Psoriatic arthritis generally keeps a low profile. Before pro-golfer Phil Mickelson went public about having psoriatic arthritis, many people may not have known it existed. If you're one of the millions living with the condition, you should know what your treatment options are in order to avoid painful and debilitating symptoms.
WebMD researched the most common psoriatic arthritis treatment options and the latest developments in psoriatic arthritis joint and skin care; treatments that have emerged in recent years, and how psoriatic arthritis management can improve the quality of your life and prevent long-term damage.
Psoriatic Arthritis Medications
Nearly 7.5 million people in the U.S. have psoriasis. Between 10% and 30% of people with psoriasis also develop psoriatic arthritis. As autoimmune disorders, both conditions lead the immune system to attack healthy cells in your skin or joints. Left untreated, psoriatic arthritis can cause intense pain and leave joints permanently deformed.
Treatment for psoriatic arthritis depends on your symptoms. The most commonly used medications include:
- Nonsteroidal anti-inflammatory drugs: NSAIDS can reduce pain, swelling, and inflammation, which can help loosen up joints that may be especially stiff in the mornings. They are available by prescription or over-the-counter in the form of aspirin, ibuprofen, or naproxen sodium.
Disease-modifying anti-rheumatic drugs: DMARDs treat psoriasis by blocking certain activities in the immune system and slowing the growth of skin cells. DMARDs include:
- Biologic agents, such as the anti-TNF-alpha medications
Tumor necrosis factor blockers: TNF blockers can relieve psoriatic arthritis symptoms and prevent long-term damage by blocking certain activities in the immune system. TNF blockers need to be injected or infused, depending on which kind is being used. TNF blockers include:
- Etanercept (Enbrel)
- Infliximab (Remicade)
- Adalimumab (Humira)
- Certolizumab pegol (Cimzia)
New Developments in Psoriatic Arthritis Medications
New treatments have improved the outlook for people with psoriatic arthritis. "The goal of treatment should be a dramatic improvement in pain so it doesn't impact the patient's tasks of daily living," says Alice Gottlieb, MD, PhD, chair of dermatology and dermatologist-in-chief at Tufts Medical Center.
"Since the early 2000s, when TNF blockers were first used for psoriatic arthritis, the bar for treatment has been raised," says Christopher Ritchlin, MD, rheumatologist at the University of Rochester Medical Center, and professor in the department of medicine, allergy/immunology, and rheumatology at the University of Rochester. For many people, TNF blockers restore their energy, their ability to function, and their overall quality of life, especially at first.
"The response sometimes diminishes over time," says Ritchlin. If and when this happens, physicians have a number of options to restore relief, either by adding another medication to the treatment plan, or by trying a different TNF-blocking therapy.
Creating Your Psoriatic Arthritis Health Care Team
It's important that you have a health care team that meets your needs with psoriatic arthritis. This team may include:
- Rheumatologist for your joints
- Dermatologist for your skin
- Primary care provider to look after your overall health
- Social worker or therapist to help you cope with emotional and social challenges
Be sure to ask others who have psoriatic arthritis for physician referrals. You can also search the National Psoriasis Foundation web site for specialists in your area. When interviewing potential health care providers, be sure to ask:
- How many psoriasis patients do you typically treat each month?
- How do you gauge my quality of life with psoriasis and psoriatic arthritis?
- What are the latest treatment options for skin and joint care?