How Is Psoriatic Arthritis Treated?

Psoriatic arthritis (PsA) is an autoimmune disease that targets the joints and skin when the immune system attacks healthy tissue. PsA typically affects people with pre-existing psoriasis—a skin condition that causes raised, discolored patches, called "plaques." In rare cases, you might experience joint symptoms first and skin concerns later.  

People with PsA may experience symptoms such as joint pain, swollen fingers and toes, skin rashes, and fatigue. However, symptoms are not always persistent. You will likely experience periods where symptoms are worse (flare-ups) and periods where you have no symptoms at all (remission).

There is no cure for PsA symptoms, but getting a diagnosis and starting treatment early can help slow your disease progression and prevent permanent joint damage and disability. The goals of PsA treatment are to reduce pain, improve symptoms, and maintain the function and quality of your life. Your healthcare provider may suggest a variety of medications, therapies, and lifestyle changes that can help treat your condition. 

Medications

Medications are one of the first treatment options that your healthcare provider will recommend. Depending on your treatment plan, you can find medications over-the-counter (OTC) or your provider will prescribe them to you.

Non-Steroidal Anti Inflammatory Drugs (NSAIDs)

NSAIDs are anti-inflammatory drugs that can help improve joint symptoms. These pills may reduce swelling, pain, and morning stiffness, while also improving the range of motion in your joints.

Most pharmacies carry the following OTC NSAIDs:

• Advil or Motrin (ibuprofen)
• Aleve (naproxen)
• Bayer (aspirin)

If OTC medications aren’t reducing your symptoms, your healthcare provider may prescribe you stronger NSAIDs.

Taking NSAIDs is not risk-free. You may have side effects such as bloating, gas, or constipation. If you begin to experience high blood pressure, severe abdominal pain, or gastrointestinal (stomach or intestine) bleeding, reach out to your healthcare provider for medical care and alternative treatment options. Also, talk to your provider if you are taking blood thinners or have heart disease, kidney disease, or a history of peptic ulcer disease (sores on the lining of your stomach or small intestine); NSAIDs are not recommended for these cases.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

Disease-modifying anti-rheumatic drugs (DMARDs) help your immune system slow down disease progression. DMARDs can prevent long-term damage and reduce the inflammation in your immune system that causes joint and skin symptoms.

Research on DMARDs has grown significantly in recent years. As a result, there is a variety of DMARDs to choose from to treat PsA. Your healthcare provider may recommend any of the following DMARDs or a combination of multiple DMARDs, based on the severity of your condition and your response to treatment.

• Conventional DMARDs: Conventional DMARDs target the entire immune system. The most commonly used conventional DMARD is Otrexup (methotrexate) and your provider will advise you to take this oral pill once a week. Sandimmune (cyclosporine) and Arava (leflunomide) are other, less common types of DMARDs you might take. 
• Biologic DMARDs: If NSAIDs or conventional DMARDs aren’t working for you, your provider may opt to prescribe you a biologic DMARD (or, just biologics). Biologics target specific and individual cytokines (proteins) in your immune system that cause inflammation. You can receive biologics in the form of at-home injections or via intravenous (IV) infusion at a hospital or clinic. Your provider may suggest one of the following biologics to treat your condition.

• Targeted DMARDs: Targeted DMARDs are the newest type of DMARD medication, which come in the form of oral pills. They help block pathways and processes in the immune system cells that cause inflammation. Examples of targeted DMARDs include Xeljanz (tofacitinib), Rinvoq (upadacitinib), and Otezla (apremilast). In particular, the FDA warns that the use of Xeljanz and Rinvoq are linked to a greater risk for serious heart conditions, such as heart attack, stroke, cancer, and blood clots.

Side effects of all types of DMARDs can vary, but some people taking these medications may experience an upset stomach, nausea, diarrhea, or a loss of appetite. However, symptoms may subside once your body gets used to the drug(s). 

Because DMARDs work by suppressing your immune system, you may also be at an increased risk for developing infections. That said, your healthcare provider will frequently monitor your overall health while you are on medication to prevent any serious complications.

Topical Treatments

In addition to medication, your healthcare provider may suggest using topical treatments to reduce the appearance and irritation of skin-related symptoms. Topical treatments are generally available OTC, but you can also receive stronger topical treatments from your provider. Some treatments will contain steroids, while others will not. Your healthcare provider is in the best position to make a recommendation about which topical treatment to use.

• Topical Steroids: Corticosteroid creams (e.g., hydrocortisone) are anti-inflammatory products that can reduce itching, decrease inflammation, and relieve cracked or bleeding skin. Other options for topical steroids include creams that contain retinoids and vitamin D, which can help slow down skin cell growth. 
• Topical Non-steroids: Creams or ointments that contain coal tar and salicylic acid can also help alleviate psoriatic plaques. Coal tar reduces inflammation and slows excessive skin cell growth, while salicylic acid helps remove plaques and softens dry skin.

You might experience some skin irritation and sensitivity to sunlight if you use topical treatments for long periods of time. For best results, the National Psoriasis Foundation recommends referring to its Seal of Recognition program for psoriasis-approved products that are safe to use for those living with PsA. 

Therapies

Many people with PsA find it beneficial to add light therapy, physical therapy, or occupational therapy to their treatment plan—especially if joint stiffness and skin plaques persist after using medication. In some cases, your provider may also recommend psychotherapy (mental health therapy) to help you cope with your diagnosis.

• Light therapy: Also known as phototherapy, light therapy uses ultraviolet (UV) light rays to slow down the growth of skin cells and reduce the pain and appearance of inflammation. For best results, it is important to use light therapy consistently. It is generally safe to have a light therapy session two to three times a week. Side effects of phototherapy may include temporary redness and the appearance of dark spots on those with darker skin tones.  
• Physical therapy: Physical therapy can help you maintain your flexibility and range of motion. A physical therapy program for PsA typically involves strengthening, stretching, aerobic workouts, and massages. Each PT session will look different: your physical therapist may help you with low-impact exercises one day, and teach you how to use hot and cold compresses the next.
• Occupational therapy: An occupational therapist can be a helpful resource for managing PsA in your daily life, such as cooking or getting dressed. They can offer recommendations on how to pace yourself, plan your day, ask for social support, and prevent added stress to your joints. They can also offer information about helpful tools (e.g., a walking cane or suitcases/bags with wheels) to help you perform daily activities.
• Psychotherapy: If you begin to experience symptoms of anxiety or depression after receiving your diagnosis, you are not alone. It is OK to feel sad, stressed, or frustrated about your symptoms. A mental health professional can help you talk about your feelings, find healthy ways to cope with your symptoms, and make efforts to improve your overall quality of life. If you believe that psychotherapy may be beneficial for you, ask your healthcare provider for a referral to a mental health professional who works with people living with chronic pain or illness.

Surgery

Typically, surgery is a last-resort treatment for people with PsA and is often used only for those who are in an advanced stage of PsA. Research shows that less than 10% of people with PsA will need surgery to repair joint damage.

The goals of surgery are to improve the mobility and function of your joints, reduce pain, and prevent further joint damage. Should you need surgery, your surgical options might include:

Lifestyle Recommendations

Receiving a PsA diagnosis is a big change and it can be challenging at first to adjust to a new lifestyle. In addition to any medications, topical treatments, and therapies, your healthcare provider may suggest lifestyle changes that can help you better manage your condition. Some lifestyle recommendations can include:

• Doing low-impact exercises: It might sound counterintuitive, but getting regular, low-impact exercise can actually help keep your joints strong and flexible. You can choose which exercise is right for you: stretching, swimming, tai chi, yoga, or a combination of these.
• Eating a nutritious diet: Certain foods have anti-inflammatory effects and might help reduce inflammation in the body. Such foods include fatty fish, nuts, olive oil, lean proteins, and green leafy vegetables (e.g., kale, broccoli, spinach).
• Managing stress: Living with an autoimmune condition can be stressful. But, research suggests that learning how to deal with stress can improve your symptoms. Stress management techniques such as meditation, journaling, doing activities you enjoy, and spending time with your loved ones can benefit your overall health.
• Limiting alcohol and tobacco use: Drinking alcohol and using tobacco can lead to more inflammation in your body. You may find it helpful to limit your use of these in order to prevent PsA flare-ups.

Depending on the severity of your condition, using hot and cold compresses on your joints, wearing loose-fitted clothing, and hydrating your skin with gentle moisturizers may also help you manage symptoms.