Although there is currently no cure for psoriatic arthritis, it can be treated with medical therapies to help control pain and retain functional movement in the joints. Treatment programs focus on controlling present symptoms and preventing future joint damage.
Treatment for psoriatic arthritis is a collaborative effort between primary care doctors, rheumatologists, and dermatologists. The rheumatologist specializes in reducing pain and swelling in the joints while the dermatologist can help control outbreaks on the skin. Both focus on slowing the progression of the disease and preventing further joint damage.
The severity of the disease, among other factors, affects choice of treatment.
Medications and Treatments for Psoriatic Arthritis
Treatment programs often consist of a combination of the following:
- Topical treatments. These are the typical first line of defense treatments for the skin disease and are usually sufficient for mild cases. These are most effective at keeping psoriasis outbreaks under control, and include many relatively inexpensive products such as mild, moisturizing soaps and creams, bath oils, shampoos, and the use of a humidifier in the home. In more serious cases, the dermatologist may prescribe a non-steroidal topical cream or a steroid cream.
- Medications. Drug therapy is the main category of treatment for psoriatic arthritis. These medical therapies are employed to reduce joint pain and swelling, and some may also help the skin.
- Symptom-modifying medications
- Nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen, naproxen, and Celebrex), can help with joint pain and swelling, but are unable to alter the course of the disease.
- Steroid injections can be effective when applied directly to the joint; however they can only be used in cases where one or two joints are affected.
- Disease-modifying anti-rheumatic medications (DMARDs)
- Disease-modifying antirheumatic drugs (DMARDs such as methotrexate (also helps skin), sulfasalazine, antimalarials, azathioprine, leflunomide, and cyclosporine A) are prescribed to individuals who have arthritis in one or several joints.
- Biological agents – provide relief of symptoms and also prevent further joint damage.
- Tumor necrosis factor (TNF) inhibitors such as etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi) are FDA approved for both skin and joint disease.
- T-cell blockers work to inhibit molecules that drive psoriasis. Alefacept (Amevive) can be used for severe chronic skin psoriasis (not joint disease).
- Light therapy. This can be helpful in controlling psoriasis. Common methods include:
- Sitting in the sun for short periods each day, but not long enough to get burned.
- PUVA treatment, a prescribed therapy in which the patient takes the medicine psoralen before sitting in UVA light. This combination can relieve skin symptoms.
- UVB light therapy, in which the patient sits in front of a UVB light box.
- Exercise. This is essential to relieving stiffness and maintaining strength in the muscles surrounding and supporting the affected joints. Helpful types of exercise for psoriatic arthritis include walking, water exercise (swimming or walking), exercise bike, yoga, and stretching.
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In addition to the above treatments, the following can also be helpful for psoriatic arthritis:
- Appropriate amounts of rest and sleep to help decrease fatigue and subsequently alleviate inflammation of the joints.
- Heat and cold therapies to temporarily alleviate joint pain and help reduce swelling.
- Splints to help with joint alignment and stability.
- Physical therapy and occupational therapy.
For most patients, psoriasis and psoriatic arthritis symptoms can be managed with nonsurgical care. Most patients suffering from psoriatic arthritis can expect flare-ups of and repeated episodes of the disease.
If non-surgical treatments fail, surgery may be needed to repair or replace severely damaged joints.