How Psoriatic Arthritis Is Treated

Psoriatic arthritis (PsA) is a combination of inflammatory arthritis and the skin condition psoriasis. It is a chronic, often progressive autoimmune disease that causes painful joints and itchy, scaly, discolored patches on the skin. 

If not properly treated, PsA can lead to a reduced quality of life and possible disability.

Treatment of psoriatic arthritis is typically two-pronged. Ideally, you should have a rheumatologist to manage joint symptoms and a dermatologist to treat and prevent recurring skin rashes. 

If you're not able to see these specialists, your primary care provider may be able to manage the condition well.

The primary goal of treatment is to maximize health-related quality of life by controlling symptoms and preventing structural damage.

Depending on the severity of your condition, treatment typically includes:

  • Ointments to heal and prevent skin lesions
  • Over-the-counter (OTC) medications to relieve joint pain
  • Prescription medications to control inflammation in both the skin and joints
  • Possibly, surgery to repair or replace damaged joints

Over-the-Counter Therapies

Several OTC remedies may help relieve symptoms. These include oral and topical medications for pain, inflammation, and rashes.

Applying Cream on Psoriasis Patient

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NSAIDs

For pain, NSAIDs (nonsteroidal anti-inflammatory drugs) are typically the first-line treatment. Thats especially true for people with mild peripheral arthritis symptoms, such as achy hands, wrists, or knees. 

OTC NSAIDs include:

  • Advil/Motrin (ibuprofen)
  • Aleve (naproxen)
  • Aspirin (acetylsalicylic acid)

Side effects typically include gastrointestinal symptoms.

NSAIDs work by blocking COX-1 and COX-2 enzymes to halt or reduce the production of prostaglandins—compounds involved in inflammation—resulting in less swelling and pain. 

OTC Creams

For treating skin symptoms, topical anti-itch creams may help stop itching. OTC creams containing 1% hydrocortisone may be effective.

However, most people with PsA need prescription medications to heal skin rashes.

Topical pain-relievers might seem like they could be helpful, but they are almost never used in PsA.

Prescriptions

Since psoriatic arthritis involves both the skin and joints, different treatments may be offered for its assorted symptoms.

Your rheumatologist and dermatologist will determine your course of treatment based on the severity of your symptoms and potential positive and negative effects of treatments, along with comorbidities.

Psoriasis Treatments

Creams and ointments are used to treat the scaly, itchy patches associated with psoriasis.

Treatment is the same regardless of skin color despite psoriasis' different appearance. Patches appear pink or red on people with light skin tones and purplish or darker brown on brown or black skin.

These include:

  • Topical corticosteroids: Use short-term for inflammation, itching. Many potencies available. Cordran (flurandrenolide), Topicort (desoximetasone), and Lidex (fluocinonide).
  • Synthetic vitamin D: Helps slow skin cell growth. Medications include Dovonex (calcipotriene) and Vectical (calcitriol), both of which may irritate the skin.
  • Anthralin: Helps slow skin cell growth, removes scales, and makes skin smoother. Sold under the brand name Dritho-Scalp, it may irritate skin and shouldn't be left on for long stretches. 
  • Retinoids: Vitamin A derivatives. May decrease inflammation. Sold as Tasorac or Avage (tazarotene). May irritate skin and increase sensitivity to sunlight.
  • Calcineurin inhibitors: Reduce inflammation and plaque build-up. Prograf (tacrolimus), Elidel (pimecrolimus). Long-term or continuous use may increase risk of skin cancer. 

Research published in 2018 shows that Black people, people of Asian descent, and Native Americans are 40% less likely than White people to see a dermatologist for psoriasis. That's regardless of socioeconomic status and whether they have insurance.

Meanwhile, research shows that people of color may have more severe skin involvement with PsA.

Racial Disparities in Treatment

Many people with psoriasis may be undertreated, according to research. Some get only topical treatments while others get no treatment at all. People of color may be disproportionately undertreated.

Anti-Rheumatic Drugs

Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat inflammatory conditions and slow the disease process by modifying the immune system.

They come in three varieties—conventional synthetic, targeted synthetic, and biologics—and are believed to halt the underlying disease process through immunosuppression.  

Newer drugs for PsA include:

Pain Medication

For pain that accompanies joint inflammation and stiffness, you may benefit from prescription pain medications.

NSAIDS

NSAIDs may relieve musculoskeletal symptoms of arthritis. They're typically the first-line medication for people with mild peripheral arthritis symptoms. More than a dozen are on the market, including:

  • Celebrex (celecoxib)
  • Mobic (meloxicam)
  • Toradol (ketorolac)
  • Zorvolex (diclofenac)

Side effects typically include gastrointestinal symptoms.

Steroids

Steroids can help relieve inflammation. They're often prescribed to treat a flare-up of arthritis or psoriasis. They can be given orally or by injection. Common steroids include:

  • Cortisone
  • Prednisone
  • Methylprednisolone
  • Triamcinolone

Side effects of steroids include irritability and mood changes, increased blood sugar levels, high blood pressure, insomnia, and weight gain.

Opioids

Opioids (also called opiates) are narcotic painkillers. They include:

  • Percocet (oxycodone and acetaminophen)
  • Vicodin (hydrocodone/acetaminophen)
  • Demerol (meperidine)
  • OxyContin (oxycodone)

These medications are for short-term relief of serious or debilitating pain. Opioids can be highly addictive and should not be taken for extended periods of time.

Side effects include constipation, stomach upset, dizziness, itchy skin, and drowsiness or sedation.

Surgeries and Specialist-Driven Procedures

Fewer than 10% of people with PsA need surgical treatment. Surgery is typically a last resort and falls under three categories:

  • Joint fusion: Can offer pain relief but limits mobility. 
  • Synovectomy: Used when joint inflammation doesn't respond to drugs. All or part of the joint lining is removed. 
  • Joint replacement: Typically for large joints, such as hips and knees.

Home Remedies and Lifestyle


Being proactive in your treatment and practicing self-care are important for people with psoriatic arthritis. In addition to taking medications as prescribed, here are some ways you can help cope with the condition: 

  • Get regular exercise: Physical activity, such as walking and stretching, can help keep affected joints flexible and improve health and well-being. 
  • Lose weight: Excess weight puts added stress on joints, so losing weight may help relieve joint symptoms.
  • Manage stress: Stress can increase inflammation. Deep breathing, meditation, yoga, tai chi, or a support group may help reduce stress. If you need more help, you may want to consider counseling.
  • Keep skin protected: Moisturize with lotions, use prescription or over-the-counter topical treatments regularly, and avoid hot baths or showers. 
  • Use gentle detergents: Stick to fragrance-free detergent and fabric softeners for washing clothes to reduce skin reactions.
  • Shampoo frequently: If you get psoriasis on your scalp, shampooing often can help remove scales.

Stubborn Scalp Psoriasis

Some people may have a harder time clearing up psoriasis on the scalp than others. This is particularly true in Black people, who may need to use a medicated shampoo twice a week. If that's not enough, a topical medicine may be recommended. Your dermatologist can help you manage this.

Complementary and Alternative Medicine (CAM)

Several natural and alternative remedies can help treat PsA. These include:

  • Massage
  • Acupuncture and acupressure
  • Chiropractic
  • Moist heat
  • Icing

Cannabis

Cannabis has received little-to-no attention as a PsA treatment. However, it has been shown to relieve pain and inflammation from some other types of arthritis pain.

Cannabidiol (CBD), a component of marijuana that doesn't get you "high," has anti-inflammatory properties and is legal at the federal level.

If you want to try it, check to see if you live in a state with a medical marijuana program.

Phototherapy

Phototherapy involves exposing skin to UV light and can help heal skin patches. You do this by standing in a lightbox two or three times a week.

Special devices that emit UVB light can be used at the doctor's office or in your home, though natural sunlight can be effective as well.

The National Psoriasis Foundation recommends starting with five to 10 minutes of natural sunlight and gradually increasing your exposure over time.

If you are using medications that may cause photosensitivity, you should not use phototherapy.

Also note that phototherapy can make your skin tan or darken where it's treated. In people of color, it can make dark spots from psoriasis even more pronounced. If this concerns you, tell your dermatologist you'd rather try a different treatment option.

A Word From Verywell

Psoriatic arthritis is a painful, progressive illness that, if left untreated, can lead to a disability. However, it can be managed so you can maintain your quality of life. Follow your doctor's instructions and treatment plan and bring up any problems, concerns, or side effects you have that may impact your willingness or ability to take your medications.

Frequently Asked Questions

  • What over-the-counter treatments relieve PsA pain?

    Advil, Motrin, Aleve, and aspirin are non-steroidal anti-inflammatory drugs (NSAIDS) sold without a prescription. NSAIDs work to relieve arthritis pain by blocking an enzyme involved in inflammation and pain. 

  • Is it safe to use topical pain relievers if you have PsA?

    Maybe. People with psoriatic arthritis are at greater risk for side effects, like skin irritation and rashes. These can potentially trigger a psoriasis outbreak. If you have PsA, do a patch test on a small area of skin and watch for irritation before applying over a larger area. 

  • What is commonly prescribed to treat PsA?

    Topical corticosteroids are the most common treatment for rashes from PsA. There are more than a dozen different variations of topical corticosteroids that are commonly used. For the arthritis aspect of the disease, DMARDs are most commonly prescribed. Methotrexate is typically the first DMARD tried.

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  1. National Psoriasis Foundation. Potency chart.

  2. Fischer AH, Shin DB, Gelfand JM, Takeshita J. Health care utilization for psoriasis in the United States differs by race: An analysis of the 2001-2013 Medical Expenditure Panel SurveysJ Am Acad Dermatol. 2018;78(1):200-203. doi:10.1016/j.jaad.2017.07.052

  3. Takeshita J, Eriksen WT, Raziano VT, et al. Racial differences in perceptions of psoriasis therapies: Implications for racial disparities in psoriasis treatmentJ Invest Dermatol. 2019;139(8):1672-1679.e1. doi:10.1016/j.jid.2018.12.032

  4. Day MS, Nam D, Goodman S, et al. Psoriatic arthritis. J Am Acad Orthop Surg. 2012;20(1):28-37. doi:10.5435/JAAOS-20-01-028

  5. American Academy of Dermatology Association. Can you get psoriasis if you have skin of color?

  6. Roberts JA 4th, Mandl LA. Complementary and alternative medicine use in psoriatic arthritis patients: a reviewCurr Rheumatol Rep. 2020;22(11):81. Published 2020 Sep 28. doi:10.1007/s11926-020-00956-x

  7. National Psoriasis Foundation. Phototherapy. October 1, 2020.

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