Psoriatic Arthritis: Medical Treatments

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

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.

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 and Biologics

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 DMARDs are:

If those don't work, your doctor may prescribe a biologic. These are a newer type of DMARD. 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.

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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 sick 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, although 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.

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.

WebMD Medical Reference Reviewed by David Zelman, MD on December 05, 2016

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”

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: "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.”

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