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About 30% of people who have psoriasis—a skin condition—will develop psoriatic arthritis. It usually develops about 5 to 12 years after a psoriasis diagnosis. However, it can show up earlier or even at the same time as the skin disease. It is also possible to have psoriatic arthritis without any skin problems.
Like psoriasis, psoriatic arthritis is an autoimmune disease. This means your immune system mistakenly attacks healthy tissue. In psoriatic arthritis, it turns on your joints. This results in joint inflammation, pain and stiffness. In the most common form of psoriatic arthritis, the disease involves joints on both sides of your body. The next most common form only involves joints on one side. There are three other less common forms.
Psoriatic arthritis is a progressive disease that can cause permanent joint damage. However, many people have psoriatic arthritis symptom flares alternating with periods when symptoms are low. Seeking medical care as soon as you notice joint symptoms can help preserve joint health. Psoriatic arthritis medications are a central part of psoriatic arthritis treatment.
A cure for psoriatic arthritis does not exist. However, medications can relieve symptoms, preserve joint function, and maintain your quality of life. Doctors follow expert practice guidelines when choosing medicines to treat psoriatic arthritis. Classes of psoriatic arthritis drugs include:
- Biologics target the immune system to decrease its activity. They can bring about and maintain a remission of psoriatic arthritis symptoms. Side effects include injection site reactions and flu-like symptoms.
- Corticosteroids are powerful anti-inflammatory drugs can help control severe symptom flares. Long-term use can cause problematic side effects.
- Disease-modifying antirheumatic drugs (DMARDs) suppress inflammation and slows or stops joint damage. The side effects vary depending on the specific drug.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain and inflammation in mild psoriatic arthritis. This class includes both over-the-counter and prescription products. Stomach upset or irritation is a common side effect of this class. Taking NSAIDs with food helps prevent this. However, serious side effects are also possible.
- Phosphodiesterase 4 (PDE4) inhibitors are a new class of psoriatic arthritis drugs. Common side effects include nausea, diarrhea and headache.
Medications are part of a comprehensive treatment plan for psoriatic arthritis. Self-care is also vital for managing symptoms. This includes balancing regular exercise to relieve joint stiffness and maintain strength with rest during flares. Your doctor may also recommend physical or occupational therapy.
People with mild psoriatic arthritis may only require NSAIDs to manage symptoms. However, more active disease requires a DMARD, a biologic, a PDE4 inhibitor, or a combination of these drugs. Finding the right treatment for you may involve some trial and error. Here are 10 drugs commonly prescribed for psoriatic arthritis:
- Adalimumab (Humira) is a biologic medication. You inject it under the skin—or subcutaneously. You will get the first dose in your doctor’s office. After that, the typical dose is every other week.
- Apremilast (Otezla) is a PDE4 inhibitor. It is a tablet you take twice a day. You usually start on a low dose and increase the dose over the first several days of treatment.
- Celecoxib (Celebrex) is an NSAID, specifically a type called a COX-2 inhibitor. It is a capsule you take once or twice a day, usually with food.
- Cyclosporine (Gengraf, Neoral, Sandimmune) is an oral DMARD. It comes in different dosage forms and brands with different dosing. Be sure you understand how to take your particular form of cyclosporine. Ask your doctor or pharmacist if you have questions.
- Etanercept (Enbrel) is a biologic for once-weekly injection under the skin. Like Humira, you will get the first dose in your doctor’s office.
- Leflunomide (Arava) is an oral DMARD you usually take once daily. Your doctor may have you take it more often during the first several days of treatment.
- Meloxicam (Mobic) is an NSAID. It comes as a tablet and a suspension you usually take once daily.
- Methotrexate (Rheumatrex, Trexall) is DMARD that is available as a tablet and an injection. Doctors usually prescribe a weekly dose to decrease side effects.
- Nabumetone (Relafen) is an NSAID. It is a tablet for once- or twice-daily dosing.
- Sulfasalazine (Azulfidine) is an oral DMARD. It comes as a delayed-release tablet to minimize stomach irritation. You should take the tablet with food and a full glass of water. Doctors usually start a low dose and increase it to the full dose of two tablets twice daily.
Talk with your doctor about the risks and benefits of your treatment options. Once you start treatment, tell your doctor right away about any new symptoms or problems. Your doctor will also monitor you closely after you start treatment, sometimes as often as every four weeks. Follow-up will focus on your symptoms and lab tests. The goal is to reach minimal disease activity as quickly as possible.
Researchers continue to study many aspects of psoriatic arthritis, including treatments. This includes new biologics that use different targets than current biologics. Clinical trials can give people access to experimental treatments not currently on the market. If you are interested in participating in a trial, talk with your doctor.
