Ways to Manage Symptoms and Treat PsA

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Treatment for psoriatic arthritis (PsA) varies depending on the severity of the disease and specific symptoms that are the most problematic at the time.  Many people with PsA have to try more than one treatment option to find the best one or combination of medications to manage their symptoms. The goals of treatment for psoriatic arthritis are:

While there is no cure for psoriatic arthritis, there are many treatment options that can help, and in some cases, lead to long-term remission of symptoms. Remission implies the reversibility of functional impairment, minimal or no further progression to joint destruction, and, at least in theory, potential to heal a damaged joint.3

How severity of PsA is determined

The severity of psoriatic arthritis determines the treatment approach. Mild disease is generally characterized by oligoarticular PsA (with few joints affected) and has minimal impact on the person’s quality of life. Moderate disease has more of an impact on the daily tasks of living and physical functions. Moderate disease may also impact the mental well-being of the patient and often doesn’t respond to mild treatment. Severe disease greatly impacts the patient’s quality of life. With severe disease, a patient 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

Treatment recommendations for PsA

Several professional physician organizations have created separate guidelines for treating psoriatic arthritis to provide strategies to healthcare professionals. However, there is no single standard of care for psoriatic arthritis and the treatment varies as greatly as the disease across different patients. The three most widely used guidelines are from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), the American Academy of Dermatology (AAD) and the European League Against Rheumatism (EULAR).4-6

Treatment options for psoriatic arthritis

There are several treatment options for psoriatic arthritis, including:

  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), both over-the-counter and prescription
  • Corticosteroid injections
  • Systemics, which are prescription drugs that affect the entire body and are used when people are not responsive to or are unable to use topical medication
  • Disease-Modifying Anti-Rheumatic Drugs (DMARDs), which may relieve more severe symptoms and attempt to slow or stop joint and tissue damage and progression of psoriatic arthritis
  • Biologics, drugs, which have been genetically designed to act upon specific immunological targets, include medicines that target tumor necrosis factor (TNF), a protein that produces a wide range of inflammation in psoriatic arthritis.

In addition, common non-pharmacological treatment options used in psoriatic arthritis include physical or occupational therapy and phototherapy (light therapy) for psoriasis lesions. Physical and occupational therapy are often critical interventions to protect the involved joints and maintain function.5,6

Combination therapy

Combination therapy, or using multiple treatment options at the same time, will sometimes be recommended by your healthcare provider.  The goal of combination therapy is to optimize treatment outcomes. For example,  one medication may be used to boost the efficacy (or minimize the side effects) of another drug. Combination therapy also offers an opportunity for your healthcare provider to work with you to tailor a treatment in situations where 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 due to long-term use of systemic therapies, are most likely to be good candidates for combination therapy.

Surgery

In severe cases of psoriatic arthritis, surgical care may be indicated. Arthroscopic surgery of the synovial capsule has shown to be effective, and joint replacement or reconstructive surgery is occasionally necessary.7

Complementary alternative medicine

There are several complementary and alternative medical (CAM) treatments that some people with PsA find helpful, including massage, acupuncture, herbal remedies, and dietary changes.2 Before starting treatment with any type of CAM therapy, it is important to talk with your healthcare provider. While most CAM therapies are safe, some of them can interact with PsA treatments and require adjusting the dose of medications or consideration of a different medication.

view references
1. Acosta Felquer ML, FitzGerald O. Peripheral joint involvement in psoriatic arthritis patients. Clin Exp Rheumatol. 2015 Sep-Oct;33(5 Suppl 93):S26-30. 2. National Psoriasis Foundation. Accessed online on 5/11/16 at https://www.psoriasis.org. 3. Saber TP, Ng CT, Renard G, Lynch BM, Pontifex E, Walsh CAE, Grier A, Molloy M, Bresnihan B, FitzGerald O, Fearon U, Veale DJ. Remission in psoriatic arthritis: is it possible and how can it be predicted? Arthritis Res Ther. 2010:12(3):R94. 4. Gottlieb A, Korman NJ, Gordon KB, Feldman SR, Lebwohl M, Koo JY, Van Voorhees AS, Elmets CA, Leonardi CL, Beutner KR, Bhushan R, Menter A. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008 May;58(5):851-64. 5. Ritchlin CT, Kavanaugh A, Gladman DD, Mease PJ, Helliwell P, Boehncke WH, de Vlam K, Fiorentino D, Fitzgerald O, Gottlieb AB, McHugh NJ, Nash P, Qureshi AA, Soriano ER, Taylor WJ; Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Treatment recommendations for psoriatic arthritis. Ann Rheum Dis. 2009 Sep;68(9):1387-94. 6. Ramiro S, Smolen JS, Landewé R, et al. Pharmacological treatment of psoriatic arthritis: a systematic literature review for the 2015 update of the EULAR recommendations for the management of psoriatic arthritis. Ann Rheum Dis. 2016 Mar;75(3):490-8. 7. Psoriatic arthritis. Medscape. Accessed online on 5/11/16 at http://emedicine.medscape.com/article/2196539-overview
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