Health

Psoriatic Arthritis Treatment: A Complete Guide

Several classes of medications are used to treat psoriatic arthritis. Most require a prescription from a medical professional. Psoriatic arthritis treatments may be taken as a pill, applied topically, injected subcutaneously (beneath the skin), or given as an IV infusion.

Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce pain and inflammation. They’re usually taken by mouth, but some can be applied to the skin — as a gel, liquid, or patch — over sore joints for targeted pain relief.

While NSAIDs can help control symptoms of psoriatic arthritis, they don’t prevent joint damage.

Both over-the-counter and prescription NSAIDs are available. Some common NSAIDs include:

When taken long term, oral NSAIDs can cause stomach irritation or bleeding, and they can increase the risk of heart attack and stroke. Topical NSAIDs may be an option for people who can’t take oral NSAIDs.

Steroids

Steroids, also known as glucocorticoids, can be used in a few ways in psoriatic arthritis treatment.

They may be taken orally to reduce inflammation and alleviate pain, swelling, and stiffness, particularly during a symptom flare.

They may be injected directly into a joint to reduce pain and stiffness in that joint.

Steroids may be injected into fingers or toes affected by dactylitis, the swelling sometimes known as “sausage fingers.”

Topical steroids may be applied to fingernails or toenails when psoriatic arthritis causes pitting or flaking of the nails, or steroids may be injected into the nail matrix, at the base of the nail.

The risks of long-term systemic steroid use include increased appetite, weight gain, high blood sugar, osteoporosis, and others.

While stopping steroid treatment has long been thought to cause psoriasis flares, recent research suggests that the risk of a psoriatic flare is low.

Disease-Modifying Anti-Rheumatic Drugs

Disease-modifying anti-rheumatic drugs (DMARDs) work by suppressing inflammation-causing chemicals in the body. They can slow the progression of psoriatic arthritis and prevent permanent joint damage.

Most are taken by mouth. It can take a month or more before you’ll know whether a DMARD is working for you, according to the Cleveland Clinic.

The following medicines are DMARDs. The most commonly used is methotrexate, followed by leflunomide and sulfasalazine. Azathioprine and cyclosporine are rarely used but may be appropriate in some situations.

Potential side effects of methotrexate and leflunomide include liver damage, so liver function tests must be done before starting these drugs, several weeks after starting them, and periodically for as long as a person is taking the drug. Less serious but common side effects include diarrhea and nausea or upset stomach. A common side effect of sulfasalazine is upset stomach.

JAK Inhibitors

Janus kinase (JAK) inhibitors are a new type of DMARD that blocks certain enzymes that can cause inflammation. They are taken as pills. JAK inhibitors approved to treat psoriatic arthritis include:

Side effects of JAK inhibitors can include nausea, indigestion, diarrhea, headaches, increased risk of upper respiratory tract infections, and increased cholesterol levels. Some of these side effects may decrease over time, according to CreakyJoints.

The JAK inhibitors approved for psoriatic arthritis carry warnings about the risks of serious heart-related events, cancer, blood clots, and death associated with these drugs.

Because JAK inhibitors can raise the risk of infections, testing for tuberculosis or other infectious diseases may be required before starting treatment. Periodic blood tests for liver function and other measures are also needed while taking the drug.

Phosphodiesterase-4 Inhibitors

Phosphodiesterase-4 (PDE4) inhibitors are another new DMARD. They work by selectively targeting small molecules inside immune cells to correct the overactive immune response that causes inflammation in psoriatic arthritis. They are taken as pills.

PDE4 inhibitors are not safe during pregnancy. Side effects seen in clinical trials of apremilast include headache, abdominal pain, depression, weight loss, nausea, diarrhea, vomiting, and upper respiratory tract infections.

Biologics

Biologics target specific cells or proteins in the immune system that play a role in the development of psoriatic arthritis. They can slow or stop the inflammatory processes in the body that lead to joint damage.

The classes of biologics with approved drugs for treatment of psoriatic arthritis include:

  • Tumor necrosis factor (TNF)-alpha inhibitors
  • Interleukin 12 and 23 (IL-12, IL-23) inhibitors
  • Interleukin 17 (IL-17) inhibitors
  • Interleukin 23 (IL-23) inhibitors
  • T-cell inhibitors
The American College of Rheumatology and National Psoriasis Foundation have jointly created guidelines on which biologic to prescribe first, based on what medications a person has used before, how active their disease is, and what other medical conditions they might have, such as inflammatory bowel disease, which can be treated with some of the same biologics.

If one class of biologics doesn’t control an individual’s psoriatic arthritis symptoms, another might. Only one biologic is prescribed at a time, although they may be used in combination with nonbiologics to control symptoms and progression.

All of the biologics are administered as either a subcutaneous injection, which can be taken at home, or as an IV infusion, done in a medical office.

Because biologics can raise the risk of infections, testing for tuberculosis or other infectious diseases may be required before starting treatment with a biologic.

These biologics are approved for treatment of psoriatic arthritis:

Related Articles

Leave a Reply

Back to top button