What are the treatment options for psoriatic arthritis?
The aim of treatment for psoriatic arthritis is to control the disease and relieve symptoms. Treatment may include any combination of the following:
- Medication options, including nonsteroidal anti-inflammatory drugs (NSAIDs); corticosteroids (intermittent use); disease modifying anti-rheumatic drugs (DMARDs); and biologics.
- Heat and cold therapy.
- Joint protection and energy conservation.
Choice of medications depends on disease severity, number of joints involved, and associated skin symptoms. During the early stages of the disease, mild inflammation may respond to nonsteroidal anti-inflammatory drugs (NSAIDs). Cortisone injections may be used to treat ongoing inflammation in a single joint. Oral steroids, if used to treat a psoriatic arthritis flare, can temporarily worsen psoriasis. Long-term use of oral steroids should be avoided when possible due to the negative effects on the body over time.
DMARDs are used when NSAIDs fail to work and for patients with persistent and/or erosive disease. DMARDs that are effective in treating psoriatic arthritis include: methotrexate, sulfasalazine, and cyclosporine.
Biologic agents are an important consideration when disease control is not being achieved with NSAIDS or DMARDs. Biologics have been utilized for the treatment of psoriatic arthritis since 2005 and are highly effective at slowing and preventing progression of joint damage. Your healthcare provider will complete additional laboratory tests and review safety considerations before initiating a medication regimen. Gaining good control of psoriatic arthritis and psoriasis is important to avoid increased systemic risks, particularly heart disease.
There are also many non-pharmacologic therapies that can be used in addition to medication to help with your joint symptoms. Some of these therapies include:
Moderate, regular exercise may help relieve joint stiffness and pain caused by psoriatic arthritis. Range-of-motion and strengthening exercises as instructed and under the direction of a physical or occupational therapist may be helpful in combination with low-impact aerobics. Before beginning any new exercise program, discuss exercise options with your healthcare provider. Regardless of the exercise program you select, choose one you enjoy so that you continue to do it. Be mindful that too rigorous or improper exercise programs may make psoriatic arthritis worse.
Heat and cold therapy
Intermittent heat and cold therapy involves choosing or switching the use of moist heat and cold therapy on affected joints. Moist heat – supplied by a warm towel, hot pack, or warm bath or shower – helps relax aching muscles and relieve joint pain, swelling, and soreness. Cold therapy – supplied by a bag of ice or even a bag of frozen vegetables wrapped in a towel – can reduce swelling and relieve pain by numbing the affected joints.
Joint protection and energy conservation
Daily activities should be performed in ways that reduce excess stress and fatigue on joints. Proper body mechanics (the way you position your body during a physical task) may not only protect joints, but also conserve energy. People with psoriatic arthritis are encouraged to frequently change body position at work, at home, and during leisure activities. Maintaining good posture – sitting/standing up straight and not arching your back – is helpful for preserving function.
Your healthcare provider may recommend splinting your joints to ease inflammation or problems with joint alignment or stability. However, to maintain movement in these joints, the splints should be removed from time to time and gentle range-of-motion exercises should be performed.
Most people with psoriatic arthritis will never need surgery. However, severely damaged joints may require joint replacement surgery . The goal of surgery is to restore function, relieve pain, improve movement, or improve the physical appearance of the affected area.
What treatment is right for me?
The type of treatment will depend on how severe your symptoms are at the time of diagnosis with the goal being to control the disease to the point of remission and avoid complications. Medications may need to be changed over time to continue to maintain control and avoid disease progression and systemic effects. Some early indicators of more severe disease include onset at a young age, multiple joint involvement, and spinal involvement. Good control of the skin is important in the management of psoriatic arthritis. In many cases, you may be seen by two different types of healthcare providers, one in rheumatology and one in dermatology.
Early diagnosis and treatment can relieve pain and inflammation and help prevent progressive joint involvement and damage. Without treatment psoriatic arthritis can potentially be disabling, cause chronic pain, affect quality of life, and increase risk of heart disease. It is important to update your healthcare provider when you have a change in symptoms or if your medication regimen is no longer effective.