What are treatment options for psoriatic arthritis?
As with most arthritic conditions, treatment focuses on the management of symptoms and the prevention of permanent joint damage, as there is no cure for this disease. Since symptoms can vary over time, so will treatment options. A major concern with this arthritis is joint damage, so early treatment and intervention are key. Although medications appear to be the most common method for the management of psoriatic arthritis, TeleMed2U rheumatologists also offer integrative, holistic treatment approaches as well, based upon a “S.E.N.S.E.” - ible approach: Stress management, Exercise, Nutrition, Sleep & positive social Engagements.
Here are the different types of medications currently available for psoriatic arthritis :
- Nonsteroidal anti-inflammatory drugs (NSAIDs)- usually the initial treatment option for this condition, especially in milder cases.
- Corticosteroids- can be useful for the treatment of swollen, painful joints especially in injection form.
- Disease-modifying antirheumatic drugs (DMARDs)- usually used when NSAIDs fail to manage symptoms or if patients have many symptomatic joints. Helpful with slowing the progression of joint damage. Examples include:
- methotrexate* (Rheumatrex, Trexall, Otrexup, Rasuvo)
- leflunomide (Arava)
- hydroxychloroquine (Plaquenil) - usually avoided because it can cause psoriasis symptoms to flare up
- sulfasalazine (Azulfidine)
*If you are taking methotrexate, make sure you are also taking a folic acid supplement like MTX Advanced Support: https://theralogix.com/products/mtx-support-folic-acid-b12-supplement
- Immunosuppressants- helps to manage the immune system responsible for the condition
- azathioprine (Imuran)
- reserved for only severe cases of psoriatic arthritis
- cyclosporine (Neoral, Sandimmune, Gengraf)
- Biologic response modifiers (biologic agents)- used in the form of injection of infusions. Examples include:
- TNF-Inhibitors: adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi) or infliximab (Remicade - IV)
- IL-17 Inhibitors: ixekizumab (Taltz) or secukinumab (Cosentyx)
IL-12/23 Inhibitors: ustekinumab (Stelara) - can also treat psoriasis as well as psoriatic arthritis
- T-Cell Blockers: abatacept (Orencia) - can treat PsA but NOT psoriasis
- JAK Inhibitor: tofacitinib (Xeljanz)
- New drug- decreases inflammation by targeting an enzyme responsible for its development
- Apremilast (Otezla)
If medications fail, what are other treatment options available?
Surgery may sometimes be needed to repair the damaged joint, especially if deformity develops. Joint replacement surgery is traditionally used in these situations, but your surgeon would decide what the best option is based on the severity of the joint. Physical and occupational therapy may also be beneficial for the treatment of psoriatic arthritis. These treatment modalities are used to help strengthen and increase flexibility to the body.
Is exercise helpful for treatment against psoriatic arthritis symptoms?
Like with most arthritic conditions, exercise is vital to helping with the stiffness and pain in the affected joints. A healthy lifestyle involving exercise and proper diet is also helpful with keeping weight under control that puts less pressure on the joints and reduces further damage.
If psoriatic arthritis is not treated properly, it can become disabling for those involved. Our physicians at TeleMed2U are capable of developing an effective treatment plan for your psoriatic arthritis which can be done from the comforts of your home.