Psoriatic arthritis (PsA) stems from the skin condition psoriasis. According to the Arthritis Foundation, about 30 percent of people with psoriasis eventually develop PsA. The arthritic portion of PsA is related to inflammation (swelling), which can cause redness and pain in your joints.
Once you’ve received a PsA diagnosis, pain management may be your primary concern in treating the condition. However, simply taking pain medications isn’t enough to keep symptoms at bay. Furthermore, a sole focus on pain management doesn’t treat PsA’s underlying triggers. To effectively treat PsA and lessen the incidence of flare-ups, talk to your doctor about a comprehensive treatment and lifestyle plan that treats pain while managing your disease overall.
What causes PsA
PsA is caused by psoriasis, an inflammatory condition that often results in patches of red and silver scaly lesions on your skin. Some people with psoriasis develop PsA over time.
Psoriasis itself is an autoimmune disease. This is a class of conditions where the immune system attacks healthy tissues and cells. Inflammation and excess skin cells result.
In addition to skin lesions from psoriasis, PsA can cause joint stiffness and pain. It can also cause significant swelling in your fingers and toes, as well as lower back pain.
Treating the pain of PsA
Pain in PsA is caused by chronic inflammation. It results in pain and stiffness in joints, which can sometimes occur on only one side of your body. PsA has similar symptoms to rheumatoid arthritis, another type of autoimmune disease.
Numerous medication options are available for treating pain in PsA. It’s important to note that while these medications can help you feel better and move easier, they don’t treat the underlying causes of the condition.
Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a common treatment option for various forms of arthritis. Unlike acetaminophen (Tylenol), NSAIDs reduce both inflammation and pain. Your doctor will likely recommend over-the-counter versions such as ibuprofen (Advil) first. You may need a prescription NSAID if an over-the-counter version doesn’t work.
NSAIDs can interact with other medications and lead to long-term complications (such as stomach bleeding), so it’s important that you discuss all current medications you take with your doctor before using them.
Antidepressants may be used for those with PsA who have depression symptoms. They are also sometimes used to help decrease sensitivity to pain. Specifically, your doctor may recommend noradrenergic and specific serotonergic antidepressants.
Going beyond pain management
Pain is just one facet of PsA treatment. Because the pain is attributed to inflammation, treatment ought to address the causes of inflammation. While pain is sometimes more noticeable, inflammation is directly linked to joint damage. Treating PsA as a whole can help reduce inflammation and its potential damage.
Medications for inflammation
Some medications work double-duty in PsA. For example, prescription and over-the-counter NSAIDs can help treat both pain and inflammation. However, most other medications that are meant to alleviate pain don’t automatically treat inflammation as well.
Pain is caused by inflammation in PsA, so it’s important to reduce the swelling first. Some types of medications include:
Biologics work by targeting immune system responses that attack healthy tissues and cause PsA symptoms. Biologics are available via intravenous infusion or injection. They can help reduce pain over time, but may take up to three months to reach full effect.
Biologics you may be prescribed include adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), and ustekinumab (Stelara).
Steroid injections provide quick relief from severe inflammation.
Immunosuppressants, which include cyclosporine (Sandimmune) and azathioprine (Azasan, Imuran).
TNF-alpha inhibitors are also considered biologics. They reduce TNF-alpha in your body to stop the attack on healthy cells and tissues. Humira and Enbrel are two examples of these medications.
Disease-modifying antirheumatic drugs (DMARDs) work by slowing down joint damage. These include leflunomide (Arava), sulfasalazine (Azulfidine), and methotrexate.
Treating the pain of PsA also won’t treat psoriasis skin lesions. You’ll still need to seek dermatologic care for these. A dermatologist can prescribe light therapy, corticosteroids, or ointments to help make you more comfortable. Treating skin lesions can also reduce the chances of infection.
Self-care can also go a long way in terms of PsA management by reducing the number of related flare-ups. The Arthritis Foundation outlines the following methods:
- weight loss (in cases of excess weight putting extra stress on your joints)
- balanced diet (can also fight fatigue)
- regular exercise to help keep joints lubricated
- stress management
- meditation/mindful breathing exercises
- no smoking
- limited alcohol intake
Long-term considerations for PsA
PsA is a long-term condition. Since there isn’t a cure, quality of life depends greatly on overall management of the disease.
Pain management can help during flare-ups. However, flare-ups are often temporary, so it’s important to treat your condition as a whole to prevent them from the start. When PsA isn’t comprehensively treated, it can become disabling. If you continue to experience symptoms despite treatment, talk to your doctor about modifying your plan.