Medications can relieve symptoms such as joint pain, stiffness, and swelling for people with psoriatic arthritis. The right drugs can also slow disease progression and prevent or limit permanent joint damage.
Psoriatic arthritis (PsA) is an autoimmune condition where the immune system attacks the joints and causes inflammation and tissue damage.
Treatments for PsA may include pain relievers, drugs that fight inflammation, and long term medications that calm the immune system’s attack on the joints. Treatments include:
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- disease modifying antirheumatic drugs (DMARDs)
- small molecule medications
No single treatment works for everyone, so a person with PsA will work with their medical provider to find the right medication or therapy.
This article looks at the long and short term medications that can help treat PsA, along with the latest advances in treatments.
Otherwise known as NSAIDs, these are over-the-counter or prescription medications that can relieve or reduce various types of pain. Over-the-counter NSAIDs are typically a lower dose than prescription strength.
How they work
One of the ways that NSAIDs help PsA is by lowering inflammation in the joints that the condition affects. NSAIDs do this by blocking prostaglandins, which are chemicals in the body that cause pain and inflammation. This anti-inflammatory effect can help with symptoms of PsA.
NSAIDs are safe for most people if they take them under a doctor’s directions and only for a short time. But people who take NSAIDs for extended periods may experience side effects that can be serious.
Risks of using NSAIDs include:
- skin reactions, such as reddening or blisters
- allergic reaction, such as hives, itching, wheezing, swelling, or a rash
- stomach bleeding or bleeding in the digestive tract
- heart attack or stroke, though aspirin does not increase this risk
In summary, NSAIDs are not suitable for long term use. NSAIDs are helpful for occasional pain and stiffness, but not as a continual therapy for PsA.
Corticosteroids, also called glucocorticoids, are powerful inflammation fighting drugs that may come in oral form (pills) or an injection.
How they work
Corticosteroids can quickly reduce swelling and pain in joints by suppressing the body’s autoimmune response. Sometimes, people who have a severe attack of PsA symptoms may need to take corticosteroids for a week or two to bring inflammation under control.
Due to their side effects, doctors often recommend taking corticosteroids only when necessary and for the shortest time. If a person takes corticosteroids for more than a few days, they must come off them gradually, or they may experience withdrawal symptoms.
Side effects of corticosteroids include:
- weight gain and greater appetite
- extra body fat in the face, back of the neck, and around the abdomen
- mood swings, including feeling sad, anxious, or depressed
- sleep problems
- higher risk of infections and complications from minor infections
- thinning skin
- increased risk of cataracts or glaucoma
- bone loss and osteoporosis
- increase in blood sugar levels and risk of diabetes
These side effects usually go away once people stop taking the medication.
DMARDs are long term medications that can relieve more severe symptoms of PsA and help protect joints from damage. DMARDS may be pills or injections.
There are many different types of DMARDs, but doctors only use some of them to treat PsA. Many DMARDs treat other autoimmune diseases, such as rheumatoid arthritis or inflammatory bowel disease (IBD).
Doctors use some DMARDs to treat PsA as an off label use. This means that the FDA has not approved the drug to treat PsA, but it may work for this purpose.
How they work
DMARDs may suppress the immune system, which can slow or prevent PsA attacks on the joints. These are known as immunosuppressive drugs.
Drugs that suppress the immune system may make someone more likely to get infections. Some DMARDs can reduce the frequency of PsA flares or help a person achieve disease remission.
Types and side effects
The most common DMARDs for PsA are:
- methotrexate (Rheumatrex, Trexall)
- sulfasalazine (Azulfidine)
- leflunomide (Arava)
- cyclosporine (Gengraf, Neural, Sandimmune)
- hydroxychloroquine (Plaquenil)
Methotrexate is an immunosuppressive drug that treats psoriasis. It also works well for PsA and can help prevent damage to joints. Rarely, methotrexate can cause liver damage, so a person will need to see their doctor regularly for tests.
Sulfasalazine is a type of sulfa drug that has powerful anti-inflammatory effects. People who are allergic to sulfa drugs cannot take it. It helps prevent joint swelling, inflammation, and damage that PsA causes.
Although this is a rheumatoid arthritis drug, some doctors prescribe it for PsA. It may cause diarrhea in up to 20 percent of people.
Cyclosporine is an immunosuppressant that helps treat autoimmune conditions. Side effects include high blood pressure, headache, and stomach pain.
Certain drugs that treat malaria can help with PsA. Results may take several months, however. Side effects include headaches, dizziness, nausea, vomiting, and vision changes.
Acthar is an injectable medication that can help the body make its own steroid hormones, which helps lower inflammation. Acthar is useful for fast relief of severe inflammation and swelling.
Azathioprine (Imuran) is a drug that suppresses the immune system, which helps with both PsA and skin psoriasis.
Biologics are a different type of DMARD. People must take them via injection or intravenous drip.
Up to 60 percent of people may achieve remission after 1 year of treatment with biologics, according to the Arthritis Foundation. Remission means that there is “minimal disease activity,” or the disease is not causing serious symptoms or joint damage.
How they work
Biologics fight inflammation by targeting certain cells in the immune system, which helps calm the overactive immune response.
Some examples of biologics that treat PsA include:
Tumor necrosis factor-alpha inhibitors
Tumor necrosis factor-alpha inhibitors (TNF-alpha) fight inflammation by targeting a specific protein in the immune system.
These drugs include:
- etanercept (Enbrel)
- adalimumab (Humira)
- infliximab (Remicade, Renflexis, Inflectra)
- golimumab (Simponi)
- certolizumab (Cimzia)
T cell inhibitors, or selective co-stimulation moderators
This medication prevents certain immune system activity that causes inflammation.
Abatacept is the only drug in this class.
Interleukin inhibitors (IL inhibitors) help lower inflammatory proteins known as interleukins.
Ustekinumab (Stelara) is an IL inhibitor.
Biologics can cause a higher risk of infection, and a person cannot take them if something else has already weakened their immune system. Some people notice side effects, including flu-like symptoms, feeling unwell, or soreness at the site of the injection.
A new type of oral (pill) treatments for PsA is known as small molecule medication.
The name derives from the fact that small molecule medication targets molecules inside immune cells. This action helps correct the overactive immune response that can cause both PsA and psoriasis skin disease.
New oral drugs for PsA include:
Apremilast (Otezla) is a drug that prevents the body from making an enzyme that can cause inflammation.
Doctors may prescribe this medication to people who have found that DMARDs do not work, especially if they cannot take biologics. Rare side effects may include body weight loss, depression, and suicidal behavior.
Tofacitinib (Xeljanz) is a drug that stops an enzyme that may lead to inflammation. Rare side effects can include bowel perforation, lymphoma, and an increase in cholesterol levels.
Common side effects for small molecule medications include headache, diarrhea, nausea, and upper respiratory infections. These drugs can lower a person’s ability to fight infections.
With many PsA medications available, many people can find relief from PsA symptoms.
Other therapies and lifestyle changes, such as physical therapy, exercise, and weight loss, can be a good complement to medication. People with PsA should work closely with their doctor to follow a complete treatment plan that will help them live the healthiest life possible.