How Psoriatic Arthritis Is Treated

Psoriatic arthritis 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 red patches on the skin. If not properly treated, it can lead to a reduced quality of life and possible disability.

Treatment of psoriatic arthritis is typically two-pronged. Patients often see both a rheumatologist to manage the autoimmune responses that lead to inflammation and a dermatologist to treat and prevent recurring skin rashes. 

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 medications to relieve joint pain, prescription medications to modify the immune response and treat pain, and possibly surgery to repair or replace damaged joints. 

Over-the-Counter (OTC) Therapies

There are several different OTC remedies that may help relieve symptoms and come in oral and topical medications for pain, inflammation, and rashes.

NSAIDs

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

NSAIDs work by blocking Cox-1 and Cox-2 enzymes to halt or reduce the production of prostaglandins resulting in less swelling and pain. 

OTC NSAIDs include Advil (ibuprofen), Motrin (ibuprophen), Alleve, (naproxen), and aspirin. Side effects typically include gastrointestinal discomfort and symptoms. 

Topical Pain Relievers

Topical pain-relieving creams, ointments, rubs, or sprays can help to soothe painful joints, but people with psoriatic arthritis need to used these products with care.

The most common side effect of topical creams is rashes and skin irritation. It is recommended to test these products on small patches of skin first. 

Different products contain different formulations and may work better for your individual pain that others. Ingredients commonly found in in OTC topical pain relievers include:

  • Capsacin, the compound responsible for the heat in hot peppers, is a highly effective topical pain reliever for joint pain. Creams that contain capsaicin typically cause a warm tingling or burning sensation that fades over time. Though capsaicin creams are effective, it may take several applications before you feel relief.
  • Counterirritants, such as menthol, camphor or methyslicylate, create a warming or cooling sensation that eases pain. Be sure to wash your hands thoroughly after applying and keep counterirritants away from eyes. 
  • Salicyltes contain similar compounds to aspirin that relieve pain in the area where applied, particularly on joints that are close to the skin, such as fingers, knees, and elbows. If you are allergic to aspirin or taking a blood thinner, talk to your doctor before using. 

Be sure to follow the package instructions for any topical pain-reliever and avoid touching your eyes or gentials. Never apply to damaged skin, and do not use along with heat therapy as it could cause irritation or burns.

Anti-Itch Creams

For treating skin symptoms, topical anti-itch creams may help to stop the itch. OTC creams containing 1% hydrocortisone may be effective, however, most people with psoriatic arthritis need prescription medications to heal skin rashes. 

Prescriptions

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

Your rheumatologist will determine your course of treatments by the severity of symptoms and potential positive and negative effects of different treatments, along with comorbidities.

Psoriasis Treatments

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

  • Topical corticosteroids help to reduce inflammation and relieve itching. There are more than a dozen different corticosteroids available in various potencies, including Cordran (flurandrenolide), Psorcon (diflorasone diacetate), Topicort (desoximetasone), and Lidex (fluocinonide). These medications should only be used for short-term relief and using them over longer periods can can cause the skin to thin and they may lose effectiveness. 
  • Synthetic vitamin D helps to slow skin cell growth. Medications include Dovonex (calipotriene) and Vectical (calcitriol), both of which may irritate skin. Calcitrol may be less irritating, but it more expensive than caliportrine. 
  • Anthralin can help to slow skin cell growth, remove scales and make skin smoother. Sold as brand name Dritho-Scalp, antrhalin may irritate skin and should not be left on skin for a prolonged period. 
  • Retinoids, or vitamin A derivatives, can help to decrease inflammation. Sold as Tasorac or Avage (tasarotene), retinoids may irritate skin and increase sensitivity to sunlight. It is not recommended for women who are or may become pregnant or are breastfeeding. 
  • Calcineurin inhibitors reduce inflammation and plaque build up. Sold as Prograf (tacrolimus) and Elidel (pimecrolimus), these topical are not recommended for long-term or continuous use due to a possible increased risk of skin cancer. 

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 are also available for psoriatic arthritis and include:

Pain Medication

For pain that accompanies joint inflammation and stiffness, many patients rely on prescription pain medications such as NSAIDs, steroids, and opioids.

  • NSAIDs may be used to relieve musculoskeletal signs and symptoms of arthritis and are typically the first-line medication for people with mild peripheral arthritis symptoms. There are more than a dozen different prescription NSAIDs on the market, including Celebrex (celexoxib), Mobic (meloxicam), Toradol (ketorolax) and Zorvolex (diclofenac). Side effects typically include gastrointestinal symptoms.
  • Steroids help to relieve inflammation and are often prescribed to treat a flareup of arthritis or psoriasis and can be given orally or by injection. Common steroids include cortizone, prednizone, methylprednisolone, and triamcinolone. Side effects of steroids include irritability and mood changes, increased blood sugar levels, high blood pressure, insomnia, and weight gain.
  • Opioids are narcotic pain killers and include percocet, hydrocodine, demerol, and oxycontin. These medications are given 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 of narcotic pain killers include constipation, stomach upset, dizziness, itchy skin, and drowsiness or sedation.

    Surgeries and Specialist-Driven Procedures

    Less than 10 percent of people with psoriatic arthritis need surgical treatment, according to a review in the Journal of the American Academy of Orthopedic Surgeons. Surgery is typically a last resort and falls under three categories:

    • Joint fusion is when the joint is fused together. This can offer pain relief but limits mobility. 
    • Synovectomy is used when the damage is limited to the joint lining. The surgeon can remove all or part of the joint lining to ease the pain. 
    • Joint replacement is typically used for large joints, such as hips and knees. The injured joint is removed and replaced with an artificial one. 

    Home Remedies and Lifestyle

    Being proactive in your treatment and practicing self-care is 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 daily, can help keep affected joints flexible and improve health and wellbeing. 
    • Lose weight. Excess weight puts added stress on joints. If you are carrying extra pounds, losing weight can help you feel better. Maintaining a healthy weight will hep you feel better long term.
    • Manage stress. Stress can increase inflammation and make it hard to manage daily activities. Deep breathing exercise, meditation, yoga, tai chi, or joining a support group can help to reduce stress. If these self-care methods do not work, talk to your doctor for other ideas. Some people find one-on-one counseling can help them learn new coping skills. 
    • Keep skin protected. Moisturize with lotions, remember to use any prescription or over-the-counter ointments or creams daily, and avoid hot baths or showers. 
    • Use gentle detergents. Stick to fragrance-free detergent and fabric softeners for washing clothes to reduce skin reactions.

    Complementary Alternative Medicine (CAM)

    There are several natural and alternative health remedies for psoriatic arthritis. Massage, acupuncture, and acupressure can help to loosen muscles and ease pain and stiffness. Some people find relief through chiropractic as well. Other alternative treatments for psoriatic arthritis include: 

    • Cannabis can be used to treat arthritis pain and is available through medical marijuana programs in several states. Cannabis has been shown to provide both analgesia and anti-inflammatory effects associated with arthritis pain. Many patients prefer to use marijuana for pain relief instead of opioids. Cannabidiol (CBD), a non-psychoactive component of marijuana, has anti-inflammatory properties and is legally available in most states.
    • Heat or cold therapy can provide pain relief. Moist heat can relax muscles and ease soreness and stiffness, while icing areas can reduce swelling and numb pain. 
    • Phototherapy involves exposing skin to UV-light and can help to heal skin patches. 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 Arthritis Foundation recommends starting with 5 to 10 minutes of exposure to natural sunlight and gradually increase. If you are using medications that may cause photosensitivity, you should not use phototherapy.

      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 to take your medications.

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