Prescription medication is necessary to treat the underlying immune response of psoriatic arthritis (PsA) and prevent lasting joint damage. However, some over-the-counter (OTC) drugs may help relieve mild symptoms of PsA.
PsA is a chronic condition that causes joint swelling, stiffness, and pain. It develops when an abnormal immune response causes inflammation in the joints. Over time, this inflammation can cause lasting joint damage.
Psoriatic arthritis most commonly affects people with the skin condition psoriasis.
“About a third of people with psoriasis will develop psoriatic arthritis, so it’s important for the dermatologists to screen for arthritis-type symptoms,” Elisabeth Roter, MD, a rheumatologist at UH Mentor Internal Medicine in Ohio, told Medical News Today.
Certain OTC medications may help relieve joint pain and swelling from PsA, but these treatments will not stop the underlying immune response that causes inflammation in PsA. Prescription medication is necessary to treat the underlying immune response and prevent joint damage.
“People with very, very mild psoriatic arthritis that minimally affects only one joint or a couple of joints may be able to control their symptoms with over-the-counter anti-inflammatory painkillers, but these won’t stop the underlying disease progression. If they still have symptoms, it’s time to see a rheumatologist,” said Roter.
Several nonsteroidal anti-inflammatory medications (NSAIDs) are available without a prescription, including:
- ibuprofen (Advil)
- naproxen sodium (Aleve)
These OTC NSAIDs may help reduce joint pain and swelling from PsA.
Acetaminophen (Tylenol) may also help relieve joint pain from PsA.
Most people with PsA also have psoriasis, which causes dry, scaly patches of skin.
Several products are available to treat psoriasis without a prescription, including:
- low dose hydrocortisone creams and ointments
- creams, ointments, shampoos, and other products that contain coal tar
- topical salicylic acid
- moisturizing lotions
If someone has very mild PsA or psoriasis, OTC treatments may be enough to manage the condition. But many people with PsA or psoriasis require prescription medication to treat it.
Some research suggests that omega-3s — available as OTC supplements — could be beneficial in PsA and potentially reduce the number of NSAIDs needed, preventing side effects from prolonged NSAID treatment.
Lifestyle changes are another nonprescription method of managing PsA. Low impact exercises and proper dietary choices to reduce excess fat — as fats can trigger inflammation — are good habits for people with PsA.
NSAIDs can help relieve joint pain and swelling that results from inflammation in PsA.
But for most people with this condition, NSAIDs alone are not enough to treat it.
If someone develops PsA, a doctor or dermatologist will likely refer them to a rheumatologist for treatment. They will prescribe one or more DMARDs.
Treatment with DMARDs can help reduce symptoms of PsA, but some people still need to take OTC or prescription-strength NSAIDs to manage joint pain or swelling.
“[DMARDs] can treat inflammation in psoriatic arthritis quite well and slow down the progression of the disease, but sometimes those treatments don’t get rid of all of the symptoms,” explained Roter.
“Someone may still have pain from damage that’s already been done to their joints, in which case, over-the-counter or prescription-strength anti-inflammatory painkillers can be helpful to take care of that last bit of discomfort,” she said.
Prescription-strength NSAIDs are available in higher doses than OTC NSAIDs.
Although NSAIDs are generally safe, taking high doses over long periods of time
Finding the right DMARD may reduce the number of NSAIDs that someone with PsA needs to take.
Early treatment with prescription-strength disease-modifying antirheumatic drugs (DMARDs) is
These are often prescribed “off-label.” That means they are being used to treat diseases outside of their approved indications by the Food and Drug Administration (FDA). Some of the DMARDs doctors commonly prescribe off-label to treat PsA include:
Some of the same prescription medications are effective for treating both PsA and psoriasis.
A person should inform a doctor if they develop new or worsening joint pain, swelling, or stiffness.
If they are already in contact with a dermatologist for psoriasis, they may refer them to a rheumatologist for joint treatment.
“If there’s anything more than the mildest of arthritis symptoms, rheumatologists need to take a prominent role. If you have psoriatic arthritis and it causes damage, that damage remains even after you get the inflammation under control, so early treatment is important,” said Roter.
The FDA has approved multiple medications to treat psoriasis and PsA. Some medications work to treat both conditions, while others may only be effective for one condition or the other.
Examples of drugs approved for one condition but not yet the other include Ilumya (tildrakizumab) and Sotyktu (deucravacitinib), which are currently in clinical trials for use in treating PsA.
Examples of drugs that are approved for both psoriasis and PsA include adalimumab (Humira) and secukinumab (Cosentyx).
Abatacept (Orencia) is to treat PsA but has shown promise in treating new cases of psoriasis.
If someone has both conditions, their dermatologist and rheumatologist should ideally communicate to coordinate their care and provide appropriate treatment.
“There’s a fair amount of overlap in treatments for psoriasis and psoriatic arthritis, but there are some agents that we have in dermatology that are not approved for use in psoriatic arthritis, and there are some agents that are approved for psoriatic arthritis that are not approved for skin psoriasis,” Neil Korman, MD, PhD, a dermatologist and director of the Murdough Family Center for Psoriasis at UH Cleveland Medical Center in Ohio, told Medical News Today.
“It’s harder when each doctor makes their own treatment decision. The way to do it is to work together,” he said.
PsA is a chronic, inflammatory condition that can cause lasting joint damage without early treatment.
OTC NSAIDs can help relieve pain and swelling from PsA. Tylenol may also help reduce joint pain. However, these medications do not treat the underlying immune response that causes inflammation in psoriatic arthritis.
Doctors prescribe DMARDs to treat the underlying immune response in PsA. This type of treatment can help stop the condition from worsening, prevent last joint damage, and reduce symptoms.
If someone continues to experience joint symptoms despite taking a DMARD, they should inform their doctor. They may prescribe a different DMARD, add a prescription-strength NSAID to their treatment, or recommend OTC NSAIDs or other treatments to manage symptoms.
Many people with PsA also have psoriasis. OTC treatments may be enough to treat mild psoriasis, but people with moderate to severe psoriasis typically need prescription medications.
Some of the same prescription medications work to treat both PsA and psoriasis.