Psoriatic Arthritis: What You Need to Know
Treatment of Psoriatic Arthritis
Psoriatic arthritis is treated much like rheumatoid arthritis. Common treatment includes drugs that might slow the process of joint damage in psoriatic arthritis (called disease-modifying antirheumatic drugs or DMARDs); and nonsteroidal anti-inflammatory drugs (NSAIDs), which treat symptoms without changing the course of psoriatic arthritis.
The drug apremilast (Otezla) doesn't fall into either of the above categories. It's an inhibitor of an enzyme called phosphodieasterase-4 (PDE-4). Otezla is FDA-approved to treat psoriatic arthritis and is taken orally.
Typically, the DMARDs reduce skin psoriasis as well as psoriatic arthritis. DMARDs include:
Biologic agents, including adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), inflixirnab (Remicade), and ustekinumab (Stelara)
Although DMARDs often slow joint damage in short-term studies, it remains to be seen whether they prevent long-term joint damage from psoriatic arthritis.
These medicines treat symptoms like pain, swelling, and stiffness. NSAIDs include ibuprofen (Motrin), naproxen (Naprosyn), indomethacin (Indocin), piroxicam (Feldene), and aspirin. NSAIDs improve symptoms but don’t affect the progression of joint damage.
Other drugs used for psoriasis or psoriatic arthritis include hydroxychloroquine, gold compounds, and retinoic acid derivatives (Soriatane).
Prognosis of Psoriatic Arthritis
Like skin psoriasis, psoriatic arthritis can’t be cured. With treatment, though, most people with psoriatic arthritis do well. Pain and swelling usually persist, but are controlled with pain medicines and DMARDs.
About 20% of people with psoriatic arthritis will develop a destructive form of the disease. Certain characteristics of psoriatic arthritis can help identify aggressive cases:
- Frequent or multiple effusions (fluid on the joint, making it swell)
- Involvement of more than five joints
- High level of medication use in the past for psoriatic arthritis
- Already having damage on X-rays or MRI scans, making future damage likely.
In people with joint damage or signs of aggressive psoriatic arthritis, DMARDs are the preferred treatment.
Psoriatic arthritis can be deceptive. Sometimes, psoriatic arthritis is only mildly painful, even when it’s destructive. If you have symptoms of psoriatic arthritis, see your doctor. Close follow-up and conscientious treatment could slow the process of joint damage.