Treating Advanced Psoriatic Arthritis

Medically Reviewed by Melinda Ratini, MS, DO on July 21, 2022
5 min read

While there’s no cure for psoriatic arthritis, there are treatments that can help ease the joint pain, swelling, and stiffness it causes. Some also help keep the disease from further harming your joints. That’s especially important when you have advanced psoriatic arthritis with damaged joints, disabling pain, or other symptoms that make your life more difficult.

Psoriatic arthritis affects each person differently. But when you have an advanced case, the condition may involve five or more of your joints. It interferes with your daily activities and your quality of life. You might have spondylitis, inflammation that causes pain and stiffness in your back. Your joints may be very swollen or deformed, and you may have bone damage.

In rare cases, you could develop a very serious type of psoriatic arthritis called arthritis mutilans. It can eventually destroy small bones in your fingers and hands and lead to permanent disability.

When psoriatic arthritis is treated early, that often stops the disease from progressing. Some people, though, aren’t diagnosed until their condition is advanced. Some have a hard time sticking with treatment, or finding a treatment that works for them.

There’s no single best way to treat psoriatic arthritis at any stage. When one approach doesn’t work, you and your doctor can try another. You may need to try several different medications. You might use more than one drug, and your doctor could frequently adjust your doses.

When deciding what treatment to use, your doctor will also consider your personal preferences and circumstances, such as:

  • Whether you want to avoid shots or have trouble getting to a clinic for frequent infusions
  • Whether your insurance fully covers certain drugs (especially some of the more expensive biologic ones)
  • Whether you have other health conditions, such as diabetes or heart disease, that limit or complicate your options

Symptoms of psoriatic arthritis tend to come and go. People with mild forms of the diseases might only need treatment when their joints hurt. They could get short-term relief from over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen (or their prescription counterparts).

If your psoriatic arthritis is more serious, your doctor will probably prescribe one or more disease-modifying antirheumatic drugs (DMARDs). These drugs work on your immune system to reduce inflammation.

They may start with conventional DMARDs. These can reduce pain, swelling, and skin symptoms. They have not been proven to help prevent joint damage, though.

The most common drug of this type is methotrexate. You usually take it once a week in pills or as a shot. When you take methotrexate, you might also get doses of folic acid to protect your liver. Other drugs in this category include leflunomide (Arava) and sulfasalazine. It may take 6 weeks or more to see results with conventional DMARDs.

If you have severe psoriatic arthritis, or you don’t get results from conventional DMARDs, your doctor may prescribe another type of DMARD called a biologic. You might get one along with a conventional DMARD.

Biologic drugs work by targeting very specific parts of your immune system. You could see results in as little as 2 weeks, though they can take 3 months or more to reach full effectiveness. They include:

Tumor necrosis factor (TNF) inhibitors. These drugs target a protein that causes inflammation. You get them in shots or by IV infusion. The most serious side effect is a higher risk of infections. These drugs include etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), golimumab (Simponi), and certolizumab pegol (Cimzia). Because they can slow joint damage, some doctors recommend them as the first treatment for people who already have serious symptoms. But your insurance might require you to start with less expensive drugs, such as methotrexate.

Alternative biologics. If you have advanced psoriatic arthritis, your doctor may turn to biologics that block other parts of your immune system. These include drugs that act on immune system proteins known as interleukins. Examples include ustekinumab (Stelara), secukinumab (Cosentyx), ixekizumab (Taltz), and ixekizumab (Tremfya). Another option is abatacept (Orencia), which works on immune system cells called T lymphocytes. All these drugs require shots or infusions and may increase your risk of infection.

Janus kinase inhibitors. When other options fail, some people try pills such as tofacitinib (Xeljanz) and tofacitinib (Rinvoq). They block the action of enzymes called Janus kinases, which play a role in your body’s immune response. These drugs come with strong safety warnings because they’ve been linked with blood clots, cancer, and heart disease.

Most people with psoriatic arthritis never need surgery. But if the condition has badly damaged your joints, your doctor might recommend it. An operation could help ease pain, restore movement, and improve your quality of life. But it doesn’t treat the inflammation your condition causes. For that, you’ll still need to take medication.

These surgeries can be used to treat psoriatic arthritis:

Joint replacement surgery. This is the most common type of surgery done for psoriatic arthritis. Your surgeon replaces a damaged joint, such as those in your hip or knee, with an artificial version made of metal or plastic. The procedure can reduce pain and improve movement in the joint.

Joint fusion. Usually done in your spine, ankles, or hands, this surgery joins together bones that make up a joint. That keeps the joint in a fixed position and eases pain, though it limits movement.

Synovectomy. In this operation, the surgeon removes inflamed tissue that lines your joint (called the synovium). It relieves pain and can improve your range of motion. It’s often done arthroscopically, using a tiny camera and instruments to do the surgery through very small cuts in your skin.

For arthritis mutilans, your doctor may do more than one of these types of surgery, along with bone grafts. The goal is to try to save the use of your hand.

Physical therapy helps you keep or increase strength and flexibility, especially if you start it soon after you’re diagnosed. You might learn to use heat and cold to ease your symptoms. A physical therapist also can help you design a safe home-exercise program and teach you to use assistive devices.

An occupational therapist can teach you how to put less strain on your joints during daily activities, like getting dressed and doing housework. The therapist might also suggest changes you can make around your house to make life easier and safer.

Certain lifestyle changes can help keep your psoriatic arthritis from getting worse and help your treatment plan be more effective:

  • If you’re overweight or obese, talk to your doctor about the best ways to lose weight. Losing excess pounds will reduce stress on your joints. Studies have shown it can also help the drugs you take for your psoriatic arthritis may work better.
  • Find exercise you like that’s not too hard on your joints. It helps ease pain, decrease fatigue, and improve your mobility. Possibilities include walking, cycling, swimming, yoga, and tai chi.
  • If you smoke, make a plan to quit. Some studies suggest that the less people smoke, the less their joints hurt.

Psoriatic arthritis can also take a toll on your mental health, especially when your symptoms are serious. To improve your quality of life, find mental and emotional support. You might join a support group, or get professional counseling. Your doctor can refer you to a therapist who can help.