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Psoriatic arthritis (PsA) 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 PsA, 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.
You may work with a team of dermatologists (skin specialists), rheumatologists (joint and immune system specialists), physical therapists, and other practitioners to identify the most effective treatment options for your PsA. Your treatment may differ depending on the joints affected, such as the shoulder or joints in the hands or feet. Your team can also help you adopt self-care practices that protect joints and skin, minimize flares, reduce stress, and improve overall health and quality of life.
Your doctors will consider several factors when developing a treatment plan. These factors may include:
They may also take a “treat-to-target” approach, where you and your doctor set goals for disease improvement and adjust treatment if those targets aren’t met.
No single treatment works for everyone with PsA. Some medications relieve symptoms, while others help keep the disease under control. Your treatment plan may combine different drugs for PsA and psoriasis. Talk to your doctor if you have concerns about how well your current treatments are managing your PsA. Your doctor can help you understand if switching treatments or making certain lifestyle modifications might help you.
Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve PsA symptoms but don’t affect disease progression or prevent joint damage. By reducing swelling, pain, and stiffness, these medications can make it easier for you to walk and move. NSAIDs are typically used alone for mild PsA without joint damage and can also be combined with other treatments that help control the disease.
Popular over-the-counter NSAIDs for PsA include:
Prescription NSAIDs, like celecoxib (Celebrex) may also be used. However, long-term NSAID use may lead to side effects, including stomach problems like ulcers and gastrointestinal bleeding.
Also simply known as steroids, corticosteroids are sometimes used to treat PsA flares or ongoing inflammation. Corticosteroids may be taken orally (by mouth) or injected into joints for higher doses. These medications are typically prescribed when the disease affects a small number of joints.
Long-term or repeated steroid use can increase the risk of joint damage as well as serious health issues, including:
Additionally, Cushing syndrome (a hormone disorder) can develop after long-term steroid use.
Disease-modifying antirheumatic drugs are systemic drugs prescribed for moderate to severe PsA that hasn’t responded to treatment with NSAIDs. By reducing joint and tissue damage, DMARDs can relieve symptoms and slow the progression of PsA.
Conventional DMARDs reduce the immune system’s response that leads to attacking healthy tissue. These medications are typically taken by mouth. Common medications prescribed for PsA include:
Many people start to see improvements within about six weeks of starting these medications.
If conventional DMARDs and NSAIDs aren’t effective, or if there is severe joint damage, biologic drugs may be prescribed. Biologics target specific cells or proteins of the immune system that promote inflammation. Biologic DMARDs are either injected or infused intravenously (into a vein).
Tumor necrosis factor (TNF) inhibitors, a class of biologics, are often used in 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, joint inflammation, and comorbidities (co-occurring conditions) such as cardiovascular disease. Examples include:
Another class of biologics, called interleukin (IL) inhibitors, work a bit differently in the body. Interleukins are a group of proteins in the body that tell cells to turn on and cause inflammation. IL inhibitors work by blocking these proteins, which can decrease inflammation and relieve joint pain and damage.
Biologics are usually taken long term as maintenance drugs to prevent disease flares. Significant improvements may take three to four months of treatment.
There are now several biosimilars approved by the U.S. Food and Drug Administration (FDA) available for psoriatic arthritis. Biosimilars are highly similar to existing biologics but may be more cost-effective. These alternatives provide additional treatment options for some while maintaining efficacy and safety.
Targeted DMARDs may be used if conventional or biologic DMARDs don’t work or cannot be taken. Unlike biologic DMARDs, which are injected, these are oral medications.
Targeted DMARDs interfere with specific aspects of the immune system involved with inflammation.
Tofacitinib (Xeljanz) and upadacitinib (Rinvoq) block the activity of proteins called Janus kinases (JAKs), 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 obstructing an enzyme called phosphodiesterase 4 (PDE4). Apremilast is known as a phosphodiesterase inhibitor.
Abatacept (Orencia) targets T cells, which the body can make too much of in PsA. During inflammation, T cells get “switched on,” and abatacept targets this specific activation.
Physical therapy, including occupational therapy and massage therapy, can be an important part of a PsA 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 you can do at home. They may show you how to relax stiff muscles and numb sore joints by applying heat and cold. If you have trouble with mobility or daily function, your therapist may prescribe custom-fitted braces, splints, or other supportive items.
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.
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 increase the risk of developing other chronic diseases. Regular, low-impact exercise such as walking, swimming, and cycling can increase endurance and ease joint stiffness. Modified yoga and pilates exercises may also help increase strength.
Obesity is a major factor in inflammatory arthritis and increases the risk of cardiovascular issues and fatty liver disease. Studies suggest that weight loss can reduce the severity of psoriatic disease.
There’s no specific diet for psoriasis, but many physicians and researchers recommend eating a balanced diet with plenty of fresh fruit and vegetables, lean meats, and unsaturated fats. Maintaining a healthy weight for your body can help reduce the severity of psoriasis and PsA.
Several studies have found a link between smoking and PsA. Smoking not only worsens PsA treatment outcomes but can also lead to cardiovascular disease and other health problems.
For some people, tension and stress trigger PsA symptoms. Participating in activities that aim to reduce 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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I have recently found a simple OTC supplement that seems to help with my psoriatic arthritis- related digestion issues. It is Apple Cider Vinegar “ACV”taken daily. It is inexpensive and readily… read more