Psoriatic Arthritis medications & treatments
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Psoriatic Arthritis (PsA) is a chronic, inflammatory arthritis that is usually linked to the skin condition psoriasis. Approximately 7 million Americans are affected by psoriasis and up to 30% of these people may develop psoriatic arthritis. It usually develops 7 to 10 years after the onset of psoriasis skin symptoms. Psoriatic arthritis affects men and women equally and is most common between the ages of 35 to 55, although it can affect any age. It is more common in whites than in other races or ethnicities.
What is psoriatic arthritis?
Psoriatic arthritis (PsA) is a chronic, autoimmune form of arthritis that affects the joints and where tendons and ligaments connect to bone. It is commonly associated with psoriasis, an autoimmune skin disease. In PsA, the immune system attacks itself, causing inflammation and damage to your joints. It is similar to rheumatoid arthritis (RA) in symptoms but it doesn’t produce the typical RA antibodies and it affects fewer joints than RA.
Psoriatic arthritis can affect any joint in the body but it most commonly occurs in the large joints of the lower extremities and the small joints of the fingers and toes. Although less common, it can also affect the pelvis and spine (spondylitis).
Psoriatic arthritis causes
Psoriatic arthritis is an autoimmune disease, which means your body’s immune system mistakenly attacks healthy tissue causing pain and joint damage. Experts do not know why certain people will develop PsA but they think a combination of the following plays a role:
- Genetics. Approximately 40% of those with PsA have a family history of psoriasis or arthritis.
- Environmental factors. PsA can be triggered by factors such as infection, trauma to your joints or bones, obesity, or stress.
How is psoriatic arthritis diagnosed?
There is no single test that can confirm a psoriatic arthritis diagnosis. It is easier to confirm a diagnosis if psoriasis exists along with symptoms of arthritis. Your healthcare provider will typically make the diagnosis using your symptoms, medical history, a physical exam, blood tests, and X-rays of any affected joints. If they suspect you have PsA, they may refer you to someone who specializes in these conditions, called a rheumatologist.
Psoriatic arthritis symptoms
Symptoms of psoriatic arthritis often resemble those of rheumatoid arthritis and other autoimmune disorders so they cannot be used to confirm a diagnosis. Some common symptoms of PsA include:
- Joint pain and swelling
- Joint stiffness and reduced range of motion
- Painful, sausage-like swelling of your fingers and toes (dactylitis)
- Lower back pain
- Nail changes, such as pitting or separating from the nail bed
- Pain or swelling where tendons and ligaments attach to the bone (enthesitis); most commonly the back of the heel
- Inflammation of the eye (uveitis)
Your doctor may run some tests to rule out other conditions that could be the cause of your symptoms. These can include:
- Blood tests to check for inflammation and rule out other conditions such as rheumatoid arthritis. They can include C-reactive protein and rheumatoid factor (RF).
- Testing joint fluid for uric acid crystals to rule out gout or infectious arthritis.
- X-rays to check for joint damage that occurs with PsA and not other types of arthritis.
What are some psoriatic arthritis treatment options?
In psoriatic arthritis, disease flares can alternate with periods of remission. While there is no cure for PsA, treatments can reduce inflammation and pain, slow the progression of the disease, and improve your quality of life.
- Traditional DMARDs. Traditional disease-modifying antirheumatic drugs (DMARDs) are oral medications that can slow the progression of PsA. The most common examples include Trexall (methotrexate) and Arava (leflunomide).
- Biologics. These injectable medications work quicker than traditional DMARDs by targeting specific immune messages and interrupting the signal. This helps to reduce inflammation and prevent joint damage. Examples include Humira (adalimumab), Enbrel (etanercept), and Simponi (golimumab).
- Targeted DMARDs. Oral medications such as Xeljanz (tofacitinib) or Otezla (apremilast) are typically used when other treatments have not been successful.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Motrin (ibuprofen) and Aleve (naproxen) can be used as an initial treatment to reduce inflammation and pain in mild cases of psoriatic arthritis. Some people find that they lose their effectiveness after a few weeks.
- Corticosteroids. These medications may be effective to treat flare-ups but should be used at the lowest effective dose for a short period of time. They can be taken orally or injected directly into the affected joint.
Although rare, surgery may be recommended in cases where the joints are severely damaged or not responding to treatment. An orthopedic surgeon can perform joint replacement surgery to reduce pain and improve function.
Early, aggressive treatment of PsA helps to minimize the effect of the disease on your quality of life.
What is the best medication for psoriatic arthritis?
The best medication for the treatment of psoriatic arthritis will depend on the individual’s specific medical psoriatic arthritis, medical history, medications that the individual is already taking that may potentially interact with psoriatic arthritis medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter psoriatic arthritis medications approved by the Food and Drug Administration (FDA).
Best medications for psoriatic arthritis
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Otezla (apremilast)||PDE-4 inhibitors||Oral||30mg twice daily.||Diarrhea, nausea, headache, upper respiratory infection|
|Humira (adalimumab)||TNF inhibitor||Injection||400mg under the skin every 4 weeks.||Injection site reaction, rash, infection, headache|
|Abrilada (adalimumab-afzb)||TNF inhibitor||Injection||400mg under the skin every 4 weeks.||Injection site reaction, rash, infection, headache|
|Remicade (infliximab)||TNF inhibitor||Injection||5mg/kg of body weight via IV infusion every 8 weeks.||Stomach pain, nausea, headache, infection|
|Enbrel (etanercept)||TNF inhibitor||Injection||50mg under the skin twice weekly for 3 months and then 50mg once weekly thereafter.||Injection site reactions, infections, diarrhea|
|Simponi (golimumab)||TNF inhibitor||Injection||200mg under the skin to start, 100mg at week 2, then 100mg every 4 weeks thereafter.||Upper respiratory tract infection, injection site reactions, viral infections|
|Cimzia (certolizumab)||TNF inhibitor||Injection||400mg under the skin, repeat at 2 and 4 weeks, then 200mg under the skin every 2 weeks.||Upper respiratory tract infection, injection site reactions, nausea, joint pain, common cold|
|Entyvio (vedolizumab)||Integrin blocker||Injection||300mg IV infusion at 0, 2, and 6 weeks, then every 8 weeks thereafter.||Common cold, headache, joint pain|
|Stelara (ustekinumab)||Interleukin inhibitor||Injection||Initial weight-based IV infusion, then 90mg under the skin every 8 weeks thereafter.||Upper respiratory tract infection, injection site reaction, headache|
|Tremfya (guselkumab)||Interleukin inhibitor||Injection||100mg under the skin at week 0, week 4, then 100mg every 8 weeks thereafter.||Infections, headache, injection site reactions, joint pain, elevated liver enzymes|
|Skyrizi (Risankizumab)||Interleukin inhibitor||Injection||150mg under the skin at week 0, week 4, then 150mg every 12 weeks thereafter.||Upper respiratory tract infections, headache, fatigue, injection site reactions|
|Cosentyx (secukinumab)||Interleukin inhibitor||Injection||300mg under the skin at weeks 0, 1, 2, 3, 4, and then 300mg every 4 weeks thereafter.||Infections, common cold symptoms, diarrhea|
|Taltz (ixekizumab)||Interleukin inhibitor||Injection||160mg under the skin to start, then 80mg every 2 weeks for 6 doses, then 80mg every 4 weeks thereafter.||Injection site reactions, upper respiratory infections, nausea|
|Orencia (abatacept)||DMARD||Injection||125mg under the skin once weekly.||Headache, common cold, nausea, infection, dizziness|
|Trexall (methotrexate)||Antimetabolite||Oral||May give weekly dose divided as 2.5mg every 12 hours for 3 doses.||Nausea, vomiting, diarrhea, stomach pain|
|Arava (leflunomide)||Immunosuppressant||Oral||100mg daily for 3 days then 10mg to 20mg once daily.||Diarrhea, respiratory infections, hair loss, high blood pressure, rash, nausea|
|Azulfidine (sulfasalazine)||5-Aminosalicylic acid derivative||Oral||2g to 3g per day divided twice daily.||Loss of appetite, headache, nausea, vomiting, upset stomach|
|Xeljanz (tofacitinib)||JAK inhibitor||Oral||1 tablet (5mg) twice daily.||Common cold, diarrhea, headache, upper respiratory tract infections, high blood pressure|
|Naprosyn (naproxen)||NSAID||Oral||500mg to 1000mg daily divided every 12 hours.||Stomach pain, constipation, dizziness, drowsiness, headache, heartburn|
|Celebrex (celecoxib)||COX-2 inhibitor||Oral||200mg once daily or divided every 12 hours.||Headache, hypertension, fever, indigestion, cough, vomiting|
|Kenalog (triamcinolone acetonide)||Corticosteroid||Injection||The dose will depend on the size of the joint being treated.||Joint swelling, bruising, cough, sinus infection|
Your healthcare provider will determine the right dosage based on your response to the treatment, medical psoriatic arthritis, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of psoriatic arthritis medications?
As with all medicines, those used for psoriatic arthritis will have some side effects, depending on the class you are taking:
- NSAIDs commonly cause stomach pain, headache, indigestion, nausea, diarrhea, and constipation.
- Oral DMARDs such as Xeljanz (tofacitinib) can cause diarrhea, nausea, headache, upper respiratory infection, and high blood pressure.
- Injectable DMARDs such as Humira (adalimumab) and Stelara (ustekinumab) commonly cause infections, injection site reactions, headache, diarrhea, and joint pain.
- Corticosteroids can cause weight gain, acne, mood changes, high blood pressure, and fluid retention.
What are some home remedies for psoriatic arthritis?
While medications are the first-line treatment for PsA, there are some lifestyle changes and self-care management strategies you can use to help reduce your symptoms and maintain your quality of life:
- Regular exercise. Regular physical activity can strengthen the muscles around your joints and keep them flexible. Try walking, bicycling or water aerobics, or other low-impact exercise programs.
- Lose weight. Extra weight can worsen your arthritis pain. Weight loss can help reduce the stress on your joints, especially if you are overweight or obese.
- Use heat and cold. Heat and cold therapies can reduce inflammation and pain in your joints. Heat therapy helps increase blood flow which can help reduce pain. Cold therapy can numb the sore area and reduce pain and inflammation.
- Stop smoking. Smoking increases your risk of developing psoriasis, which is commonly linked with PsA.
- Manage your stress. Stress can trigger or worsen flares. Try meditation, find a support group, or try exercises such as yoga or tai chi to help you relax.
- Use braces or shoe inserts. Inserts and braces can help support your joint to help take pressure off of it when you stand or walk.
- Use assistive devices. Using canes or walkers can help you safely move around while relieving pressure on your joints. If you have arthritis in your hands, there are devices to help you perform daily tasks that require gripping.
Frequently asked questions about psoriatic arthritis
Can I develop psoriatic arthritis if I don’t have psoriasis?
While psoriasis is commonly linked with PsA, a study from 2017 found that about 15% of participants received a diagnosis of PsA before psoriasis.
Does psoriatic arthritis affect your nails?
Yes, almost 80% of people with PsA have fingernail or toenail changes. Nail changes can include pitting (dents), crumbling, discoloration, or separation from the nail bed.
What are some complications of psoriatic arthritis?
Although PsA typically affects your joints, the inflammation throughout the body can cause some complications. People with PsA can develop a severe, debilitating form called arthritis mutilans. It affects the small bones in your hands and fingers, destroying the joints and causing deformations. People with PsA are also at a higher risk of developing diabetes, high blood pressure, cardiovascular disease, Crohn’s disease, and vision problems.
What’s the difference between psoriatic arthritis and rheumatoid arthritis?
While they both usually cause joint pain, tenderness and swelling, there are some differences between PsA and RA. Blood tests for people with PsA are almost always rheumatoid factor (RF)-negative. The joint pain in RA usually affects both sides of the body (symmetrical) while PsA joint pain is usually only felt on one side of the body (asymmetrical). It is also more common in PsA to have joint pain in the heel, the lower spine, and the joints at the tips of the fingers. Unique to PsA is the “sausage finger or toe,” where the swelling involves the whole finger or toe.
Related resources for psoriatic arthritis
- Facts you should know about psoriatic arthritis. MedicineNet
- Psoriatic arthritis practice essentials. Medscape
- Psoriatic arthritis overview. MayoClinic
- About psoriatic arthritis. National Psoriasis Foundation
- Psoriatic arthritis. Arthritis.org
- Psoriatic arthritis fast facts. Rheumatology.org
- Overview of psoriatic arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases