conventional DMARDs reduce the immune system’s response to attacking healthy tissue. Common medications prescribed for psoriatic arthritis include:
These medications are taken by mouth.
Many people can start to see improvement after taking these medications for six weeks.
If DMARDs and NSAIDs can’t keep a person’s PsA under control — or in cases involving extensive, irreversible joint damage — a doctor may prescribe biologic drugs.
Unlike conventional DMARDs, biologics target specific cells or proteins of the immune system that promote inflammation. Biologic DMARDs are either injected or infused intravenously (by IV).
Tumor necrosis factor (TNF) inhibitors — one class of biologics — are now first-line treatments for severe PsA that hasn’t responded to other therapies. TNF inhibitors are highly effective at treating a wide range of PsA symptoms, including skin and nail lesions, inflammation of the joints, and comorbidities such as cardiovascular disease.
Adalimumab (Humira) is one of the most commonly prescribed TNF inhibitors for PsA. Others include:
The U.S. Food and Drug Administration (FDA) has approved newer biologics for psoriatic disease to stop inflammation. They work by inhibiting certain functions in the body that cause inflammation. These medications include:
Biologics are usually taken long-term as maintenance drugs to prevent disease flares. They generally show the greatest improvement after three to four months of use.
Targeted DMARDs may be used if conventional or biologic DMARDs don’t work or cannot be taken. Unlike biologic DMARDs, which are injected, these medications are taken by mouth.
Targeted DMARDs work by interfering with specific aspects of the immune system involved with inflammation. Tofacitinib (Xeljanz) and upadacitinib (Rinvoq) inhibit chemicals, called Janus kinases (JAK), which are involved in signaling the immune system to attack the tissues. These drugs are known as JAK inhibitors. Apremilast (Otezla) decreases inflammatory action within cells by inhibiting an enzyme called phosphodiesterase 4 (or PDE4 for short). Apremilast is known as a phosphodiesterase inhibitor.
Many drugs can help with managing symptoms of psoriatic arthritis but don’t affect the course of the disease, prevent joint damage, or slow progression.
NSAIDs can make it easier to walk and move by reducing swelling, pain, and stiffness. They can be used alone for mild cases of psoriatic arthritis without joint damage. They can also be used alongside other treatments, like DMARDs.
Popular over-the-counter NSAIDs for psoriatic arthritis include:
Celecoxib (Celebrex) and other prescription NSAIDs may also be used. Long-term use of NSAIDs can cause side effects including stomach problems, such as ulcers and gastrointestinal bleeding.
Also simply known as steroids, corticosteroids may be injected into joints to treat flares or ongoing inflammation. They are typically prescribed when the disease affects a small number of joints. Injections allow doctors to deliver a higher dose of medication than with oral medications.
Long-term and repeated steroid injections can increase joint damage, as well as the risk of infection and chronic diseases such as osteoporosis, bone fractures, high blood pressure, obesity, diabetes, and heart disease. Cushing syndrome can develop after long-term steroid use.
Joint replacement surgery may be an option for severely diseased joints that do not respond to medication. Replacement can help restore function, relieve pain, increase movement, and improve quality of life. Surgery requires downtime for recovery, and there are risks of infection.
Physical therapy, including occupational therapy and massage therapy, can be an important part of a psoriatic arthritis treatment plan. The goal of physical therapy is to preserve and restore joint mobility with range-of-motion exercises that build muscle and tendon strength.
A physical therapist may teach you exercises to do at home. They may show you how to relax stiff muscles and numb sore joints by applying heat and cold. Your therapist may prescribe custom-fitted braces, splints, or other support if you have trouble with mobility or daily function.
Guidelines recommended by the American College of Rheumatology and the National Psoriasis Foundation include lifestyle changes in addition to medication.
Pain and stiffness may make it hard to exercise, but lack of movement can worsen PsA symptoms and lead to obesity, osteoporosis, heart disease, and other chronic diseases. Regular, low-impact exercises such as walking, swimming, and cycling can increase endurance and ease joint stiffness. Modified yoga and pilates exercises may also help increase strength.
Being overweight with psoriatic arthritis is like getting a “double dose” of inflammation, according to several studies. Obesity is a major contributor to most forms of inflammatory arthritis and can increase your risk of developing cardiovascular problems and fatty liver disease. Studies have also found that losing weight can reduce psoriatic disease severity.
There is no specific diet for psoriasis, but many physicians and researchers recommend a balanced diet with plenty of fresh fruit and vegetables, lean meats, and unsaturated fats. Maintaining a healthy weight can help reduce the severity of psoriasis and psoriatic arthritis.
Several studies have found a link between smoking and psoriatic arthritis. Smoking not only worsens PsA treatment outcomes, but it can also lead to cardiovascular disease.
For some people, psoriatic arthritis symptoms are triggered by tension and stress. Participating in stress management activities that combat stress, such as meditation, exercise, and complementary therapies, may help you relax and manage stress.
Always speak with your doctor before beginning any new exercise, nutrition, or weight loss program.
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