The goal of treating psoriatic arthritis is to reduce pain and other symptoms as well as prevent future joint damage. Treatment may involve a collaboration between the patient, primary care doctor, rheumatologist, and dermatologist.
Usually more than one treatment will be recommended. For example, medications and dietary changes may be used together.
Medications to Treat Psoriatic Arthritis
Most people who have psoriatic arthritis take a regular medication to keep joint inflammation, pain, and swelling under control. Some medications help with both psoriatic arthritis and psoriasis symptoms.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and Celebrex, can help with joint pain and swelling. These medications may relieve symptoms but do not change the biologic processes of the disease itself.
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Disease-modifying anti-rheumatic medications (DMARDs) suppress the immune system (psoriatic arthritis is an auto-immune disease). Examples of DMARDs include methotrexate, which may also help skin symptoms; sulfasalazine; antimalarials; azathioprine; leflunomide; and cyclosporine A.
Biologic medications are technically a subset of DMARDs. Biologics prevent specific proteins in the body from participating in the inflammatory process. By doing so, biologics reduce inflammation and potentially stop the disease process.
Most biologic medications are given through injection or intravenously. Biologics used to treat psoriatic arthritis include:
- Tumor necrosis factor (TNF) inhibitors, such as etanercept (Enbrel), certolizumab (Cimzia), adalimumab (Humira), infliximab (Remicade) and golimumab (Simponi)
- Interlukin 17 inhibitors, including secukinumab (Cosentyx), brodalumab (Siliq), and ixekizumab (Taltz)
- Interleukin-12 and -23 (IL-12/23) inhibitors, such as ustekinumab (Stelara)
- JAK inhibitors, including tofacitinib (Xeljanz)
Biologics may be used on their own or in combination with traditional DMARDs.
Treating Psoriatic Arthritis without Medication
Many recommended treatments for psoriatic arthritis involve changing everyday habits. Some people may find that making these lifestyle changes helps reduce pain and even reduces their need for medications. (Medication changes should always be made in consultation with the prescribing physician).
Gluten-free diet. Having psoriasis increases the likelihood of also having a gluten sensitivity or celiac disease. If this is the case, avoiding gluten can decrease psoriasis symptoms and body-wide inflammation. People with a suspected gluten sensitivity can avoid gluten for 3 months to test its effects.
Exercise. Exercise is essential to maintaining muscle strength, supporting joints, and relieving psoriatic arthritis pain and stiffness. Examples of helpful types of exercise include walking, water exercise (swimming or walking), biking, yoga, and strength training with light weights.
Physical therapy and occupational therapy. Professional therapists can tailor strengthening exercises to a patient’s needs, anatomy, and lifestyle. They may also provide tips and retraining to help cope with existing joint problems.
Rest. While exercise is necessary to maintain healthy joints, sometimes rest is needed to manage pain and fatigue.
Splints. A physician or physical therapist may recommend a splint to support a joint that is becoming mis-aligned or unstable.
Quitting nicotine. Smoking and other nicotine use can make psoriasis and psoriatic arthritis symptoms worse. This may be because nicotine increases inflammation in the body, because smoking affects how the body metabolizes treatment medications, or a combination of both.
Vitamin D. Limited evidence1,3,4 has shown taking vitamin D reduces psoriatic arthritis symptoms. Vitamin D is sold in many forms; for people with psoriatic arthritis, experts recommend 0.5 µg alfacalcidol or 0.5 to 2.0 µg calcitriol daily. Supplements may be taken for 6 months before results are noticeable.
Steroid injections. A corticosteroid injection might be appropriate if joint inflammation is severe or does not go away after other treatments have been tried. Research shows that steroid injections can cause damage to the joint’s soft tissue, especially if used repeatedly on the same joint. In addition, steroid injections may only be used on one or two joints at a time.
Treatments for Psoriasis
In addition to the treatments described above, a physician may recommend treatments to help improve symptoms of psoriasis. For example, topical treatments, light therapy, and medications called T-cell blockers may be recommended for psoriasis.
Surgery for Psoriatic Arthritis
If damage to a joint is severe, and the pain and loss of movement affects daily living, surgery may be recommended. A surgeon may repair or replace the damaged joint. Most patients who have psoriatic arthritis can manage symptoms without surgery.