The approach to treatment

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 and crippling.

The type of treatment will depend on how severe your symptoms are at the time of diagnosis. Some early indicators of more severe disease include onset at a young age, multiple joint involvement, and spinal involvement. Good control of the skin may be valuable in the management of psoriatic arthritis. In many cases, you may be seen by two different types of doctors – a rheumatologist and a dermatologist.

What are the treatment options for psoriatic arthritis?

The aim of treatment for psoriatic arthritis is to relieve symptoms. Treatment may include any combination of the following:

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. However, oral steroids, if used to treat the psoriatic arthritis, can worsen the skin rash due to psoriasis worse.

DMARDs are used when NSAIDs fail to work and in patients with erosive disease. DMARDs that are effective in treating psoriatic arthritis include: methotrexate, sulfasalazine, cyclosporine, and biologic agents.

The biologic agents are among the most exciting drug treatments. Both DMARDS and Biologics not only do these drugs reduce the signs and symptoms of psoriatic arthritis, but they also slow down joint damage.

There are also many non-medicine therapies that can be used in addition to medicine to help with your joint symptoms. Some of these therapies include:

Exercise

Moderate, regular exercise may relieve joint stiffness and pain caused by the swelling seen with psoriatic arthritis. Range-of-motion and strengthening exercises – designed specifically for you – combined with low-impact aerobics, may be helpful.

Regardless of the exercise program you select, choose one you enjoy so that you continue to do it. Improper exercise programs may make psoriatic arthritis worse. Before beginning any new exercise program, discuss exercise options with a doctor. Also, begin new exercise programs under the supervision of a physical therapist or qualified professional, preferably one with experience working with arthritis patients.

Heat and cold therapy

Heat and cold therapy involves 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.

Splinting

Your doctor 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.

Surgery

Most people with psoriatic arthritis will never need surgery. However, severely damaged joints may require joint replacement surgery (arthroplasty; ie, natural joints are replaced with man-made ones). The goal of surgery is to restore function, relieve pain, improve movement, or improve the physical appearance of the affected area.

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