Psoriatic arthritis is a complex disease characterized by joint pain, tenderness, and swelling, often accompanied by the skin symptoms of psoriasis. Nearly 30 percent of people with psoriasis develop psoriatic arthritis.

Although there’s no cure for psoriatic arthritis (also known as PsA), treatment can control disease progression and reduce painful symptoms. New therapies approved for the chronic inflammatory disorder provide even more options for personalized care and better outcomes. Remission (complete disappearance of symptoms) is rare, but 40 percent of patients with PsA can expect to achieve minimal disease activity, according to the Arthritis Foundation.

Treatment is most effective when PsA is diagnosed early and treatment begins soon after. A delay of just six months can lead to joint damage, according to the National Psoriasis Foundation.

Developing a PsA Treatment Plan

A team of dermatologists, rheumatologists, physical therapists, and other practitioners can work together to identify the most effective treatment options for your psoriatic arthritis type and stage. They 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:

• Reduce inflammation
• Treat skin and nails
• Relieve pain
• Protect joint mobility
• Stop disease progression
• Reduce the risk of developing related health conditions

Your doctors will typically consider several factors when developing a treatment plan. These factors may include:

• Number of joints affected by psoriatic arthritis
• Severity of joint and skin symptoms
• Areas of great pain and concern
• Other health problems (known as comorbidities)
• Insurance coverage

Many clinicians now follow a “treat to target” approach, in which the doctor and a person with PsA jointly decide 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 — determines whether a target has been reached. At each visit, medications may be changed or increased until a low level of disease activity is achieved. Complete remission with PsA is rare.

Medications for Psoriatic Arthritis

No single treatment works for everyone with PsA. Some medications can control disease and joint damage, while others only manage symptoms, such as pain or skin lesions. For that reason, rheumatologists often prescribe multiple drugs for psoriatic arthritis and psoriasis as part of a comprehensive treatment plan.

Drugs That Control Disease

Disease-modifying antirheumatic drugs, or DMARDs, are systemic drugs prescribed for moderate-to-severe PsA that has not responded to treatment with non-steroidal anti-inflammatory drugs (NSAIDs). DMARDs can impact the disease course by reducing joint and tissue damage and slowing the progression of psoriatic arthritis, as well as relieving symptoms.

DMARDs

Older, conventional DMARDs prescribed for psoriatic arthritis include Methotrexate (sold under brand names including Trexall), Sulfasalazine, Arava (leflunomide), and Cyclosporine. Newer DMARDs, such as Xeljanz (tofacitinib) and Otezla (apremilast), work by interfering with specific aspects of the immune system involved in inflammation.

Visit Treatments for Psoriasis to read more details about specific DMARDs, including side effects.

Biologic DMARDs

When psoriatic disease can’t be controlled with conventional DMARDS and NSAIDS — or in cases where extensive, irreversible joint damage is present — biologic drugs may be prescribed. Unlike conventional DMARDs, biologics target specific cells or proteins of the immune system that promote inflammation. Biologic DMARDs are either taken as pills, injected, or given in an intravenous infusion (by IV). Biologics are usually taken long-term as maintenance drugs to prevent disease flares. They generally show the greatest improvement after three or four months of use.

Tumor necrosis factor inhibitors, one class of biologics, are 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.

Humira (adalimumab) is one of the most commonly prescribed TNF inhibitors for PsA. Others include Enbrel (etanercept), Remicade (infliximab), and Simponi (golimumab).

Newer biologics approved for psoriatic disease stop inflammation by inhibiting certain functions in the body that cause inflammation. They include Stelara (ustekinumab), Cosentyx (secukinumab), and Taltz (ixekinumab).

Visit Treatments for Psoriasis to read more details about specific biologic DMARDs, including side effects.

Drugs That Manage Symptoms

Many drugs are used to manage symptoms of psoriatic arthritis, but do not affect the course of disease, prevent joint damage, or slow progression.

NSAIDs

Non-steroidal anti-inflammatory medications are typically prescribed for mild cases of psoriatic arthritis without joint damage. NSAIDs can reduce swelling and pain, making it easier to walk and move. Popular over-the-counter NSAIDs for psoriatic arthritis include aspirin, Advil or Motrin (ibuprofen), and Aleve (naproxen). Celebrex (celecoxib) 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.

Corticosteroids

Also simply known as steroids, corticosteroids may be injected into joints to treat flares or ongoing inflammation. They’re typically prescribed when the disease affects only a small number of joints. Injections allow doctors to deliver a higher medication dose than is possible with oral medications.

Long-term and repeated steroid injections can increase joint damage, as well as the risk of infection, bone fractures, and chronic diseases such as osteoporosis, high blood pressure, obesity, diabetes, heart disease. Cushing syndrome can also develop after long-term steroid use.

Surgery for Psoriatic Arthritis

Joint replacement surgery may be an option for severely damaged joints that do not respond to medication. Replacement can help restore function, relieve pain, increase mobility, and improve quality of life. Surgery requires downtime for recovery, and there are risks of infection.

Physical Therapy for Psoriatic Arthritis

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 are having trouble with mobility or daily functions.

Lifestyle Changes for Psoriatic Arthritis

Guidelines recommended by the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF) 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 lead to obesity, osteoporosis, heart disease, and 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.

Weight Loss

Being overweight with psoriatic arthritis is like getting an extra dose of inflammation, according to several studies. Obesity is a 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.

Healthy Diet

There is no specific diet recommended for people with psoriasis, but many doctors 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.

Stop Smoking

Several studies have found a link between smoking and psoriatic arthritis. Smoking not only worsens PsA treatment outcomes, it can also lead to cardiovascular disease.

Reduce Stress

For some people, psoriatic arthritis symptoms are triggered by tension and stress. Participating in activities that combat stress — such as meditation, exercise, and complementary therapies — may help you relax and also ease your symptoms.

Always speak with your doctor before beginning any new exercise, nutrition, or weight loss program.

References

1. About Psoriatic Arthritis — National Psoriasis Foundation
2. Evaluation and Management of Rheumatic Diseases: A Case-Based Review — HCP Live
3. Using Treat-To-Target for PsA — Arthritis Foundation
4. Why early diagnosis is critical for psoriatic arthritis — National Psoriasis Foundation
5. Psoriatic Arthritis Treatments — Arthritis Foundation
6. First Medications for PsA — Arthritis Foundation
7. Psoriatic Arthritis — Arthritis Foundation
8. Psoriatic Arthritis: Diagnosis and Treatment — American Academy of Dermatology
9. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) — National Psoriasis Foundation
10. Steroid Injections — Cleveland Clinic
11. DMARDs — Arthritis Foundation
12. Tumor necrosis factor inhibitors in psoriatic arthritis — Expert Review Clinical Pharmacology
13. Steps in the management of psoriatic arthritis: a guide for clinicians — Therapeutic Advances in Chronic Disease
14. Moderate to Severe Psoriasis and Psoriatic Arthritis: Biologic Drugs — National Psoriasis Foundation
15. Systemic Treatment: Biologics and Oral Treatments — National Psoriasis Foundation
16. Study Examines How Psoriatic Arthritis Patients Do After Surgery ­— National Psoriasis Foundation
17. 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis — Journal of Psoriasis and Psoriatic Arthritis
18. Psoriatic Arthritis Self-Care Tips — Arthritis Foundation
19. Physical therapy can help you manage PsA pain — National Psoriasis Foundation
20. Psoriatic Arthritis: Management and Treatment — Cleveland Clinic
21. Weight loss with treatment can help psoriatic arthritis — National Psoriasis Foundation
22. Weight loss greatly improves psoriasis, study finds — National Psoriasis Foundation
23. Treatment guidelines in psoriatic arthritis — Rheumatology
24. Smoking Increases the Risk of Psoriatic Arthritis — Arthritis Foundation

Laurie has been a health care writer, reporter, and editor for the past 14 years. Learn more about her here.

Ariel Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Learn more about him here. Review provided by VeriMed Healthcare Network.