Psoriatic arthritis is a chronic inflammatory disease that develops in some people with psoriasis. It can cause pain and inflammation in the joints, skin and nails, skull, spine, fingers, and toes.
Psoriatic arthritis (PsA) can severely affect the quality of life. Without treatment, it can lead to joint destruction and disability.
There is currently no cure, but an early diagnosis and targeted treatments may slow or halt its progression. Treatment can also help prevent accompanying health issues, such as heart disease and depression.
Drug treatments for PsA include:
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- disease-modifying antirheumatic drugs (DMARDs)
- biologics, including tumor necrosis factor (TNF) inhibitors
Nondrug approaches include dietary choices, avoiding smoking, and exercising. Some supplements and alternative therapies may also help.
In this article, learn more about the drug and nondrug options for treating PsA.
Drug-based treatments for PsA aim to:
- manage inflammation
- relieve pain and discomfort
- treat the skin symptoms of psoriasis
- prevent further damage and complications caused by ongoing inflammation
- keep the joints mobile to help the person stay active
NSAIDs can help relieve pain and reduce inflammation. They work by blocking the production of prostaglandins, compounds that signal the immune system to trigger an inflammatory response.
Some common over-the-counter NSAIDs are ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). Stronger versions are available by prescription.
However, NSAIDs can increase the risk of heart attack, stroke, bleeding, and kidney problems. People with a history of cardiovascular disease should consult a healthcare professional before using this type of drug.
Corticosteroids mimic the action of the anti-inflammatory hormone cortisol, which the adrenal glands produce. Taking these drugs, by mouth or as injections, can help relieve pain and inflammation.
However, long-term use can cause side effects such as facial swelling, weight gain, diabetes, and weak bones. For this reason, a doctor will prescribe the lowest dosage for the shortest period that is effective.
A doctor may prescribe a DMARD alongside NSAIDs or corticosteroids. A person may take DMARDs as pills, as injections, or intravenously.
Some options include the nonbiologic DMARDs methotrexate (Rheumatrex) and apremilast (Otezla). Methotrexate is a synthetic DMARD that comes as tablets or injections. Apremilast is a small-molecule drug that is only available as tablets.
Leflunomide (Arava), meanwhile,
DMARDs can help suppress the overactive immune response that causes persistent inflammation. They can take several weeks to work, however, and are not effective for everyone.
Biologics are a type of DMARD. If a person’s symptoms do not respond to nonbiologic DMARDs, the doctor may prescribe a biologic drug. These are only available as injectables.
- adalimumab (Humira)
- etanercept (Enbrel)
- golimumab (Simponi)
- infliximab (Remicade)
- ustekinumab (Stelara)
- abatacept (Orencia)
- tofacitinib (Xeljanz)
Most biologics work by blocking a specific protein produced by immune cells. This protein signals other cells to start the inflammatory process. In this way, the drugs help prevent the inflammation that leads to symptoms of PsA.
Biologics can lead to a higher risk of infection, however, because they suppress the immune system.
The choice of drug treatment depends on
- the extent and severity of the symptoms
- which areas of the body they affect
- the presence or risk of joint damage
- the person’s overall health
- any previous reactions to these types of medications
- any other medications that the person is using
- personal preference
The doctor will likely use a treat-to-target approach, which involves monitoring the symptoms and adjusting the treatment accordingly.
The best treatment plan depends on factors specific to each person, but below, find the drugs that a doctor might recommend at each stage of PsA:
|Drug therapy||Effect of PsA on the quality of life|
|Mild||NSAIDs, possibly with local corticosteroid injections||PsA does not significantly effect daily functioning.|
|Moderate||DMARDs or TNF inhibitors||PsA limits everyday tasks and physical and mental functions and does not respond to NSAIDs.|
|Severe||DMARDs and TNF inhibitors||Pain occurs with everyday tasks, and PsA otherwise affects physical and mental functioning. The symptoms do not respond to DMARDs or TNF inhibitors alone.|
A number of nondrug approaches can play a key role in managing PsA.
Regular exercise may help a person:
- maintain muscle strength
- keep the joints mobile
- manage weight
A healthcare professional, such as a physical therapist, works with a person to develop a suitable exercise plan. They may also use body manipulation to help ease pain.
Which exercises are best for people with PsA?
An occupational therapist can help find new ways to carry out daily tasks. They can also advise about the use of devices, such as a cane, to help people stay mobile.
Obesity, diabetes, and other aspects of metabolic syndrome are more common in people with PsA than those without it, according to a
Carrying extra weight can increase the risk of heart disease and other complications, and it may reduce the effectiveness of DMARDs and biologic agents. Additional weight can also put strain on painful joints.
Managing weight may help manage symptoms and reduce the risk of complications.
Learn more about the links between PsA and body weight.
Managing stress can help a person face the challenges of living with PsA. Tips for managing stress include:
- playing music
- practicing deep breathing
- doing meditative exercise, such as yoga and tai chi
Learning about PsA may also help manage stress by providing an idea of what to expect.
How can people avoid stress and other triggers for psoriasis?
Having a diet rich in whole foods and fresh fruits and vegetables may benefit people with PsA.
Added sugars, red meats, and processed foods appear to increase the risk of inflammation, while many fresh, plant-based products contain antioxidants, which help protect against inflammation.
For people with gluten sensitivity, a
Which foods may be helpful or harmful for people with PsA?
Other lifestyle factors
Smoking tobacco appears to be a risk factor for PsA, and alcohol may affect how treatments work. Be sure to discuss any tobacco and alcohol use with the doctor when they are developing the treatment plan.
Many people manage PsA with complementary and alternative medicine, in addition to conventional treatments. It is important to discuss these therapies with a healthcare professional before trying them.
- Vitamin D supplements
may helpsome people.
- Omega-3 fish oil supplements
may reduceinflammation and pain.
- Curcumin, a compound in turmeric,
may haveanti-inflammatory and immunosuppressant benefits for people with PsA.
Managing PsA may involve using NSAIDs, corticosteroid injections, and DMARDs. If symptoms are severe, the doctor may recommend biologic therapies. Regardless of the severity, the doctor may also recommend strategies such as changing the diet and exercising.
The treatment plan will also depend on the severity of PsA, prior treatments, the person’s overall health, and their preferences. The doctor will continue to monitor the symptoms and adjust the plan over time.