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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 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, rheumatologists, 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:
Your doctor may take a treat-to-target approach, in which you and your doctor jointly decide on goals for disease improvement and how to modify treatment if those targets aren’t met.
The goals of PsA treatment include:
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 only manage symptoms, while others can help you keep the disease under control. Your treatment plan may include a combination of 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.
NSAIDs can help manage symptoms of PsA but don’t affect the course of the disease, prevent joint damage, or slow progression. By reducing swelling, pain, and stiffness, these medications can make it easier for you to walk and move. They can be used alone for mild cases of PsA without joint damage. They can also be used alongside other treatments that help control the disease.
Popular over-the-counter NSAIDs for PsA 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 are sometimes used to treat PsA flares or ongoing inflammation. Corticosteroids may be taken by mouth or — to allow doctors to deliver a higher dose — injected into joints. These medications are typically prescribed when the disease affects a small number of joints.
Long-term and repeated steroid use can increase joint damage, as well as the risk of infection and chronic (ongoing) diseases such as osteoporosis, bone fractures, high blood pressure, obesity, diabetes, and heart disease. Additionally, Cushing syndrome can develop after long-term steroid use.
DMARDs 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 taken by mouth. Common medications prescribed for PsA include:
Many people can start to see improvement after taking these medications for six weeks.
If conventional 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 (into a vein).
Tumor necrosis factor (TNF) inhibitors — one class of biologics — are often used for people with 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.
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, which 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. The greatest improvement usually shows up after three to four months of treatment.
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.
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.
Living with 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’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.
MyPsoriasisTeam is the social network for people with psoriatic arthritis and their loved ones. On MyPsoriasisTeam, more than 112,000 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.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Laurie Berger has been a health care writer, reporter, and editor for the past 14 years. Learn more about her here.
Amanda Jacot, PharmD earned a Bachelor of Science in biology from the University of Texas at Austin in 2009 and a Doctor of Pharmacy from the University of Texas College of Pharmacy in 2014. Learn more about her here.
