Medications can relieve symptoms such as joint pain, stiffness, and swelling in people with psoriatic arthritis. The right drugs can also slow disease progression and prevent or limit permanent joint 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 a healthcare professional 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.
These are over-the-counter (OTC) or prescription medications that can relieve or reduce various types of pain. OTC NSAIDs typically come in lower doses than prescription-strength versions.
How they work
One of the ways NSAIDs help with PsA is by decreasing inflammation in the joints that the condition affects. They do this by blocking prostaglandins, which are chemicals in the body that cause pain and inflammation. This anti-inflammatory effect can help reduce symptoms of PsA.
NSAIDs are safe for most people if they take them under a doctor’s direction and only briefly. 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, which may involve hives, itching, wheezing, swelling, or a rash
- bleeding in the stomach or digestive tract
- heart attack or stroke, though aspirin does not increase this risk
In summary, NSAIDs are not suitable for long-term use. They are helpful for occasional pain and stiffness but not as an ongoing therapy for PsA.
Corticosteroids, or glucocorticoids, are powerful inflammation-fighting drugs that may come in oral form (pills) or as an injection.
How they work
Corticosteroids can quickly reduce swelling and pain in joints by suppressing the body’s autoimmune response. Sometimes, people experiencing a severe flare of PsA symptoms may need to take corticosteroids for a week or two to bring inflammation under control.
Due to the side effects of corticosteroids, doctors often recommend taking them 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, in the back of the neck, and around the abdomen
- mood changes, 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
Most of 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 types of DMARDs, but doctors use only some of them to treat PsA. Many DMARDs treat other autoimmune diseases, such as rheumatoid arthritis and inflammatory bowel disease (IBD).
Doctors use some DMARDs to treat PsA as an off-label use. This means that the FDA has not approved a drug to treat PsA, but it may work for this purpose.
How they work
DMARDs are immunosuppressive drugs. They may suppress the immune system, which can slow or prevent PsA attacks on the joints.
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 enter remission.
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 joint damage. 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 have allergies to sulfa drugs cannot take this medication. It helps prevent the joint swelling, inflammation, and damage that PsA causes.
Certain drugs that treat malaria, such as hydroxychloroquine, can help with PsA, but results may take several months. Possible side effects include headaches, dizziness, nausea, vomiting, and vision changes.
Acthar is an injectable medication that helps the body make its own steroid hormones, which can help 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 different type of DMARDs. People must take them via injection or intravenous drip.
How they work
Biologics fight inflammation by targeting certain cells in the immune system. This helps calm the overactive immune response.
The following are some examples of biologics that treat PsA:
Tumor necrosis factor-alpha (TNF-alpha) inhibitors
TNF-alpha inhibitors fight inflammation by targeting a specific protein in the immune system.
- etanercept (Enbrel)
- adalimumab (Humira)
- infliximab (Remicade, Renflexis, Inflectra)
- golimumab (Simponi)
- certolizumab (Cimzia)
T-cell inhibitor, or selective co-stimulation moderator
This medication prevents certain immune system activity that causes inflammation.
Abatacept is the only drug in this class.
Interleukin (IL) inhibitors
IL inhibitors help decrease interleukins, a type of inflammatory proteins. 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, a general feeling of being unwell, or soreness at the injection site.
Small molecule medication is a new type of oral (pill) treatment for PsA.
The name comes 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.
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 can include weight loss, depression, and suicidal behavior.
Common side effects of small molecule medications include headache, diarrhea, nausea, and upper respiratory infections. These drugs can decrease a person’s ability to fight infections.
With several types of PsA medication available, many people can find relief from PsA symptoms.
Other therapies and lifestyle strategies, such as physical therapy, exercise, and weight loss efforts, can complement 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.