What are Ways to Manage Symptoms and Treat Psoriatic Arthritis?
Treatment for psoriatic arthritis (PsA) varies depending on the severity of the disease and specific symptoms that are the most problematic at the time.
There are many treatment options to improve psoriatic arthritis
Many people with PsA have to try more than one treatment option to find the best one or a combination of approaches to manage their symptoms.
While there is no cure for PsA, there are many treatment options that can help. The goals of treatment for psoriatic arthritis are to:1,2
- Provide relief from the symptoms of pain, swelling, and stiffness
- Protect the joints from disease progression
- Maintain mobility and prevent disability
In some cases, treatments may lead to long-term remission of symptoms. Remission may mean reversing the functional impairment, minimal or no worsening of joint destruction, and the possible healing of a damaged joint.3
How is PsA severity determined?
The severity of PsA determines the treatment approach. Mild disease generally means PsA that only affects a few joints (oligoarticular PsA) and has minimal impact on the person’s quality of life.4
Moderate disease has more of an impact on the daily tasks of living and physical functions. Moderate PsA may also impact the mental well-being of the person and often does not respond to mild treatment.4
Severe PsA greatly impacts a person's quality of life. With severe disease, a person with PsA cannot perform major daily tasks of living without pain or dysfunction, and there is a large impact on both physical and mental well-being.4
Psoriatic arthritis treatment recommendations
Several professional physician organizations have created separate guidelines for treating PsA. However, there is no single standard of care, and treatments vary greatly.
In 2019, the National Psoriasis Foundation and the American College of Rheumatology released A Guideline for Treatment of Psoriatic Arthritis. This guideline uses a treat-to-target approach, which may become the standard of care for psoriatic arthritis.
Since guidelines frequently change as new treatments and research become available, it is important for each person to talk to their doctor about what treatments are right for them.
Breaking down treatment options
There are several treatment options for PsA, including:
- Non-steroidal anti-inflammatory drugs (NSAIDs), both over-the-counter and prescription
- Corticosteroid injections
- Traditional (non-biologic) disease-modifying anti-rheumatic drugs (DMARDs), which may reduce inflammation and slow or stop joint and tissue damage
- Biologic DMARDs, which have been genetically designed to work upon specific immunological targets, such as tumor necrosis factor (TNF) and interleukins (IL)
- Biosimilars, which are a type of biologic therapy that is highly similar to an already-approved biological product
- Target-specific DMARDs, which work on specific cellular enzymes to reduce inflammation and help relieve joint pain, swelling, and stiffness
- Other drugs, including cyclosporine (Sandimmune®, Neoral®, Gengraf®) and Imuran® (azathioprine)
- Acthar Gel (repository - corticotropin injection)
In addition, common non-drug treatment options used in PsA include physical or occupational therapy and phototherapy (light therapy) for psoriasis lesions.
Physical and occupational therapy are often important interventions to protect the involved joints and maintain function.
What is combination therapy?
Combination therapy will sometimes be recommended by your doctor. This means using multiple treatment options at the same time. The goal of combination therapy is to optimize treatment outcomes.
For example, one drug may be used to boost the efficacy or minimize the side effects of another drug. Combination therapy also allows your doctor to tailor a treatment for you when there is a concern that traditional PsA treatments may be less effective.
For instance, people who have PsA and psoriasis or those who are at risk of organ damage are most likely to be good candidates for combination therapy.
Can those with psoriatic arthritis get joint surgery?
In severe cases of PsA, surgical care may be needed. Arthroscopic surgery of the synovial capsule has shown to be effective for some people. Joint replacement or reconstructive surgery is also sometimes needed.5
Complementary and alternative treatment options
There are several complementary and alternative medical (CAM) treatments that some people with PsA find helpful. This includes massage, acupuncture, and herbal remedies.
Before starting treatment with any type of CAM therapy, it is important to talk to your doctor. While most CAM therapies are safe, some of them can interact with PsA treatments.2
Lifestyle changes are also important ways that people with PsA can manage symptoms. This may include diet, exercise, and physical therapy. It is also recommended that people with PsA avoid smoking or stop smoking.