Many people living with psoriasis also experience psoriatic arthritis. Although the conditions are closely linked, each has its own recommended first-line treatment.
New guidelines recommend a “treat to target” approach. That means a treatment plan has more flexibility based on a person’s individual preferences. First, you and your doctor determine a specific goal and how to measure progress. Then your doctor works with you to select treatments.
Together with your doctor you may be able to choose a treatment that improves symptoms or stops progression of the disease.
Seventy to ninety percent of people with psoriasis experience itch associated with the condition, according to the National Psoriasis Foundation. Psoriatic itch may feel like burning or biting on the skin.
Topical hydration, such as rich moisturizers and scale-softening lotions, may ease this symptom.
Some find greater relief from a topical steroid like hydrocortisone, calamine lotion, camphor, or benzocaine. Although these topicals may relieve your itch, they may also cause dryness.
If these aren’t working for your case, there are prescription options to treat psoriatic itch. These include antihistamines, steroids, capsaicin, and topical anesthetics.
For both psoriasis and psoriatic arthritis, NSAIDs are a common first-line treatment. Typically available over the counter, NSAIDs include aspirin, ibuprofen (Advil), and naproxen sodium (Aleve). Your doctor may provide a prescription-strength NSAID if appropriate.
NSAIDs are anti-inflammatory medications. They reduce joint pain and swelling, therefore reducing symptoms of psoriatic arthritis (PsA).
Some people experience stomach irritation from NSAIDs. It’s important to take them with food. Other possible side effects of long-term use may include liver and kidney damage and heart problems.
DMARDs reduce immune system activity, which reduces inflammation. Unlike NSAIDs and topical medications, which treat symptoms of PsA, DMARDs stop the disease progression and, in some autoimmune conditions, rebalance the immune system. This treatment not only relieves pain but it should also slow joint damage.
This class of drugs can be nonbiologic or biologic. Nonbiologic DMARDs are widely prescribed. The most common is methotrexate. This medication reduces psoriasis symptoms and may help with PsA.
Methotrexate has several potential side effects, including:
- lung inflammation
- low white blood cell count
- liver damage
Leflunomide and sulfasalazine are other nonbiologic DMARDs that may also work against psoriatic arthritis, although their effectiveness in people living with PsA has not yet been shown.
There are also biologic medications that are considered DMARDS, such as Humira and Remicade.
Biologics are medications made from biological materials. They mimic normal immune system cells and products. They can be created using sources such as proteins, antibodies, and cells.
Enbrel, Cosentyx, and Humira are three biologics used to treat psoriasis and psoriatic arthritis. These medications are highly targeted, which means they may have fewer side effects than other treatment options.
Since these drugs work by blocking a protein important to the immune system, they reduce immune function. This means you may have a higher risk of infections.
PsA is the result of an overactive immune system and is considered an autoimmune disease. That’s why a class of immunosuppressant drugs may slow the disease by reducing inflammation and inhibiting the immune attack against your own cells.
Examples of immunosuppressants are azathioprine and cyclosporine. Both medications may ease the joint pain and swelling characteristic of PsA.
Each also has potential side effects. For cyclosporine, side effects can include nausea, vomiting, liver and kidney problems, and birth defects. Azathioprine may cause stomach irritation and rash.
Like biologics, these drugs work by blocking the immune system. This means you may have a higher risk of infections.
PsA and psoriasis are long-term conditions, so it’s common for people to seek alternative or complementary therapies to improve their physical and emotional well-being.
Stress often triggers psoriasis flares. Using mind-body techniques such as meditation, yoga, and tai chi may assist with overall health and potentially improve your symptoms.
>Nutrition, diet, and exercise can also help keep PsA symptoms under control. Keeping a healthy weight reduces pressure on the joints and lowers systemic inflammation. In general, exercising releases feel-good endorphins, which may improve your overall mood.
Lastly, physical or occupational therapies are recommended for PsA patients to maintain joint health and improve their quality of life.
Your doctor can help determine the best treatment plan for you, based on your symptoms. Some people find it helpful to monitor their symptoms and treatments in a journal. Over time, you’ll discover what medications work well to manage your psoriasis and PsA.