Psoriatic Arthritis Treatment

Psoriatic arthritis (PsA), can affect both the inside and outside of your body. The main goal of psoriatic arthritis treatment is to control the inflammation that causes your joints to swell and ache. That will ease your pain and help prevent further damage.

If you’ve been diagnosed with psoriatic arthritis, your doctor has probably talked to you about your treatment plan. There are several ways to ease symptoms like stiff, aching joints and scaly, itchy skin patches. Some treatments may even help protect your joints, too.

Medications can often help manage psoriatic arthritis, but when they don't, surgery might be an option. Your treatment will depend on how severe your condition is. You may need to try more than one thing before you and your doctor find what works. You can also make lifestyle adjustments and talk to your doctor about alternative and complementary treatments that could help.

NSAIDs

If your arthritis is mild, your doctor may recommend a non-steroidal anti-inflammatory drug (NSAID). It stops your body from making the chemicals that cause inflammation.

You can get NSAIDs over the counter and by prescription. The most common are aspirin, ibuprofen, and naproxen.

What's good for your joints may be hard on other parts of your body, though. NSAID side effects can include heart attacks, strokes, stomachaches, ulcers, or bleeding -- especially if you take large doses over a long time. To help, your doctor may prescribe a drug called misoprostol that will protect your stomach lining, or something that will lower acid and prevent ulcers, such as omeprazole.

You doctor may also suggest a different NSAID, celecoxib (Celebrex).

DMARDs

If your disease is more severe or doesn't respond well to NSAIDs, your doctor may prescribe a disease-modifying antirheumatic drug (DMARD). These can slow or stop pain, swelling, and joint and tissue damage. They're stronger than NSAIDs, and they may take longer to work. The most commonly used are:

Immunosuppressants

If you can’t take a DMARD, you might get a type of drug called an immunosuppressant. As the name suggests, these drugs really rein in your immune system, which is what’s causing the problem in an autoimmune condition like PsA. They can also make it more likely that you’ll get an infection. They include:

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Biologics

If immune suppression don't work, your doctor may prescribe a biologic. These are a newer type of DMARD. Rather than tamp down your entire immune system, these medications block a protein that causes inflammation. They include:

You can often take biologics as a shot under your skin, but for some, you'll need to go to your doctor's office to get the medicine through your vein (IV). You'll probably also take methotrexate.

Biologics work well for many people, but they have downsides. They're expensive, and they can have side effects and risks. You may get dizzy, feel like you've got a cold, or have a reaction where you get your shot.

They can also lower your immune system's response. When you're taking one, let your doctor know if you get the flu or another infection. You'll be tested for tuberculosis (TB) before starting your biologic and checked while you're on it. You'll also get tested for hepatitis B and C.

A biologic can raise your chances of getting lymphoma, a blood cancer, but this is rare.

Enzyme Inhibitor

Apremilast (Otezla) is a new kind of drug for long-term inflammation diseases like psoriatic arthritis. It's a pill that works by blocking a specific enzyme, a kind of protein, called PDE-4. That helps to slow other reactions that lead to inflammation.

You may lose weight when you're taking it, so your doctor will want to watch how you're doing. Other possible side effects include diarrhea, nausea, headache, and mood changes or depression.

Steroids

Corticosteroids are powerful anti-inflammatory drugs that relieve severe pain and swelling. You take them by mouth or inject them directly into a joint or muscle. They're not the same as the muscle-building type of anabolic steroids.

Prednisone is a common steroid. It can help for a short time, but it might make the skin rash worse.

Doctors prescribe steroids only when you really need them. If you use them for a long time, you could have serious side effects such as brittle bones, weight gain, hypertension, and diabetes.

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Surgery

Most people with psoriatic arthritis will never need surgery. But when nothing else has worked, surgery can relieve pain, help an affected joint work, and allow you to move more.

A procedure called synovectomy removes the diseased lining of a joint. If the damage is very bad, you may need surgery to replace your joint, called arthroplasty. When a joint can't easily be replaced, joint fusion might make it stronger, more stable, and less painful.

Light Therapy

Exposing your skin to ultraviolet (UV) light can help get rid of psoriasis skin plaques. But because UV light can damage skin and possibly lead to skin cancer, it’s important to get light therapy only with a doctor’s OK. Different types include:

  • Narrowband UVB phototherapy . You’ll probably get it at a clinic to begin with, especially if you have widespread disease. You’ll cover your eyes and genitals, and the rest of you will be exposed to the light for a few seconds to a few minutes. You’ll probably go about three times a week for 3 months. If you respond well, and your insurance covers the cost, you can get a smaller home unit. It can be a good option if you need weekly treatments to keep you in remission. You’ll still be under a doctor’s supervision.
  • Excimer laser. This uses narrowband UVB to treat smaller areas, like psoriasis on your scalp. You’ll get 20-25 treatments over 2-3 weeks and should see results after a month or so.
  • PUVA. This combines UVA rays with a pill called psoralen, which makes your skin more sensitive to light. You can’t get this treatment long, though, because UVA rays are more damaging than UVB. You’ll get 20-25 treatments over a 2- to 3-week period. You should see results after about a month.

Lifestyle Changes for Psoriatic Arthritis

You can make some changes that will improve your quality of life:

  • Eat healthy food. Focus on a healthy eating plan like the Mediterranean diet. Opt for foods that may ease inflammation, like:
    • Coldwater fish
    • Colorful fresh fruit
    • Colorful fresh veggies
    • Flaxseed
    • Olive oil
    • Pumpkin seeds
    • Walnuts
  • Stay away from foods that might cause inflammation, such as:
    • Fatty red meat
    • Processed food
    • Refined sugar
    • Dairy products
  • Exercise: When your joints are sore, you may not want to move. But doing so can:

    Keep your joints and tendons loose

    • Keep the inflammation that comes with this disease in check
    • Lessen the workload on your joints
    • Lower your risk of other conditions that come with PsA, like heart disease, diabetes, and Crohn’s disease

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Walking, biking, and swimming are all good options.

  • Get to, and stay at, a healthy weight. Almost half the people with PsA are overweight. Studies show that losing just 10% of your body weight can improve your response to medications for psoriasis and psoriatic arthritis.
  • Manage your stress. Things that make you worry can also make your PsA worse. Exercise, medication, and talk therapy can all help.
  • Rest. Give an achy joint a break. You can go back to what you were doing when you feel better.
  • Don’t drink. Mixing some PsA medications with alcohol can lead to liver damage. Your doctor can let you know if you should quit.

Complementary and Alternative Therapies

You can try:

  • Acupressure and acupuncture: These ancient Chinese treatments involve putting pressure on or inserting needles into the body’s healing points or energy lines. Acupressure isn’t proven to help, but studies show that acupuncture can ease your pain.
  • Curcumin: There’s some proof that this substance, the active ingredient in the spice turmeric, can help curb inflammation.
  • Massage: It can help stretch your muscles and joints, promote circulation in your lymph system, and help you relax.
  • Reiki: This Japanese relaxation technique can help you manage stress.
  • Tai chi: This gentle Chinese exercise helps with relaxation and can ease sore, stiff joints.
  • Yoga: The controlled movements can relax stiff muscles, ease sore joints, and boost your range of motion. It can also help with pain.
  • Vitamin D: As an ointment, it’s been used to treat psoriasis for years. You can also get it from foods like:
    • Cod-liver oil
    • Coldwater fish like Sockeye salmon, mackerel, tuna
    • Vitamin D-fortified products like nonfat milk, orange juice, yogurt
    • Eggs
    • Swiss cheese

Always talk to your doctor before you add any supplement or treatment. Look for a practitioner who is certified and, if possible, has experience with people who have psoriasis and psoriatic arthritis.

Get Regular Checkups

Your doctor needs to keep an eye on how your disease is progressing and how well your treatment’s working. She also can keep an eye on whether or not you’re getting a related condition (she’ll call it a comorbid condition) like type 2 diabetes, obesity, depression, and anxiety.

WebMD Medical Reference Reviewed by David Zelman, MD on April 29, 2019

Sources

SOURCES:

Sharon Mayo, health educator, National Psoriasis Foundation.

Alice Gottlieb, MD, PhD, Dermatologist-in-Chief, Tufts Medical Center.

National Psoriasis Foundation: “Psoriatic Arthritis” “Psoriatic Arthritis Treatments,” “Alternative Therapies,” “Anti-Inflammatory Diet,” “Get the most from your primary care provider,” “Living With Psoriatic Arthritis,” “Pros and cons of phototherapy,” “Treating Psoriatic Arthritis,” “Vitamins and Supplements.”

American College of Rheumatology: “NSAIDS: Nonsteroidal Anti-Inflammatory Drugs.”

American Academy of Dermatology: “Guidelines of care for the management of psoriasis and psoriatic arthritis.”

MedLine Plus Medical Encyclopedia: “Diclofenac and misoprostol.”

Johnston, BL and Conly, JM. Canadian Journal of Infectious Diseases and Medical Microbiology, July-August 2006.

UpToDate: “Patient education: Psoriatic arthritis (Beyond the Basics),” "Treatment of psoriatic arthritis."

Schett, G. Therapeutic Advances in Musculoskeletal Disease, October 2010.

FDA: “FDA approves Inflectra, a biosimilar to Remicade.” “FDA approves Amjevita, a biosimilar to Humira.”

Mayo Clinic: “Psoriatic Arthritis.”

Arthritis Foundation: “Light Therapy for Psoriatic Arthritis.”

NYU Langone Health: “Lifestyle Changes for Psoriatic Arthritis.”

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