Ways to Manage Symptoms and Treat PsA

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 approaches to manage their symptoms. The goals of treatment for psoriatic arthritis are:

While there is no cure for PsA, 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 PsA determines the treatment approach. Mild disease is generally characterized by oligoarticular PsA (only a few joints are 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

While several professional physician organizations have created separate guidelines for treating PsA to provide strategies to healthcare professionals, there is no single standard of care for PsA and the treatment varies as greatly as the disease across different patients. In addition, the guidelines that have been created are frequently changing, as new treatment options and new research becomes available, and each person with PsA is advised to speak to their doctor about which treatments are best for their situation.

Treatment options for PsA

There are several treatment options for PsA, including:

  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), both over-the-counter and prescription
  • Corticosteroid injections
  • Traditional, or non-biologic, Disease-Modifying Anti-Rheumatic Drugs (DMARDs), which may reduce inflammation and attempt to slow or stop joint and tissue damage and progression of psoriatic arthritis
  • 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 are highly similar to an already approved biological product
  • Target-specific DMARDs, which work on specific cellular enzymes, such as phosphodiesterase type 4 (PDE4), to reduce inflammation and help relieve joint pain, swelling and stiffness
  • Other medications, including cyclosporine (brand names: Sandimmune®, Neoral®, Gengraf®), Xeljanz® (tofacitinib), Imuran® (azathioprine), and others

In addition, common non-pharmacological treatment options used in PsA 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.

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 PsA, 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.5

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.

Written by: Emily Downward | Last reviewed: April 2018.
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