Psoriatic Arthritis: Beyond Skin Deep

Psoriatic arthritis (PsA) is a condition that develops in 6 to 42 percent of people who have been previously diagnosed with psoriasis, according to the Arthritis Foundation. Common PsA symptoms include joint pain, tenderness, swelling, and limited range of motion. People who have PsA may also experience severe fatigue and conjunctivitis of the eye. The topical medications you might already be taking to manage the skin plaques and nail pitting associated with psoriasis are most likely unable to control your arthritis symptoms, too. Discuss your psoriatic arthritis treatment options with your physician to determine what is appropriate for you.

Relieving Pain

Pain relief is one of the most immediate goals when treating psoriatic arthritis. Many of the drugs and home remedies used to alleviate your discomfort can also provide inflammation reduction though the effectiveness varies according to the severity of your symptoms.

Heat and cold therapy are options for non-medicinal pain relief. Hot compresses, showers, and baths soothe stiff and aching joints, and ice packs can take the edge off the joint tenderness and warmth you might experience. Splinting the affected areas might also give you some relief.

Your healthcare provider is likely to suggest non-steroidal anti-inflammatory drugs known as NSAIDs as a first-line treatment for mild PsA. Medications in this class are available in both over-the-counter and prescription strengths. Some of these include:

  • Diclofenac
  • Ibuprofen
  • Naproxen sodium
  • Oxaprozin

Discuss your symptoms with your doctor to help him or her determine which medication is best. Certain NSAIDs address only pain, but others might relieve both pain and inflammation. NSAIDs usually do not interfere with topical psoriasis drugs. However, they can increase the risk of stomach irritation in some people and are not always appropriate for those with kidney or liver disease.

Another type of NSAID, COX-2 inhibitors are easier on the stomach. Celecoxib is a COX-2 inhibitor that your doctor might prescribe if you are unable to take other NSAIDs. The U.S. Food and Drug Administration (FDA) has approved celecoxib for the treatment of various forms of arthritis but not psoriatic arthritis specifically. However, your physician may prescribe the drug off-label.

Corticosteroid injections are another treatment option for psoriatic arthritis. Delivered directly into the diseased joint, these potent medicines both alleviate pain and decrease inflammation.

Combating Inflammation

Topical medications that address the skin symptoms of psoriasis reduce redness and inflammation on a superficial level. They are not strong enough to diminish high levels of inflammation in the joints. Steroid injections can target this inflammation, but they are not a long-lasting solution for everyone. Strong systemic drugs (oral or injectable) are often needed to conquer the arthritis component of psoriasis. Three types of systemic drugs are used to control the inflammation associated with PsA: immunosuppressants, sulfas, and retinoids.

The goal of immunosuppressants is to keep your body from attacking itself, i.e., preventing the scaly rash of psoriasis or the joint pain of PsA. Immunosuppressants lower your immune system’s response, so taking them can make you more susceptible to illness. Carefully follow your doctor’s directions regarding this type of medication.

Cyclosporine is effective in treating both the skin and joint symptoms of psoriasis in many people, but it can increase your chances of developing kidney damage. Your doctor will run periodic blood tests to assess your kidney function throughout your course of treatment.

Methotrexate is more commonly known as a treatment for cancer but is also FDA approved for psoriasis and psoriatic arthritis. Discuss the pros and cons of this medication with your doctor; although low doses of the drug are generally well tolerated, higher doses may cause lung damage, seizures, vision changes, weakness, or other potentially serious side effects, according to the National Psoriasis Foundation (NPF)

Sulfasalazine is a drug that sometimes quickly improves the swelling and inflammation of PsA (within four to eight weeks). According to the NPF, about one-third of patients experience this rapid response. Those who are allergic to sulfa drugs should not take sulfasalazine. Minor flu-like symptoms and stomach upset are common side effects.

Acitretin is a retinoid that can reduce both skin and joint inflammation. Women of childbearing age are strongly urged to use a reliable method of birth control while taking acitretin as the risk of birth defects increases with exposure to the drug.

Slowing Disease Progression

In addition to addressing the symptoms of psoriatic arthritis, treatment of this disease also involves slowing its progression. Disease-modifying anti-rheumatic drugs (DMARDs) try to minimize joint and tissue damage. Some DMARDs are also called biologics. Biologics are drugs derived from living cells, and they target the specific part of the immune system that causes a disease in an attempt to correct the problem. DMARDs may be injections, IV infusions, or oral medications. Some of those prescribed for PsA include:

  • Adalimumab is administered by subcutaneous injection, usually biweekly, and you can learn to self-administer it.
  • Azathioprine is an oral DMARD taken up to three times daily.
  • Etanercept is another injectable medication you can administer yourself once or twice weekly.
  • Hydroxychloroquine is an oral medication taken daily.
  • Minocycline is another daily oral medication.

DMARDs and biologics can cause some potentially serious side effects such as diarrhea, chills, abdominal pain, nausea, low blood cell counts, and liver damage. Report all side effects to your doctor immediately to avoid complications.

Psoriatic arthritis may be a life-long condition, but it is manageable. Speak to your healthcare provider about your symptoms to determine how best to approach your pain, limited range of motion, and joint damage.