If you or a loved one has recently been diagnosed with psoriatic arthritis (PsA), you may have questions about the treatment options available. While there is no cure for psoriatic arthritis, there are many treatment options that can help relieve common symptoms like swelling, stiffness, and joint pain. From medical treatments like nonsteroidal anti-inflammatory drugs (NSAIDs) and biologics to natural remedies and lifestyle changes, we’ll explore some common forms of PsA treatment.
Remember: You should always consult your doctor before starting any treatment.
Medications Used to Treat Psoriatic Arthritis
NSAIDsNSAIDs are one of the most common traditional treatments used to treat the pain and discomfort associated with psoriatic arthritis. They can relieve musculoskeletal symptoms, control swelling, relieve pain and morning stiffness, and improve range of motion in affected joints. In milder cases, this may be the only medication needed to treat symptoms. Examples of over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen (Aleve). In addition, stronger NSAIDs are available with a prescription.
SteroidsCorticosteroids can also help reduce the swelling and pain associated with psoriatic arthritis. If a joint is particularly affected, you may get a steroid injection directly into that joint. Steroids can also be taken in tablet form to reduce inflammation, swelling, and pain. However, long-term use of steroid tablets is not recommended due to potentially significant side effects.
DMARDsAnother common treatment for psoriatic arthritis is a class of medications called DMARDs (disease-modifying antirheumatic drugs). DMARDs work by targeting the underlying cause of psoriatic arthritis, which is an abnormal immune response in the body. This response causes the immune system to attack various tissues and cells, including healthy joint tissue. DMARDs block chemicals that cause inflammation, which can relieve symptoms, slow the progression of PsA, and prevent further joint damage. DMARDs are usually taken orally in tablet form. Examples include methotrexate (Trexall, Otrexup), leflunomide (Arava), sulfasalazine (Azulfidine), azathioprine (Imuran, Azasan), and cyclosporine (Gengraf, Neoral, Sandimmune). DMARDs can take several weeks to work. Therefore, it is important to continue taking the medication even if you don't see an immediate effect. DMARDs affect the entire immune system and can produce side effects such as bone marrow suppression, liver damage, and increased risk of infection.
Other MedicationsPhosphodiesterase 4 (PDE4) inhibitors, such as apremilast (Otezla), have recently been approved for people with psoriatic arthritis who haven't responded well to previous DMARDs. This medication, taken in tablet form, reduces the activity of an enzyme in the body that causes inflammation.
BiologicsBiologics are a relatively new form of treatment for psoriatic arthritis. They target specific molecules or chemicals in the immune system that cause psoriatic arthritis. These drugs are usually used in people with severe psoriatic arthritis or for people who haven't responded to other treatments. Biologics are usually injected or infused into a vein and can be used alone or in combination with other drugs, such as older DMARDs. Examples include adalimumab (Humira), abatacept (Orencia), infliximab (Remicade), apremilast (Otezla), certolizumab (Cimzia), etanercept (Enbrel), tofacitinib (Xeljanz), golimumab (Simponi), ixekizumab (Taltz), secukinumab (Cosentyx), and ustekinumab (Stelara). Biologics may cause side effects, such as liver and kidney problems. Therefore, you will need regular blood or urine tests to check for this possibility. Biologics do not work right away, and it is usually recommended to continue treatment for at least three months before evaluating whether the drug is working.
Non-drug Treatments
A healthy lifestyle can make psoriatic arthritis symptoms easier to manage.
Lifestyle Changes to Consider
- Weight:Maintaining a healthy weight can reduce stress on your joints. If you are overweight, losing weight can ease joint pain.
- Exercise:Regular, light exercise helps keep joints flexible and strengthens muscles, which support joints. Exercise has also been shown to reduce overall inflammation, increase energy levels, and improve mood.
- Nutrition:Eating a healthy, balanced diet ensures your body has the right nutrients and vitamins to support joint health. In particular, a diet low in processed and high-fat foods has been shown to be effective for many health conditions.
- Smoking:Smoking has a pro-inflammatory effect on the body. Additionally, smokers are at a higher risk for developing psoriatic arthritis and are more likely to experience severe symptoms. Smoking also reduces the effectiveness of certain medications used to treat psoriatic arthritis.
- Alcohol:Alcohol can increase the risk of developing psoriatic arthritis and make symptoms worse. Additionally, some medications should not be taken with alcohol.
- Physical therapy:Physical therapy may be useful for some people with psoriatic arthritis to maintain joint flexibility and build strength.
- Home aids:Using home aids, such as a can opener, can help maintain independence while taking pressure off joints.
- Coping with stress:High levels of psychological stress can negatively impact physical illness. Participating in stress-reducing activities, such as yoga, meditation, and mindfulness, may help.
Surgery
For patients with severe psoriatic arthritis, doctors may recommend surgery. This is often the treatment of choice when damaged joints need to be removed and replaced with artificial joints.
Alternative Therapies
There is limited clinical evidence supporting the following treatments as effective for psoriatic arthritis symptoms. However, they are generally safe and may improve overall health. These alternative therapies and remedies include:
- Turmeric:Curcumin, a natural component in turmeric, is said to have anti-inflammatory properties.
- Epsom Salts and Hydrotherapy:Since ancient times, people have used thermal baths and Epsom salts to treat rheumatic diseases. These can have the dual effect of relieving joint stiffness and combating psychological stress.
- Massage:Massage can help relax tight muscles that accompany joint pain. However, massaging the painful area is not recommended.
Resource Links
- "Psoriatic arthritis" from MedlinePlus
- "Treatments for psoriasis" from the National Psoriasis Foundation
- "Psoriatic arthritis" from the National Institute of Arthritis and Musculoskeletal and Skin Diseases
- "Psoriatic arthritis" from the National Health Service
- "Psoriatic arthritis: diagnosis and treatment" from the Mayo Clinic
- "Psoriatic arthritis" from BMJ Best Practice
- Gossek et al. (2019). EULAR recommendations on drug treatments for psoriatic arthritis: 2019 update.
