Psoriatic arthritis (PsA) causes joint pain, tenderness, and swelling, often along with the skin symptoms of psoriasis. Around 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 better outcomes.

Early diagnosis and treatment of PsA can help prevent or limit joint damage as the disease progresses.

Although there is no cure for psoriatic arthritis, treatment can control disease progression and reduce painful symptoms.

Determining the Right Treatment for You

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 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:

• The number of joints affected by PsA
• The severity of your joint and skin symptoms
• Your most bothersome symptoms
• Other health problems you may have
• Your insurance coverage

What Are the Treatments for Psoriatic Arthritis?

No single treatment works for everyone with PsA. Some medications relieve PsA 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.

1. Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve PsA symptoms but don’t affect disease progression or prevent joint damage. NSAIDs are typically used alone for mild PsA without joint damage and can also be combined with other treatments.

Popular over-the-counter NSAIDs for PsA include aspirin, ibuprofen, and naproxen. Prescription NSAIDs, like celecoxib, may also be used. However, long-term NSAID use may lead to side effects, including stomach problems.

2. Corticosteroids

Also simply known as steroids, corticosteroids are sometimes used to treat PsA flares. Corticosteroids may be taken orally (by mouth) or injected into joints. Steroids can provide fast relief, but long-term use comes with the risk of serious side effects. Doctors will usually use the lowest dose for the shortest duration possible to achieve results.

Potential side effects include:

• Osteoporosis (weakened bones that are more prone to fractures)
• Hypertension (high blood pressure)
• Weight gain
• Diabetes

3. Conventional Disease-Modifying Antirheumatic Drugs

Disease-modifying antirheumatic drugs (DMARDs) are systemic drugs that reduce inflammation. DMARDs can relieve symptoms and slow the progression of PsA.

Conventional DMARDs reduce the immune system’s ability to attack healthy tissue. Common medications prescribed for PsA include leflunomide, methotrexate, and sulfasalazine.

4. Biologic Disease-Modifying Antirheumatic Drugs

If conventional DMARDs and NSAIDs aren’t effective, or if there is severe joint damage, biologic drugs may be prescribed. Biologic DMARDs are either injected or infused intravenously (into a vein).

Biologics are usually taken in the long term as maintenance drugs to prevent disease flares. It may take several weeks to notice improvements.

Biologics target specific cells or proteins of the immune system that promote inflammation. They can be grouped by the part of the immune system they target.

Tumor Necrosis Factor Inhibitors

Tumor necrosis factor (TNF) inhibitors target TNF-alpha, a protein that causes inflammation. TNF inhibitors are often the first type of biologic doctors prescribe. Examples include:

• Adalimumab (Humira)
• Certolizumab pegol (Cimzia)
• Etanercept (Enbrel)
• Golimumab (Simponi)
• Infliximab (Remicade)

Interleukin Inhibitors

Interleukin (IL) inhibitors target different parts of the immune system to control inflammation. Each interleukin inhibitor targets a specific type of interleukin.

• Bimekizumab-bkzx (Bimzelx)
• Guselkumab (Tremfya)
• Ixekizumab (Taltz)
• Risankizumab-rzaa (Skyrizi)
• Secukinumab (Cosentyx)
• Ustekinumab (Stelara)

T-Cell Inhibitors

T-cell inhibitors also aim to control inflammation by targeting a type of white blood cell. One of these treatments is abatacept (Orencia).

A Note on Biosimilars

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.

5. Targeted Disease-Modifying Antirheumatic Drugs

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 in 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 body’s 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.

6. Physical Therapy

Physical 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.

7. Surgery

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.

8. Lifestyle Changes

Guidelines recommended by the American College of Rheumatology and the National Psoriasis Foundation include lifestyle changes in addition to medication.

Exercise

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.

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.

Maintain a Healthy Weight

Obesity is a factor in inflammatory arthritis and conditions like cardiovascular issues and fatty liver disease. For some individuals, weight loss may help improve symptoms. Be sure to talk to your doctor about whether this is an appropriate approach for you.

Eat a Healthy Diet

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.

Quit Smoking

Smoking can be a trigger for PsA. Smoking can also lead to cardiovascular disease and other health problems. Ask your doctor about tools to help you quit smoking.

Reduce Stress

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.

Talk With Others Who Understand

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

Are you living with psoriatic arthritis? What treatments have you tried? Share your experience in the comments below, or start a conversation by posting on your Activities page.