OTC Treatment Options for Psoriatic Arthritis

NSAIDS, Topicals, and Natural Treatments

In This Article

Psoriatic arthritis (PsA) is an autoimmune disease related to psoriasis, an inflammatory skin condition. In addition to inflamed joints that are characteristic of psoriatic arthritis, some people with PsA will also experience skin symptoms and nail changes. PsA tends to occur in cycles with periods called flares where symptoms worsen and periods of remission where symptoms reduce or disappear for some time. 

Current prescription medical treatments can help prevent flare and relieve symptoms of PsA. There are also over-the-counter (OTC) treatments that can help relieve symptoms, including non-steroidal anti-inflammatory drugs (NSAIDs), topical medicines and natural supplements. Some approaches relieve symptoms, while others can help reduce flares.

NSAIDs

First-line treatment options for PsA are NSAIDs, which can help with mild symptoms of joint pain and swelling. Having mild symptoms generally means that you have a joint or two that are inflamed. 

NSAIDs are not usually an option if you have severe psoriasis because it can lead to flare-ups, this according to research reported in The Journal of Clinical and Aesthetic Dermatology. Most doctors will prescribe NSAIDs provided a person does not report frequent and severe skin flares, ulcers or kidney problems.

The determination to use NSAIDs to treat PsA symptoms is usually decided based on the severity of disease. Disease severity is determined by the extent of a person’s pain and the number of joints affected. Unfortunately, there has been some recent research that indicates that NSAID users have more risks for PsA. 

One 2015 cohort study from researchers from the Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School finds that long-term NSAID use was a potential risk factor to PsA. The researchers suggested doctors screen patients with other PsA risk factors for psoriasis and PsA if they are using NSAIDs for long periods.

When used for treating mild PsA, NSAIDs will need several weeks to build up in the body before they can be an effective treatment for inflammation. NSAIDs—even for long periods—are usually tolerated well by most people. But they are also known for causing some very serious side effects, including stomach pain and bleeding. Even prescription NSAIDs, such as Celebrex, a COX-2 inhibitor, increase the risk for adverse events, including heart attack. Your doctor will look at your family and medical history to determine if you have risk factors, such as heart disease, heart attack and stroke, before prescribing OTC and prescription NSAIDs.

Other common side effects of long-term NSAID use are:

  • Heartburn
  • The tendency to bleed more easily
  • Headaches and dizziness
  • Ringing in the ears
  • Allergic reaction, including rashes, wheezing and throat swelling
  • High blood pressure
  • Leg swelling

You should not take NSAIDs if you:

  • Previously had serious side effects from a pain reliever or fever reducer
  • Have a high risk for stomach bleeding
  • Have stomach problems, including heartburn
  • Have high blood pressure, heart disease, liver problems or kidney disease
  • Have asthma
  • Take diuretic medications

Your doctor will want you to have regular monitoring if you have using NSAIDs for long periods. This will include checking your blood pressure and blood work for liver and kidney problems.

You can find NSAID pain relievers, including ibuprofen, aspirin and naproxen sodium your local pharmacy or supermarket, at online retailers, and directly from the manufacturer.  These medications do not require a prescription.

Topical Treatments

Over-the-counter topical treatments for PsA skin symptoms and psoriasis include lotions, foams, moisturizers, bath solutions and more. These products usually common two active ingredients—salicylic acid and tar. Both compounds have been approved for the Food and Drug Administration (FDA) for treating psoriasis.

Salicylic acid is a peeling agent that works by causing the other layer of your skin to shed. It is used for a variety of skin conditions. As a treatment for psoriasis, it helps soften and remove psoriasis plaques. Sometimes, salicylic acid can cause skin irritation and long-term use over the same skin areas can lead to hair loss. It is a good idea to talk to your doctor about side effects and how they may affect you.

Tar—made from both coal and wood—is used for a variety of conditions, but it mostly used for treating skin symptoms of PsA and psoriasis. It can help to reduce excessive skin growth and restore your skin’s appearance. Tar may help with inflammation, itching, and scaling. Tar can irritate the skin, so it is a good idea to test in a small skin area first. Tar is known for staining clothing and bed linens. It may lighten colored hair and make you more sun-sensitive. You should wash off tar solution off before heading outdoors, use sunscreen, and monitor your sun exposure. Your risk for sunburn is increased in the first 24 hours after skin application so limit your time in the sun after application.  

Some research indicates that tar may increase skin cancer risk, but only in high concentrations over long periods, so make sure to follow up with your doctor regularly and share information about any changes to your skin.

Additional OTC products to add to your skin treatment plan for PsA include moisturizers, bath solutions, anti-itch creams, and scale lifters. 

Moisturizers can help to keep your skin lubricated to reduce redness and itching. Stay away from products that are full of fragrances and try heavy creams and ointments to help lock water into the skin. Use moisturizing soap and add moisturizers to skin after washing hands and showering.

Bath solutions can be helpful in treating PsA skin symptoms. Epsom salts, Dead Sea salts, and oilated oatmeal can help with removing skin scales and soothing itching. Soak for at least 15 minutes in the bath and apply moisturizer after getting out of the bath.

Anti-itch creams contain key ingredients to help with skin dryness, redness, and itching. Look for products that contain calamine, hydrocortisone (a weak steroid), camphor, diphenhydramine hydrochloride (HCl), benzocaine, and menthol. These products may also cause irritation and dryness so, check with your doctor to find out which products can best help you.

Scale lifters can help loosen and remove scales on the scalp and the body. Look for products that contain salicylic acid, lactic acid, urea, or phenol. These products should not be used on sensitive skin sites. 

The effectiveness of OTC topicals for treating PsA skin symptoms will vary person-to-person. Many of these treatments can cause allergic reactions and side effects, including skin irritation, even if they contain natural ingredients. If irritation continues, discontinue use. OTC topical treatments are available in drug stores, supermarkets, and at many online retail websites.

Natural Treatments

Some natural supplements can help relieve PsA symptoms and reduce risks for flares. However, it is important to note that many natural remedies do not have enough scientific evidence to back up their effectiveness.

Turmeric: Curcumin, which is the active ingredient in turmeric, has anti-inflammatory properties. Studies have shown turmeric can help treat PsA naturally by changing how some genes function. You can use turmeric as a spice or take it in supplement form.

Capsaicin: Capsaicin is a substance found in chili peppers. There has been some research that indicates creams containing capsaicin may help numb pain receptors to bring about joint pain relief.

Fish oil:  Fish oil is loaded with omega-3 fatty acids, which studies suggest may ease pain inflammation and swelling. Sources of fish oil include supplements and oily fish, such as tuna and sardines.

When OTC Treatments Don’t Help

You should talk to your doctor if your joint and symptoms get worse or don’t respond well to OTC treatments. Your doctor may suggest traditional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate. DMARDs can help to reduce or stop pain and swelling and reduce the potential for joint tissue damage. They work by curbing the immune system to keep it from causing inflammation.

DMARDs are also available in a biologic form. Biologic DMARDs work by targeting cells at the molecular level to stop inflammation at its early stages. These medications are given by injection or infusion into a vein.

DMARDs are stronger than NSAIDs and will take longer to work. And because they are systemic (affecting the entire body) drugs, they may cause some serious side effects including stomach upset, liver problems, blood pressure issues, and an increased risk for infection. It may also take some time to find the best treatment to manage your PsA joint and skin symptoms.

A Word From Verywell

You should talk to your doctor before starting any OTC treatment as these may interact with other medications or treatments. Supplements should never replace treatments prescribed by your doctor and the FDA does not approve the purity, quality, composition or strength of these products. Any supplement or OTC product that causes side effects should be stopped. And you should also tell your doctor about any side effects or adverse reactions experienced. 

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