Psoriasis, a skin condition caused by an autoimmune issue, can actually affect more than your skin. According to the National Psoriasis Foundation, about 30 percent of people with psoriasis also develop a painful joint condition called psoriatic arthritis.
In the same way that your immune system attacks your skin to produce a scaly rash with psoriasis, it can also attack your joints, leaving them swollen and inflamed.
The pain of psoriatic arthritis is usually centered in the fingers and toes, but you might also notice soreness in your:
- lower back
The pain can get worse when you’re under stress or have a flare-up of psoriasis. Between these flare-ups are pain-free periods called remissions.
Psoriatic arthritis does more than just cause aches and pains. Over time, it can damage your joints. Without treatment, it can cause you to lose the use of certain affected joints. If you and your regular doctor think you may be dealing with psoriatic arthritis, make an appointment with a rheumatologist to discuss treatment options.
Psoriatic arthritis medication is one way to treat the pain from this autoimmune issue, but there are many other nondrug options available.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Your doctor might first recommend treating your psoriatic arthritis pain with ibuprofen (Motrin, Advil), or naproxen (Aleve). These drugs relieve pain and ease swelling in the joints.
You can buy NSAIDs over the counter. Stronger versions are available with a prescription.
Most side effects of NSAIDs are mild and go away on their own. However, the likelihood and severity of certain side effects can increase with dosage and length of treatment.
Serious side effects of NSAIDs include:
- gastrointestinal issues
- heart attack and stroke
- kidney problems
- allergic reactions
The type of NSAID you use, and dosage, should be a decision between you and your doctor.
Phosphodiesterase 4 (PDE4) is an enzyme that regulates inflammatory action inside our cells. When it isn’t controlled, PDE4 can elevate the level of inflammation in the body. PDE4 inhibitors have been developed to help manage inflammatory issues such as airway diseases, psoriatic arthritis, and atopic dermatitis (otherwise known as eczema).
Apremilast, commonly sold under the brand name Otezla, is prescribed to treat both psoriasis and psoriatic arthritis. It is designed to be taken continually.
Common side effects of Otzela include diarrhea, nausea, headache, and upper respiratory infection.
Serious side effects of Otezla include:
- diarrhea, nausea, and vomiting
- weight loss
Your doctor will help you decide if a PDE4 inhibitor is the right psoriatic arthritis medication for you.
Disease-modifying antirheumatic drugs (DMARDs)
DMARDs don’t just relieve pain, they stop or slow the disease in inflammatory forms of arthritis, such as psoriatic arthritis. Specifically, DMARDs can stop inflammation from slowly destroying joint tissue.
You take these drugs by mouth, through an injection, or directly into a vein.
Currently, there are three types of DMARDs: conventional DMARDs that dampen your entire immune system, targeted DMARDs that target pathways inside immune cells, and biologic DMARDs, which are created by cells themselves and work on immune proteins called cytokines.
There are many DMARDs on the market. A few include:
- cyclosporine (Neoral, Sandimmune)
- methotrexate (Rheumatrex, Trexall)
- sulfasalazine (Azulfidine)
DMARDs can take a few weeks to start working. Because they suppress immune system response, they can lower your body’s ability to fight infections. It may also be more dangerous to receive a vaccine while on a DMARD.
Because there are so many different kinds of DMARDs, many have their own set of possible side effects. But a few serious side effects of DMARDs include:
- risk of infection
- fetal damange
- nausea / vomiting
- liver damage
After starting on DMARDs, your doctor will likely test you regularly to see how you’re responding.
Biologic drugs are more specific types of DMARDs, and are often prescribed when conventional DMARDs aren’t working. They consist of genetically engineered proteins that target specific areas of the immune system that fuel inflammation.
There are four kinds of biologics, each targeting a specific inflammatory area. They can be taken by mouth or given via infusion. A few examples include:
- adalimumab (Humira)
- certolizumab (Cimzia)
- golimumab (Simponi)
- infliximab (Remicade)
- belimumab (Benlysta)
- rituximab (Rituxan)
- sarilumab (Kevzara)
- secukinumab (Cosentyx)
- ustekinumab (Stelara)
- abatacept (Orencia)
Like DMARDs, biologics suppress the immune system and can make it harder for your body to fight infections. Because each type targets a different type of inflammation, they each have their own possible side effects.
In general, the serious side effects of biologics can include:
- infusion site reaction
- diarrhea or stomach pain
- bleeding or bruising
- unusual fatigue
The decision to go on biologics, and which biologic is right for you, is a decision you’ll make with your specialist.
Doctor-prescribed psoriatic arthritis medications aren’t the only way to treat pain. Other options include:
- Topical pain relievers. There are creams, gels, and patches you can put onto your skin that include lidocaine and capsaicin, an ingredient found in chili peppers. Common side effects of topical pain relievers include skin rash and irritation.
- Steroid injections. Corticosteroids help reduce inflammation when they are injected directly into a joint. These steroids include cortisone and prednisone. Injecting steroids more than three times a year may make tendons and ligaments more fragile.
Medicine is one way to relieve psoriatic arthritis pain, but you can also try nondrug therapies:
If you’ve been living with psoriatic arthritis for a long time, or you have a severe case that isn’t calmed by medication, you may opt for surgery. There are a few types of surgical procedures currently available, including more minimally invasive procedures such as arthroscopy (which involves small incisions and specialized instruments), to total joint replacement.
A holistic practice rooted in ancient China, acupuncture involves the light insertion of long, thin needles into the skin. While no large-scale clinical studies have proven the effectiveness for psoriatic arthritis pain relief, the National Psoriasis Foundation recommends this relatively safe practice on a patient-by-patient basis. Additionally, a small 2017 study out of China found that acupuncture provided “statistically significant effects” on the area of pain.
When dealing with a psoriatic arthritis flair-up, the last thing many people may want to do is work out. However, physical activity is one of the best things you can do for your joints. Staying active keeps joints limber and can help restore muscle strength.
Ask your doctor which exercises are best for you. They might recommend that you see a physical therapist who will help you start an exercise or physiotherapy program.
Hot and cold therapy
Both heat and cold can help with pain, so choose which works best for you, or switch between therapies. Applying a cold pack to your joints helps pain and swelling. A heating pad can help soothe tight muscles.
Following a more healthful diet may help ease the symptoms of psoriatic arthritis. According to the National Psoriasis Foundation, certain foods and eating plans can potentially reduce or prevent inflammation in the body. One such diet is the gluten-free diet. Another diet, the Mediterranean diet, was shown in an observational study from 2020 to have “antinflammatory properties” specifically related to psoriatic arthritis.
Ultraviolet light, whether from the sun or an artificial source, may provide symptom relief from psoriasis and psoriatic arthritis. Ultraviolet B (UVB) light — the kind that can cause sunburns — has an anti-inflammatory effect on the skin, and stimulates the production of vitamin D, which is also used to help treat psoriasis. Besides natural sunlight, there are a few different types of targeted light therapies, but it’s important to discuss your options with your specialist before trying any of them on your own. Also note: Indoor tanning does not fall into the category of light therapy.
Doctor-recommended braces or splints can help relieve pressure on joints.
Meditation can help you relax, typically by asking you to focus on your breath to relieve stress. Less stress may mean less psoriatic arthritis pain.
If you’re dealing with a psoriatic arthritis flare-up, and it’s possible to take a break and relax, do it! Resting can take stress off your joints.
Finding the psoriatic arthritis medication or alternative treatment that works best for you may take trial and error, but given the surplus of options available, you and your doctor will most likely find the therapy — or combination of therapies — that works for you.