Psoriatic arthritis is a chronic inflammatory joint disease that develops in some people with psoriasis. Psoriasis can affect the joints, skin and nails, skull, spine, fingers, or toes, causing them to become inflamed and painful.

It is a serious condition that can become steadily worse. If left untreated, psoriatic (PsA) can lead to joint destruction, disability, and impaired quality of life.

Although there is currently no cure for PsA, early diagnosis and targeted treatment plans may slow, or even halt, its progression.

PsA has traditionally been managed using a combination of nonsteroidal anti-inflammatory drugs (), corticosteroids, and disease-modifying anti-rheumatic drugs (DMARDs).

Recent advances in understanding the bodys immune response to PsA has led to new therapies, including the use of necrosis factor inhibitors (TNFs).These have been shown to reduce the progression of joint damage in some patients.

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Drug treatments may control inflammation and relieve discomfort for people with PsA.

The current pharmacological treatment options for PsA aim to:

NSAIDs are used to relieve pain and reduce inflammation. They work by blocking the production of compounds known as prostaglandins. These signal the bodys immune system to trigger an inflammatory response.

The most common over-the-counter NSAIDs are ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). Stronger NSAIDs are also available by prescription.

Doctors commonly prescribe NSAIDS to people who have mild symptoms of PsA:

However, NSAIDs increase the risk of and , bleeding, and kidney problems. People with a history of cardiovascular disease should use NSAIDs with caution.

Corticosteroids mimic the anti-inflammatory hormone cortisol, which is normally made by the bodys adrenal glands. They are either taken by mouth or administered as a local injection to provide temporary inflammation relief.

However, long-term use can lead to side effects such as facial swelling, weight gain, , and weak bones.

DMARDs and biologics, a subtype of DWARDs, work to suppress the overactive immune system but may also raise the risk of infections.

DMARDs, including methotrexate, sulfasalazine, leflunomide, and cyclosporine, are frequently prescribed alongside to NSAIDs.

They help to suppress the bodys overactive immune system, which causes persistent inflammation. They can take several weeks to take effect.

A new DMARD, called apremilast (Otezla), was recently approved by both the (FDA) and (EMA) for the treatment of PsA.

It works by blocking an enzyme that regulates immune and inflammatory processes. Clinical studies suggest that it is effective and generally well-tolerated.

Biologics are a special subclass of DMARDs. One group of biologics, known as TNF inhibitors, are typically only offered to people who do not respond effectively to other DMARDs. Examples include:

Biologics work by blocking a specific protein that is produced by immune cells and which signals other cells to start the inflammatory process.

Another biologic, called ustekinumab (Stelara), works by blocking two proteins that cause inflammation. Two other biologics block another pro-inflammatory protein, these are called Ixekizumab and Secukinumab.

While biologics can be very effective, they suppress the immune system and raise the risk of infections.

Drug therapy Impact of PsA on quality of life Mild NSAIDs (possibly with local corticosteroid injections) Minimal Moderate DMARDs or TNF inhibitors Impacts everyday tasks and physical and mental functions; does not respond to NSAIDs Severe DMARDs and TNF inhibitors Cannot perform everyday tasks easily without pain; heavy impact on physical and mental functions; does not respond to DMARDs or TNF inhibitors as monotherapy

The following non-drug management strategies are recommended in addition to drug therapy:

Many people manage their PsA using complementary and alternative medicine (CAM) in addition to conventional treatments. People with PsA should discuss these therapies with healthcare providers before trying them.

Among the most popular are:

Acupuncture and massage may help relax the muscles and reduce stiffness and pain in the joints.

Some people claim that an alkaline diet may reduce inflammation in the body. An alkali diet is one where the focus is on eating alkaline foods, such as whole fruits and vegetables instead of more acidic foods, such as meat and dairy products.

A healthful diet also helps to prevent , which is a risk factor for people with PsA.

Management of PsA usually involves a combination of NSAIDs, corticosteroid injections, or a combination of the two. DMARDs and biologic therapies are prescribed for people with more severe symptoms.

The best choice of therapy will depend upon the disease severity, prior treatment, other conditions that are present, access to therapy, and patient choice.

Written by Goretti Cowley

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