Treatment for Psoriatic Arthritis
Treatment for patients who have psoriatic arthritis (PsA) involves regular physical examinations and imaging tests (e.g., x-rays) to monitor disease progression. There is no cure for the disorder, and the goals of treatment are to reduce inflammation and relieve symptoms. Exercise and adequate amounts of rest are important aspects of treatment and can help reduce joint inflammation, pain, and stiffness for most patients.
Treatment for Psoriasis Symptoms
Corticosteroidsavailable in creams, ointments, gels, lotions, and foamsmay be used to treat symptoms of psoriasis. These medications, which are applied topically to the skin, usually are used for short-term management and in combination with other topical therapies. Corticosteroids may cause thinning of the skin and progressive resistance and they must be discontinued gradually.
Prescription and over-the-counter tar medications also may be effective to treat psoriasis. These preparations are available in shampoos, as additives for the bath, and as anthralin (tar-like) creams.
Most patients with psoriasis experience improvement with sensible exposure to sunlight and the condition often improves during the summer months. Sometimes artificial ultraviolet light is administered in the physician's office. In these cases, the patient is exposed to increasing amounts of ultraviolet B (UVB) or ultraviolet A (UVA) rays.
UVA rays are used with an oral or topical substance called psoralen, which makes the skin more sensitive to treatment and improves its effectiveness. This treatment is called psoralen plus UVA (PUVA).
Treatment for Joint Pain & Inflammation
Treatment for joint pain and inflammation caused by psoriatic arthritis often depends on the type and severity of the condition. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (e.g., Advil, Motrin) may be used. NSAIDs can cause gastrointestinal side effects, including abdominal pain, nausea, and bleeding in the stomach. In some cases, corticosteroid injections are administered to help reduce severe joint pain and stiffness.
Newer medications can be used to treat severe joint pain and inflammation associated with psoriatic arthritiswhen NSAIDs and corticosteroids are ineffective. Approved medications include disease-modifying antirheumatic drugs (DMARDs; e.g., methotrexate, hydroxychloroquine), sulfasalazine, cyclosporine, biologics (biologic response modifiers, tumor necrosis alpha-factor blockers; e.g., Enbrel [etanercept], Humira [adalimumab], Remicade [infliximab], Simponi [golimumab]), and an interleukin-12/interleukin-23 inhibitor (ustekinumab).
These drugs may relieve more severe symptoms of psoriatic arthritis and attempt to slow or stop joint/tissue damage and the progression of the disease. They can be used in combination with an NSAID or a corticosteroid. Side effects may be severe and include kidney damage, high blood pressure (hypertension, and injection site reactions (e.g., redness, pain, itching)depending on which medicine is used.
In March 2014, the U.S. Food and Drug Administration (FDA) approved the first oral therapy to treat adults with active psoriatic arthritis. This medication, called apremilast (Otezla), is classified as a phosphodieasterase-4 (PDE-4) inhibitor. PsA patients who take apremilast should have their weight monitored regularly by their health care provider, as the drug may cause unexplained weight loss. This medication also is associated with an increased risk for depression. Common side effects include diarrhea, nausea, and headache.
Psoriatic Arthritis Prognosis
The prognosis (expected outcome) for patients who have psoriatic arthritis depends on a number of factors, including the following:
- Age of onset (early onset may indicate a worse prognosis)
- Evidence of bone erosion and new bone formation (indicates severe disease)
- Family history of arthritis (may indicate a severe form of the disease)
- Gender (may be more severe in women)
- Presence of certain antibodies (may affect disease progression)
- Severity of skin and nail involvement (indicate a worse prognosis)
- Type (e.g., asymmetric, symmetric, psoriatic spondylitis)