Treatment includes managing both arthritis and skin lesions, when both are present, and will depend on the severity of the psoriasis and psoriatic arthritis. In many cases, the treatments are complementary, that is, if a dermatologist is treating your skin lesions with a systemic agent such as methotrexate or etanercept (Enbrel), this treatment could also help your psoriatic arthritis. In many cases, patients with psoriatic arthritis will be referred to a rheumatologist. In most cases, your doctors (dermatologist, rheumatologist, family physician) will work together to help find the best treatment.
The dermatologist usually continues to follow your treatments and provide guidance for the care of your skin. Treatments for psoriatic arthritis include the following:
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
- slow-acting anti-rheumatic drugs (SAARDs)/disease-modifying anti-rheumatic drugs (DMARDs)
- methotrexate
- cyclosporine
- antimalarials
- gold
- penicillamine (Cuprimine, Depen)
- sulfasalazine (Azulfidine)
- etanercept (Enbrel)
- infliximab (Remicade)
- adalimumab (Humira)
- alefacept (Amevive)
- ustekinumab (Stelera)
NSAIDs are anti-inflammatory drugs that help reduce pain and inflammation in mild psoriatic arthritis. NSAIDs also help control morning stiffness, which improves a patient's range of motion. NSAIDs have been reported to cause psoriasis flare-ups in some individuals, although this is an infrequent occurrence. There are a large number of NSAIDs available, but none is superior in terms of reducing inflammation.
Slow-Acting Antirbeumatic Drugs (SAARDs)
As the name suggests, slow-acting antirheumatic drugs (SAARDs) take weeks or months to show significant benefit in most patients: This group is also called disease-modifying anti-rheumatic drugs (DMARDs).
Methotrexate
Methotrexate is recognized as being highly effective in psoriasis and psoriatic arthritis. In the past, methotrexate has been a preferred drug if patients have psoriasis and psoriatic arthritis because it has therapeutic benefits for both diseases. It can be taken orally or by injection into the muscle. Potential side effects include inflammation of the liver (hepatitis), scarring of the liver (cirrhosis), and an increased risk for infection; methotrexate is unsafe during pregnancy.
Cyclosporine
Cyclosporine is effective in treating psoriatic arthritis, although it has a number of serious side effects, including high blood pressure (hypertension) and damage to the kidney.
Antimalarials
Antimalarials are drugs originally developed for use against malaria. Antimalarials such as chloroquine (Aralen) and hydroxychloroquine (Plaquenil) have been used to treat psoriatic arthritis with modest success in limited studies. While the safety profile is relatively good, certain patients report worsening of their psoriasis when taking antimalarials.
Gold
Gold can be taken orally or by injection into the muscle. Intramuscular injections are believed to be more effective than oral treatments. Although gold works for some patients, it does not prevent psoriatic arthritis from progressing. Gold can also take a long time before it begins to work. Common side effects of gold include a sore mouth, possibly with ulcers; itchy skin or widespread rash; and a reduction in certain components of the blood (platelets). If platelet levels drop, easy bruising or bleeding can occur at sites of minor trauma.
Penicillamine (Cuprimine)
Penicillamine provides some benefit, but its slow onset of action and side effects have limited its use in the treatment of psoriatic arthritis. Common side effects of penicillamine include nausea, and an unusual metallic taste and sores in the mouth. Less commonly, increased risk of bleeding due to the drop in platelet levels, and protein in the urine can be seen.
Sulfasalazine
Sulfasalazine may be used alone or in combination with other medications. Sulfasalazine has only limited effectiveness when used alone to treat psoriatic arthritis and is not well tolerated by many patients. Common side effects of sulfasalazine include abdominal discomfort, nausea, decreased appetite, and headache. Less commonly, the liver may be inflamed (hepatitis), and white blood cell and platelet counts may drop. This can result in an increased susceptibility to infection (due to decreased white blood cells) and bleeding (due to decreased platelets). To find out more, you can check out Psoriasis Arthritis Treatment.