Treatment Options for Psoriatic Arthritis

By Stephanie Watson | June 17, 2022

Treating psoriatic arthritis (PsA) is tricky because this disease affects both the skin and joints. PsA treatment includes a combination of medication and non-drug therapies like exercise, massage, heat and cold. It’s personalized to your symptoms and the severity of your disease.

The goals of treatment are to

• Slow the disease and possibly put it into remission
• Relieve pain and other symptoms
• Protect your skin and joints

You may need to see a team of specialists, including a rheumatologist to manage joint pain and a dermatologist for skin symptoms. Work with your medical team to find the treatment approach that works for you.

Medications

Medicines are an important part of treating PsA and managing flares. Psoriatic arthritis medications may include some or all of the following:

• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be enough to control inflammation and pain in mild PsA. NSAIDs come in over-the-counter versions like aspirin, ibuprofen (Advil, Motrin) and naproxen (Naprosyn), or with a prescription from your doctor.
• Biologics. These medications are for people with more severe PsA. A type of biologic called a tumor necrosis factor (TNF) inhibitor is often the first medication doctors recommend for active PsA. TNF inhibitors approved for psoriatic arthritis include adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi, Simponi Aria) and certolizumab pegol (Cimzia). If your disease is very severe or it doesn’t respond to one or more TNF inhibitors, your doctor might try a biologic that blocks interleukin-17 (IL-17) or interleukins 12 and 23 (IL 12/23) — either  secukinumab (Cosentyx), guselkumab (Tremfya), risankizumab  (Skyrizi), ustekinumab (Stelara) or ixekizumab (Taltz). Certain people who can’t take these or who don’t have adequate response may try abatacept (Orencia), a type of biologic that works differently in the body. Some are more effective for skin symptoms while others work better for joints. You will not be prescribed more than one biologic at a time.
• Disease-modifying antirheumatic drugs (DMARDs). Conventional synthetic DMARDs like methotrexate slow or prevent inflammation that damages joints and skin. A biologic may be used with a conventional DMARD to manage symptoms. Targeted synthetic DMARDs also slow or prevent inflammation, but they target specific parts and pathways in the immune system rather than having a widespread effect, like conventional DMARDs. Three targeted DMARDs are approved to treat PsA: apremilast (Otezla), and two Janus kinase (JAK) inhibitors, upadacitinob (Rinvoq) and tofacitinib (Xeljanz).
• Corticosteroids. Injecting corticosteroids (steroids) into affected joints can quickly lower inflammation and relieve pain. Steroid injections are a short-term treatment for disease flares.
• Topical treatments. Biologics and other DMARDs also treat skin plaques and nail changes from psoriasis. Along with these treatments, you can use over-the-counter or prescription creams, ointments and other topical products containing steroids or nonsteroid medications, such as anthralin, vitamin A, salicylic acid or coal tar to relieve skin psoriasis.

Physical Therapy and Exercise

Exercise is an important part of treating PsA. Staying active relieves pain and stiffness, boosts energy and mood, and improves overall health and function. The ideal workout program for PsA includes a mix of aerobic exercises, strength training and stretching.

Walking, swimming and biking are low-impact aerobic exercises that don’t put too much stress on sore joints. Just avoid the pool during flares because the chlorine can irritate your skin. Yoga and tai chi combine deep breathing and relaxation with fitness. Check with your doctor before trying any new fitness routine and ease into it slowly. A physical therapist (PT) can teach you exercises and techniques to improve your strength and joint range of motion. The PT can create a program to maximize your mobility without causing pain. An occupational therapist (OT) can teach you techniques to make daily activities easier and less painful.

Living With PsA

In addition to medication, exercise and physical therapy, you can do a few things on your own to relieve symptoms and minimize the impact of PsA on your life.

• Stop Smoking. Not only will quitting protect your lungs and heart and improve your overall health, but it might also improve joint and skin symptoms. Smoking speeds disease progression and reduces the effectiveness of PsA treatments. Quitting isn’t easy, but it is possible to break the habit with some help from your doctor and tools like nicotine replacement therapy and counseling.
• Relieve Stress. Stress affects your immune system in ways that could trigger more disease flares and worsen PsA pain. Exercise is one way to beat stress. Relaxation techniques like deep breathing, meditation, guided imagery and massage (which also may ease pain), might also help. If you can’t get stress under control on your own, consider seeing a therapist or other mental health professional.
• Eat Well. No diet treats psoriatic arthritis, but some foods may help to reduce inflammation. Ingredients in the Mediterranean diet like fatty fish (salmon, tuna, sardines), nuts and olive oil, are good for your joints and cardiovascular health. Add in lean protein, colorful fruits and veggies and whole grains for well-balanced nutrition. Avoid foods that contribute to inflammation, like red meats and highly processed foods that are high in trans and saturated fats and sugars.
• Try Acupuncture. This traditional Chinese medicine technique places hair-thin needles along various pressure points in the body to treat a variety of ailments. Acupuncture may be a useful add-on to other treatments for managing chronic pain.
• Use Heat and Cold. Moist heat from a warm bath — or paraffin bath for hands and feet — helps relieve joint soreness. Cold from an ice pack wrapped in a towel reduces swelling. Alternate heat and cold or use whichever one feels best.
• Take It Easy. Although exercise is important, you don’t want to strain or injure your joints or trigger a flare. When you’re in pain, take a break. Rest your joints. You can go back to your normal activities once the pain has improved.
• Lose Weight. Excess body fat fuels inflammation. Carrying around extra weight is also hard on your joints. Following a healthy diet and exercise program can help you drop some of that weight. Losing just 10% of your body weight if you have obesity can significantly improve your response to treatment.